Mother and Baby Test 3
List the four defects associated with tetralogy of Fallot.
VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy
The measles vaccine is given at approximately what age? a. 2, 4, and 6 months of age b. 12-15 months and 4-6 years c. 24-30 months d. 3 years of age and 4 weeks later
b
The prudent pediatric nurse does not need to calculate the flow rate, in gtts/min, if an infusion pump is being used. a. True b. False
b
Transposition of the great arteries (TGA) - occurs when the aorta and pulmonary artery are reversed in position, with the aorta arising from the left ventricle and the pulmonary artery arising from the right ventricle. a. True b. False
b
Which of the following in Mark's diet contains gluten? a. Rice cereal b. Wheat cereal c. Carrots d. Green beans
b
Which of the following is most likely to contain "hidden" gluten? a. Mayonnaise b. Soy sauce c. Cider vinegar d. Black pepper
b
acute systemic vasculitis, cause unknown (acquired); results in damage to coronary arteries; most common under five years old; three phases of disease (acute, subacute and convalescent)
kawasaki disease
used for fluid resuscitation
lactated ringers
reaction to a protein in the milky sap of the rubber tree; latex gloves are dusted with powder to make them easier to put on and take off; when this powder combines with the latex protein, it can get into the air when the gloves are used and be inhaled reactions--irritant contact dermatitis (dry, itchy, irritated hands); allergic contact dermatitis (delayed hypersensitivity); latex allergy (immediate hypersensitivity, symptoms--hives, itching, sneezing, rhinitis, dyspnea, cough, wheezing; greatest risk with mucosal contact) prevention--use latex free products; alert employer/health care providers, schools about need for latex free products and equipment; wear MedicAlert bracelet; awareness of cross sensitivity with foods--banana, avocado, chestnuts, kiwis, passion fruit, others); prescribe epipen (accidental exposure, patients at risk); go latex free at agency; educate re: epipen use; develop emergency action plan
latex allergy
left ventricle cannot maintain adequate CO to the body; pressure backs up into the lungs; tachycardia, dyspnea cough; decreased cerebral perfusion
left sided heart failure
An infant of a mother infected with human immunodeficiency virus (HIV) is seen in the clinic each month and is being monitored for symptoms indicative of HIV infection. With knowledge of the most common opportunistic infection of children infected with HIV, the nurse assesses the infant for which sign? 1. Cough 2. Liver failure 3. Watery stool 4. Nuchal rigidity
1
The home care nurse provides instructions regarding basic infection control to the parent of an infant with human immunodeficiency virus (HIV) infection. Which statement, if made by the parent, indicates the need for further instruction? 1. "I will clean up any spills from the diaper with diluted alcohol." 2. "I will wash baby bottles, nipples, and pacifiers in the dishwasher." 3. "I will be sure to prepare foods that are high in calories and high in protein." 4. "I will be sure to wash my hands carefully before and after caring for my infant."
1
The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output? 1. Weighing the diapers 2. Inserting a urinary catheter 3. Comparing intake with output 4. Measuring the amount of water added to formula
1
The nurse provides home care instructions to the parents of a child with celiac disease. The nurse should teach the parents to include which food item in the child's diet? 1. Rice 2. Oatmeal 3. Rye toast 4. Wheat bread
1
Which home care instructions should the nurse provide to the parent of a child with acquired immunodeficiency syndrome (AIDS)? Select all that apply. 1. Monitor the child's weight. 2. Frequent hand washing is important. 3. The child should avoid exposure to other illnesses. 4. The child's immunization schedule will need revision. 5. Clean up body fluid spills with bleach solution (10:1 ratio of water to bleach). 6. Fever, malaise, fatigue, weight loss, vomiting, and diarrhea are expected to occur and do not require special intervention.
1, 2, 3, 5
Which interventions should the nurse include when creating a care plan for a child with hepatitis? Select all that apply. 1. Providing a low-fat, well-balanced diet. 2. Teaching the child effective hand-washing techniques. 3. Scheduling playtime in the playroom with other children. 4. Notifying the health care provider (HCP) if jaundice is present. 5. Instructing the parents to avoid administering medications unless prescribed. 6. Arranging for indefinite home schooling because the child will not be able to return to school.
1, 2, 5
The clinic nurse is instructing the parent of a child with human immunodeficiency virus (HIV) infection regarding immunizations. The nurse should provide which instruction to the parent? 1. The hepatitis B vaccine will not be given to the child. 2. The inactivated influenza vaccine will be given yearly. 3. The varicella vaccine will be given before 6 months of age. 4. A Western blot test needs to be performed and the results evaluated before immunizations.
2
The nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On assessment, which data would the nurse expect to obtain when asking the parent about the child's symptoms? 1. Watery diarrhea 2. Projectile vomiting 3. Increased urine output 4. Vomiting large amounts of bile
2
The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instruction? 1. "A balance of rest and exercise is important." 2. "I can apply lotion or powder to the incision if it is itchy." 3. "Activities in which my child could fall need to be avoided for 2 to 4 weeks." 4. "Large crowds of people need to be avoided for at least 2 weeks after surgery."
2
The nurse is caring for a 4-year-old child with human immunodeficiency virus (HIV) infection. The nurse should expect which statement that is aligned with the psychosocial expectations of this age? 1. "Being sick is scary." 2. "I know it hurts to die." 3. "I know I will be healthy soon." 4. "I know I am different than other kids."
2
The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). What are the general contraindications associated with receiving a live virus vaccine? Select all that apply. 1. The child has symptoms of a cold. 2. The child had a previous anaphylactic reaction to the vaccine. 3. The mother reports that the child is having intermittent episodes of diarrhea. 4. The mother reports that the child has not had an appetite and has been fussy. 5. The child has a disorder that caused a severely deficient immune system. 6. The mother reports that the child has recently been exposed to an infectious disease.
2, 5
A 6-year-old child with human immunodeficiency virus (HIV) infection has been admitted to the hospital for pain management. The child asks the nurse if the pain will ever go away. The nurse should make which best response to the child? 1. "The pain will go away if you lie still and let the medicine work." 2. "Try not to think about it. The more you think it hurts, the more it will hurt." 3. "I know it must hurt, but if you tell me when it does, I will try to make it hurt a little less." 4. "Every time it hurts, press on the call button and I will give you something to make the pain go all away."
3
A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1. Diarrhea 2. Metabolic acidosis 3. Metabolic alkalosis 4. Hyperactive bowel sounds
3
An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1. Prone position 2. On the stomach 3. Left lateral position 4. Right lateral position
3
On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1. Cracked lips 2. Normal appearance 3. Conjunctival hyperemia 4. Desquamation of the skin
3
The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? 1. Pallor 2. Hyperactivity 3. Exercise intolerance 4. Gastrointestinal disturbances
3
The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder? 1. Bile-stained fecal emesis 2. The passage of currant jelly-like stools 3. Failure to pass meconium stool in the first 24 hours after birth 4. Sausage-shaped mass palpated in the upper right abdominal quadrant
3
The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF? 1. Pallor 2. Cough 3. Tachycardia 4. Slow and shallow breathing
3
The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? 1. Immunoglobulin 2. Red blood cell count 3. White blood cell count 4. Anti-streptolysin O titer
3
The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1. Incessant crying 2. Coughing at nighttime 3. Choking with feedings 4. Severe projectile vomiting
3
A child is receiving a series of the hepatitis B-vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should ask the child and parent about a history of a severe allergy to which substance? 1. Eggs 2. Penicillin 3. Sulfonamides 4. A previous dose of hepatitis B vaccine or component
4
A child with rheumatic fever will be arriving to the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? 1. "Has the child complained of back pain?" 2. "Has the child complained of headaches?" 3. "Has the child had any nausea or vomiting?" 4. "Did the child have a sore throat or fever within the last 2 months?"
4
A parent brings her 4-month-old infant to a wellbaby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to administer which immunizations to this infant? 1. Varicella, hepatitis B vaccine (HepB) 2. Diphtheria, tetanus, acellular pertussis (DTaP); measles, mumps, rubella (MMR); inactivated poliovirus vaccine (IPV) 3. MMR, Haemophilus influenzae type b (Hib), DTaP 4. DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus vaccine (RV)
4
An infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. Which intervention should the nurse suggest to the parent? 1. Monitor the infant for a fever. 2. Bring the infant back to the clinic. 3. Apply a hot pack to the injection site. 4. Apply a cold pack to the injection site
4
The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? 1. Diarrhea 2. Projectile vomiting 3. Regurgitation of feedings 4. Foul-smelling ribbon-like stools
4
The mother with human immunodeficiency virus (HIV) infection brings her 10-month-old infant to the clinic for a routine checkup. The health care provider has documented that the infant is asymptomatic for HIV infection. After the checkup, the mother tells the nurse that she is so pleased that the infant will not get HIV infection. The nurse should make which most appropriate response to the mother? 1. "I am so pleased also that everything has turned out fine." 2. "Because symptoms have not developed, it is unlikely that your infant will develop HIV infection." 3. "Everything looks great, but be sure to return with your infant next month for the scheduled visit." 4. "Most children infected with HIV develop symptoms within the first 9 months of life, and some become symptomatic sometime before they are 3 years old."
4
The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1. Watery diarrhea 2. Ribbon-like stools 3. Profuse projectile vomiting 4. Bright red blood and mucus in the stools
4
The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis? 1. Provide less frequent, larger feedings. 2. Burp the infant less frequently during feedings. 3. Thin the feedings by adding water to the formula. 4. Thicken the feedings by adding rice cereal to the formula.
4
The nurse provides home care instructions to the parent of a child with acquired immunodeficiency syndrome (AIDS). Which statement by the parent indicates the need for further teaching? 1. "I will wash my hands frequently." 2. "I will keep my child's immunizations up to date." 3. "I will avoid direct unprotected contact with my child's body fluids." 4. "I can send my child to day care if he has a fever, as long as it is a low-grade fever."
4
The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? 1. "I will not mix the medication with food." 2. "I will take my child's pulse before administering the medication." 3. "If more than 1 dose is missed, I will call the health care provider." 4. "If my child vomits after medication administration, I will repeat the dose."
4
A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen to the infant? 1. During sleep 2. When changing the infant's diapers 3. When the mother is holding the infant 4. When drawing blood for electrolyte level testing
4 Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. Crying exhausts the limited energy supply, increases the workload of the heart, and increases the oxygen demands. Oxygen administration may be prescribed for stressful periods, especially during bouts of crying or invasive procedures. Options 1, 2, and 3 are not likely to produce crying in the infant.
A health care provider prescribes laboratory studies for an infant of a woman positive for human immunodeficiency virus (HIV). The nurse anticipates that which laboratory study will be prescribed for the infant? 1. Chest x-ray 2. Western blot 3. CD4+ cell count 4. p24 antigen assay
4 Infants born to HIV-infected mothers need to be screened for the HIV antigen. The detection of HIV in infants is confirmed by a p24 antigen assay, virus culture of HIV, or polymerase chain reaction. A Western blot test confirms the presence of HIV antibodies. The CD4+ cell count indicates how well the immune system is working. A chest x-ray evaluates the presence of other manifestations of HIV infection, such as pneumonia.
The nurse provides home care instructions to the parents of a child hospitalized with pertussis who is in the convalescent stage and is being prepared for discharge. Which statement by a parent indicates a need for further instruction? 1. "We need to encourage our child to drink fluids." 2. "Coughing spells may be triggered by dust or smoke." 3. "Vomiting may occur when our child has coughing episodes." 4. "We need to maintain droplet precautions and a quiet environment for at least 2 weeks."
4 Pertussis is transmitted by direct contact or respiratory droplets from coughing. The communicable period occurs primarily during the catarrhal stage. Respiratory precautions are not required during the convalescent phase.
Describe why a barium enema is used to treat intussusception
A barium enema reduces the telescoping of the intestine through hydrostatic pressure without surgical intervention
What are the signs of anorectal malformation?
A newborn who does not pass meconium within 24 hours; meconium appearing through a fistula or in the urine; an unusual appearing anal dimple
Differentiate between a right-to-left and a left-to-right shunt in cardiac disease.
A right-to-left shunt bypasses the lungs and delivers unoxygenated blood to the systemic circulation, causing cyanosis. A left-to-right shunt moves oxygenated blood back through the pulmonary circulation.
What cardiac complications are associated with rheumatic fever?
Aortic valve stenosis and mitral valve stenosis
List five risks in cardiac catheterization.
Arrhythmia, bleeding, perforation, phlebitis, and obstruction of the arterial entry site
List the signs and symptoms of esophageal atresia with TEF.
Choking, coughing, cyanosis, and excess salivation
increase pulse, increase respirations, retarded growth, dyspnea, orthopnea, fatigue, URI; treated with high calories and high protein diet, rest, comfort and O2
CHF
Describe the preoperative nursing care for a child with Hirschsprung disease.
Check vital signs and take axillary temperatures. Provide bowel cleansing program, and teach about colostomy. Observe for bowel perforation; measure abdominal girth.
used for Na and volume replacement; caution, go slow, monitor BP, pulse rate and quality of lung sounds as well as serum Na and urine output; hypertonic
D5 1/2 NS
isotonic until inside the body; then metabolizes glucose and becomes hypotonic
D5W
What are common signs of digoxin toxicity?
Diarrhea, fatigue, weakness, nausea, and vomiting; the nurse should check for bradycardia prior to administration
What care is needed for a child with a temporary colostomy?
Family needs education about skin care and appliances. Referral to an enterostomal therapist is appropriate.
transfer of gastric contents into the esophagus; clinical manifestations (apnea/respiratory problems, excessive vomiting first weeks of life, slow growth/poor weight gain, regurgitation of formula after eating); diagnosis (upper GI series, esophageal pH monitoring, endoscopic exam) conservation management--positioning: upright, semi-prone after feeding to promote gravity resistance to reflux; dietary: thicken feedings; feeding modifications: small feedings with frequent burping to decrease gastric distention pharmacologic therapy--medications to reduce symptoms; reglan/metaclopramide to enhance gastric emptying
GERD
Describe nursing interventions to reduce the workload of the heart
Give small, frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutral thermal environment. Organize activities to disturb child only as indicated
viral infection--infects the t-lymphocytes causing immune dysfunction; leads to organ dysfunction; leads to organ dysfunction and a variety of opportunistic infections; children have varied prognosis; some children will become acutely ill and others will only experience mild symptoms of the disease; sexual contact or exposure to blood and body fluids results in horizontal transmission; vertical transmission is when mother passes the infection to her fetus or virus is passed via breastfeeding to infant; casual contact is not a proven mode of transmission; regular blood work to monitor condition opportunistic infections--recurrent URIs, otitis media; multiple or recurrent bacterial infections; lymphadenopathy; liver and spleen enlargement; oropharyngeal candidiasis--treat with nystatin; effective if infant/child will drink
HIV/AIDS
What position would best relieve the child experiencing a tet spell?
Knee-chest position or squatting
used to expand volume, dilute medications and to keep the veins open
NS
Describe the postoperative nursing care for an infant with pyloric stenosis.
Maintain IV hydration, and provide small, frequent oral feedings of glucose or electrolyte solutions or both within 4 to 6 hours. Gradually increase to full-strength formula. Position infant on right side in semi-Fowler position after feeding.
What nursing actions are initiated for the newborn with suspected esophageal atresia with TEF?
Maintain NPO immediately, and suction secretions
What are the priorities for a child undergoing abdominal surgery?
Maintain fluid balance (I&O, nasogastric suction, monitor electrolytes); monitor vital signs; care for drains, if present; assess bowel function; prevent infection of incisional area and other postoperative complications; and support child and family with appropriate teaching.
the point over the right side of the abdomen that is 1/3 of the distance from the anterior superior iliac spine to the umbilicus; this point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum
McBurney's point
What medications are used to treat rheumatic fever?
Penicillin, erythromycin, and aspirin
List the common signs of cardiac problems in an infant.
Poor feeding, poor weight gain, respiratory distress and infections, edema, and cyanosis
What are the two objectives in treating congestive heart failure?
Reduce the workload of the heart and increase cardiac output.
Describe feeding techniques for a child with cleft lip or palate.
Use lamb's nipple or prosthesis. Feed child upright, with frequent bubbling.
If an infant is bottle fed and has an intolerance or allergy to cow's milk, which of the following formulas is recommended? a. Prosobee® b. Alimentum® c. Similac® d. Enfamil®
b
In children, CD often becomes apparent as soon as solid foods are first introduced into the diet. a. True b. False
b
Tetralogy of Fallot (TOF) is a combination of four defects. Which of the following is not a defect of TOF? a. Ventricular septal defect b. Aortic stenosis c. Enlarged right ventricle from PSD d. Aorta positioned over the VSD
b
An IV order written as "KVO" as well as, "wide open", doesn't specify the flow rate and should, therefore, not be carried out until there is clarification of the specific flow rate from the ordering physician. a. True b. False
a
Celiac disease is a GI disorder that begins in infancy. a. True b. False
a
Changes in the level of solute concentration, as occurs in various types of IV solutions, influence the movement of fluid and electrolytes between the fluid compartments. a. True b. False
a
Congenital heart defects (CHD) are the most commonly, occurring birth defects, and are the leading cause of death due to congenital abnormalities. a. True b. False
a
Food allergies most often appear in the first one to two years of life. a. True b. False
a
General symptoms, such as runny nose and sore throat, are often the initial symptoms of measles. a. True b. False
a
If Mark tests positive for anti-gliadin antibodies: a. a biopsy of his small intestine is indicated. b. it is indicative that he has celiac disease. c. a genetic screening will be performed. d. a second step, determining anti-glutenin antibodies, will be done.
a
If an atrial or ventricular septal opening exists between the left and right side of the heart, right sided pressures exceed those on the left, resulting in: a. RIGHT-->LEFT shunting. b. LEFT-->RIGHT shunting
a
Mrs. Jacks, who is 4 months pregnant, asks, "I've heard a lot about food allergies. Which foods are children most often allergic to?" A correct response is peanuts and: a. milk and eggs. b. fish and tree nuts. c. oranges and soy. d. wheat and tomatoes.
a
Solid foods should be first introduced to the infant: a. between 4 and 6 months. b. after 7 months. c. when the baby isn't sleeping through the night. d. if the baby cries every 2 hours due to hunger.
a
The last signs of measles typically are: a. rash and high fever. b. rhinitis and fatigue. c. conjunctivitis and sneezing. d. cough and loss of appetite.
a
The measles virus resides in the nose and throat of the infected person and can stay alive in the air for 2 hours after the person coughs or sneezes. a. True b. False
a
Since breast-feeding is believed to help prevent food allergies, the AAP recommends breastfeeding mothers should: a. continue breastfeeding for at least 4 months. b. exclude known allergens from their diet. c. breastfeed as long as the mother and baby want to. d. continue breastfeeding exclusively for the first 12 months.
a or b
two types of cardiac diseases; disease process--infection, autoimmune response, environmental factors, familial tendencies
acquired heart disease
vaccine; dead or attenuated pathogens
active artificially acquired
infection; contact with pathogen
active naturally acquired
examples: patent ductus arteriosus (PDA), atrial septal defect (ASD), ventricular septal defect (VSD); increase fatigue, heart murmur, increase risk endocarditis, CHF, growth retardation
acyanotic congenital heart defects--left to right shunt
a severe reaction with difficulty breathing swelling in the mouth and throat, decreased BP, shock, and even death; must take immediate action--administer epipen (gives you approx. 15 minutes), call 911, albuterol may be used for bronchospasms clinical manifestations--skin: flushing, pruritus, urticaria, angioedema; upper respiratory: congestion, rhinorrhea; lower respiratory: bronchospasm, throat or chest tightness, hoarseness, wheezing, SOB, cough; GI tract: oral pruritus, cramps, nausea, vomiting, diarrhea; CV system: tachycardia, bradycardia, hypotension/shock, arrhythmias, ischemia, chest pain
anaphylaxis
a narrowing at, above, or below the aortic valve; murmur; left ventricular enlargement; chest pain; exercise intolerance; weak; thready pulses; hypotension/dizziness/syncope; treatment: surgery (dig and diuretics for HF)
aortic stenosis
Celiac disease is a/an: a. complication of cystic fibrosis. b. autoimmune condition that occurs in response to the ingestion of gluten. c. allergic response to wheat, after the infant has had frequent exposures. d. condition where the foreign food allergen containing gluten is targeted.
b
How many days after conception does the heart starts beating? a. 12 days b. 22 days c. 32 days d. 42 days
b
inflammation of the appendix caused by an obstruction of the opening of the appendix possibly due to fecal matter, swollen lymphoid tissue, or a parasite; most common cause of emergency abdominal surgery in children, occurs at an average age of 10 years; delayed diagnosis of appendicitis due to nonspecific symptoms causes perforated appendix in one third of cases; death can occur from peritonitis clinical manifestations--abdominal pain (RLQ)--McBurney's point that increases with movement; generalized to localized; loss of appetite; vomiting; low grade fever; rebound tenderness not recommended/not reliable alert: with perforation of appendix, abdominal pain is suddenly relieved, but as peritonitis develops, it returns, along with signs of generalized acute abdomen; child will guard area of pain; fever to 101-104; may appear dehydrated; surgery needed asap with antibiotic therapy nursing interventions--monitor I&O, dressing change as ordered; ambulate!!; cough and deep breath (how can you encourage this?--with bubbles, blowing out pretend birthday candles, etc); pain management
appendicitis
a hole in the septum between the right and left atria; blood in left atrium flows into right atrium; loud, harsh murmur; many children asymptomatic; mild heart failure; may have enlarged right atrium; pulmonary hypertension; reduced blood volume in systemic circulation; treatment: surgery about 2-4 years old
atrial septal defect
A 3 year old with food allergies may: a. be proficient in reading food labels before eating. b. feel sad because they can't eat what their friends at preschool are eating. c. safely make independent decisions about the food he or she eats. d. eat a known food allergen in order to fit in with peers.
b
A food allergen is defined as: a. an immune system response to a food protein or other substance. b. food proteins or other substances in food then can cause a reaction in children with food allergies. c. a symptom of a reaction, such as hives or wheezing. d. an emergency situation that can result in death.
b
According to the CDC, a large part of this outbreak of measles is due mostly to the fact that: a. the measles vaccine is a live-virus vaccine, making children more susceptible to getting the illness. b. children are not being fully immunized. c. the measles vaccine is given in combination with other immunizations. d. there is a shortage of measles vaccine, especially in Ohio, New York, and California.
b
All the following are acyanotic defects except: a. Aortic stenosis b. Atrioventricular septal c. Coarctation of the aorta d. Pulmonary stenosis
b
All the following changes occur after birth except: a. The pulmonary vascular resistance falls. b. The pulmonary blood flow decreases. c. The patent ductus arteriosus closes. d. The foramen ovale closes. e. The ductus venosus closes
b
Another names for measles, causing this current epidemic, is rubella. a. True b. False
b
Besides standard precautions, what other precautions should be taken with measles? a. Contact b. Airborne c. Droplet d. All of the above
b
A 2-year-old child with Down syndrome is brought to the clinic for his regular physical examination. The nurse knows which problem is frequently associated with Down syndrome. a. Trisomy 13. b. Pyloric stenosis. c. Congenital heart disease. d. Fragile X chromosome
c
A characteristic, unique sign of measles is: a. crusting over of the oozing rash. b. white "strawberry" tongue. c. Koplik spots. d. swollen salivary gland.
c
An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct the defect. The nurse recognizes that surgical correction is designed to achieve which outcome? a. Stop the flow of unoxygenated blood into systemic circulation. b. Increase the flow of unoxygenated blood to the lungs. c. Prevent the return of oxygenated blood to the lungs. d. Reduce peripheral tissue hypoxia and nail bed clubbing.
c
Besides Mark's presenting symptoms, all of the following are also common symptoms of celiac disease in children EXCEPT? a. Abdominal distention and gas b. Abdominal pain c. Projectile vomiting d. Anemia
c
For parents of a child with food allergies, which of the following activities is most likely the most anxiety producing? a. Eating a meal at home that has been cooked by the parents. b. Snacking on a bag of pretzels which has a clear ingredient label. c. Attending a holiday party at a friend's house. d. Eating a homemade lunch at school.
c
Gluten is a: a. carbohydrate. b. fat. c. protein. d. mineral.
c
How many neonates are born each year with Congenital heart defects (CHDs)? a. 20,000 b. 30,000 c. 40,000 d. 50,000
c
Mark's father says, "If he does have celiac disease, what does that mean?" The healthcare provider's best response is: a. "His food intake is going to be significantly limited. You'll need to prepare special meals and avoid taking Mark to restaurants." b. "Mark has a food allergy which he'll outgrow. He'll just have to stay away from pasta and baked goods, and things like that until he does." c. "Your son is reacting to a substance called gluten. I'll have a dietician come talk with you about foods and products which contain gluten." d. "I'm not really sure. You'll need to talk to Mark's pediatrician."
c
Mrs. Jacks asks, "Should I avoid eating these allergic foods during my pregnancy?" Based on the current AAP recommendations: a. pregnant women should completely exclude common food allergens from their diet. b. there is uncertainty with both what the pregnant and breast-feeding mothers should eat. c. pregnant women should exclude foods that are common allergens only if they are allergic to them. d. there's a direct link between the foods pregnant women eat and their baby's developing food allergies.
c
Which of the following patients may be given the MMR vaccine? A: a. 2 year old undergoing chemotherapy. b. 4 year old who has HIV. c. 7 year old who has never received any vaccinations. d. 9 year old on high does of prednisone.
c
acute hemorrhage from entry site; apply direct continuous pressure at 2.5 cm (1 in) above the catheter entry site to localize pressure over the location of the vessel puncture; position the child flat to reduce the gravitational effect on the rate of bleeding
cardiac cath
invasive test used for diagnosing, repairing some defects, and evaluating dysrhythmias; can be done outpatient; risks are bleeding at entry site, infection, loss of pulse in the catheterized extremity, and dysrhythmias; preoperative care: age specific preparation
cardiac catheterization
interaction with cats/kittens (bites/scratches); caused by the bacteria Bartonella henselae; incubation period is 7 to 12 days; therapeutic management is supportive and is aimed at management of symptoms; antibiotics may be needed; S&S: headache, fatigue, fever, swollen lymph nodes
cat scratch disease
do not scratch--the blisters may become infected or cause scarring; keep fingernails trimmed short, gloves, elbow restraints; calamine lotion and Aveeno (oatmeal) baths may help relive some of the itching; cool compresses and cool to tepid baths with baking soda and calamine lotion can help soothe itching; acetaminophen can help relieve body aches and fevers; avoid aspirin products due to the risk of Reye's syndrome
chicken pox (varicella)
failure of the maxillary and premaxillary processes to fuse during the fifth to eighth week of intrauterine life; most common craniofacial anomaly; 1 in 700 births; males 3 to 1; familial history; can be diagnosed in utero by ultrasound; encourage acceptance and bonding
cleft lip and palate
a narrowing of the descending aorta; increased blood pressure and oxygen saturation in the upper extremities compared to the lower extremities (take BP in all four extremities); nosebleeds; headaches, vertigo, leg pain, weak or absent lower extremity pulses (indicate decreased cardiac output); 80% have aortic valve anomalies; congestive heart failure; treatment: surgery (Dig, diuretics, sedatives for HF, prostaglandin to keep ductus open)
coarctation of aorta
obstructive lesions (no flow); causes low cardiac output and shock
coarctation of the aorta
easily spread through airborne, droplet or direct contact transmission; most communicable disease can be prevented with immunizations; the child who is immunocompromised is most susceptible to complications of communicable diseases risks--immunocompromised status, crowded living conditions; poor sanitation; poor nutrition; poor oxygenation and impaired circulation; chronic illness ex: chicken pox (varicella), measles (rubeola), pertussis (whooping cough), rubella (german measles), mumps; all of these diseases are preventable by vaccines/immunizations; do not give measles, mumps, rubella, and/or varicella to an immune suppressed child; these are live vaccines
communicable diseases
incidence: 5 to 8 per 1000 live births; about 2 or 3 of these are symptomatic in first year of life; major cause of death in first year of life (after pre-maturity); most common anomaly is VSD; 28% of kids with CHD have another recognized anomaly (trisomy 21, 13, 18, +++); defects are described as increased, decreased, mixed or obstructive pulmonary blood flow increased pulmonary blood flow: left to right shunt--a-cyanotic anomalies; more blood to lungs thus not cyanotic; increased blood volume on right side of heart; decreased systemic blood flow (ventricular septal defect, atrial septal defect, patent ductus arteriosus
congenital heart disease (CHD)
two types of cardiac diseases; anatomic-->abnormal function
congenital heart disease (CHD)
usually a result of increased load on ventricles from structural defects; major manifestation of cardiac disease; under one year of age due to congenital anomaly; over one year with no congenital anomaly may be due to acquired heart disease
congestive heart failure
an alteration is frequency, consistency, or ease of passage of stool; may be secondary to other disorders; idiopathic (functional) constipation--no known cause; chronic constipation--may be due to environmental or psychosocial factors
constipation
steroids; decrease inflammation and reduce the activity of the immune system; lessen swellings, redness, itching and allergic reactions; used for a number of other diseases such as asthma or other autoimmune diseases; important to know that they can mask signs of infection
corticosteroids
tetralogy of fallot; squatting, cyanosis, clubbing, syncope
cyanotic congenital defects--right to left shunt
Parent education related to solid food should include: a. delaying the introduction of known food allergens to after one year of age. b. waiting until the child is over age 3 before introducing peanuts to the diet. c. avoidance of all known food allergens until the child is 5 years old. d. allowing 3 to 7 days between introducing each new food.
d
Which of the following meals is recommended for an older child with CD? a. A fried egg and rye bread toast with butter b. A hamburger with lettuce, tomato, and ketchup on a toasted whole wheat bun c. Fried chicken and french fries d. Steak and corn on the cob with butter
d
Which of the following staff persons should ideally NOT be assigned to care for a child suspected of having or has been diagnosed with measles? A staff member who is: a. 24 years old and is planning on having a baby with his wife in the coming year. b. immune since she had the measles as a child. c. 54 years old or older. d. pregnant.
d
occurs more readily in infant and children; assess HR, skin, eyes, fontanels, oral mucosa, mental status, cap refill, and urine output; therapeutic management--restore fluid volume and prevent progression to hypovolemia
dehydration
clinical manifestations--CHD: TOF
dependent on degree of right ventricular outflow obstruction; "tet/hypercyanotic spells": child assumes squatting position (decreases venous return); clubbing of digits; acidosis; treatment: place in knee chest position, O2 PRN, morphine PRN; propranolol (beta blockers) PRN; surgery
it includes binding foods; these low fiber foods that can help make your stools firmer; it includes bananas, which are high in potassium and help replace nutrients your body has lost because of vomiting or diarrhea; regular diet is recommended-EBP; also no OTC medications
diarrhea-BRAT diet controversial
direct oral elixir toward the side and back of mouth when administering; give water following administration to prevent tooth decay if the child has teeth; if a dose is missed, do not give an extra dose or increase the next dose; most common nausea, vomiting, abdominal pain and diarrhea (hold if vomiting); always take apical for 60 seconds; hold if apical pulse <100 bpm in infant and toddler, <80 bpm in the older child, <60 bpm in the adolescent
digoxin
the soiling of the underwear with stool by children who are past the age of toilet training; not consider a medical condition unless the child is at least 4 years old; a large amount of hard stool is in the intestine, and stool leaks around this mass and out through the anus prevent constipation--make sure the child gets a varied diet with plenty of fruits and vegetables and whole grain breads and cereals; drink water and other fluids frequently; be physically active every day; make sure the child has a regular time every day when he or she sits on the toilet; after a meal is the best time for this
encopresis
inadequate growth resulting from inability to obtain or use calories required for growth; weight below 5% or has persistent weight loss organic--physical cause identified: heart defect. GER, renal insufficiency, malabsorption, endocrine disease, CF, AIDS non-organic: inadequate intake of calories, such as cerebral palsy; disturbed mother infant bonding idiopathic: unexplained
failure to thrive
cardiac health history
family history of defects, early cardiac disease, and/or siblings with defects; maternal history of stillborns or miscarriages; congenital anomalies, genetic anomalies, fetal alcohol syndrome, Down's Syndrome, and/or Turner Syndrome; maternal exposure to rubella
a sign of illness--the body's weapon to fight infection; watch for signs and symptoms of dehydration; it is important to provide oral rehydration by increasing fluid intake; dress the child lightly and avoid warm, binding clothing or blankets; the use of sponging with tepid water is controversial; do not use cold water or alcohol call the physician for: any child less than 3 months who has a rectal temp above 38 (100.4); any child who is lethargic or listless, regardless of temperature; fever lasting more than 3 to 5 days; fever greater than 46 (105); any child who is immunocompromised by illness, such as cancer or HIV, will need further evaluation and treatment
fever
happens when the body reacts against harmless proteins found in foods; reaction usually happens shortly after a food is eaten; can vary from mild to severe; 8 types of food account for 90 percent of all food allergies: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat symptoms: itchy skin rashes, hives; vomiting, diarrhea, nausea, abdominal; swelling around his mouth and in his throat; wheezing and difficulty breathing; throat itches; immediate action needs to be taken introduction: birth to 1 year--breast milk or formula; introduce new foods slowly; a new food every 4 to 7 days; to check for any allergies; 4-6 months: iron fortified rice cereal; 6-8 months: yellow vegetables, fruits; 8-10 months: meat; age 1: cow's milk and other dairy products, citrus fruits and juices and wheat; age 2-eggs; age 3-peanuts and shellfish
food allergies
disorder of the abdomen that occurs when part or all of the large intestine or antecedent parts of the GI tract have no ganglion cells and therefore cannot function; failure to have bowel movement
hirschsprung disease
the left ventricle and the aorta are small and underdeveloped; the mitral and aortic valves are often narrow or absent
hypoplastic left heart syndrome
normal cardiac anatomy and cardiac function; occur in up to 50% of all at some time
innocent/functional murmurs
most common abdominal emergency affecting children under 2 years old; one portion of the bowel slides into the next much life the pieces of a telescope; bowel can become blocked and the section can die; signs and symptoms: abdominal swelling, vomiting up bile, a bitter tasting yellowish green fluid; passing stools mixed with blood and mucus, known as currant jelly stool; grunting due to pain; treatment--enema or surgery
intussusception
telescoping of part of intestine into an adjacent distal portion; occasionally due to intestinal lesions; often cause is unknown; clinical manifestation (periods of sudden and acute abdominal pain; palpable, sausage shaped mass in abdomen and/or distended abdomen; currant like jelly stool is a classic sign); an x-ray is performed first to rule out perforation of the bowel; intussusception may obstruct flow of barium from barium enema; attempt to resolve the intussusception by inflating bowel with air or administering a barium enema; if not successful, surgical reduction necessary
intussusception
also know as juvenile idiopathic arthritis (JIA); chronic autoimmune inflammatory diseases affecting joints and other tissues; it wears down and damages the articular cartilage mostly in the knees and hands; the cause is unknown; diagnosis is made by ruling out other disorders; a determination will be based on age of onset before 16 years of age, involvement of one or more joints and symptoms that last longer than 6 weeks; joint swelling, stiffness, redness usually in the morning; mobility limitations; diagnosed more often in girls than in boys; the child may experience an uneven and slow rate of growth home management--NSAIDs should be give on a routine schedule for pain and inflammation; instruct the child to take NSAIDs with food to minimize gastric irritation; teach the child/family non-pharmacological pain management techniques (distraction, relaxation); apply heat or warm moist packs to the child's affected joints prior to exercise; encourage warm baths; splint knees wrists, and hands for sleep to decrease pain and prevent flexion deformities goals of therapy--to maintain integrity of infected joints; to prevent deformities; to keep discomfort to a min; to preserve ability to do ADL; maintain integrity of affected joint
juvenile rheumatoid arthritis (JRA)
transmission: direct contact and droplet; incubation period: 10 to 21 days; communicability: 4 days before and 5 days after rash; prodromal stage: running nose, high fever, cough, conjunctivitis, rash, Koplik spots (small bright red spots with a blue white center on buccal mucosa (in the mouth); symptomatic treatment; red maculopapular rash; usually begins behind ears, hairline, forehead, or neck; progresses downward to chest to then extremities
measles or rubeola
when acid accumulates in the body or when bicarbonate is lost from body fluid, a bicarbonate deficit results and metabolic acidosis occurs; kidneys can't secrete ions or reabsorb bicarbonate; causes--ketoacidosis, shock, severe diarrhea, impaired kidney function; signs and symptoms--headache, lethargy, anorexia, deep, rapid respirations (Kussmaul), nausea, diarrhea, abdominal discomfort (in severe acidosis), coma and dangerous dysrhythmias; will cause changes in the neurologic, respiratory, GI, and cardiac systems
metabolic acidosis
more than 7.45; may be caused by steroid use, NG suctioning, prolonged vomiting, thiazide diuretic use, TPN infusion, citrates from blood transfusions, overdose of bicarbonates with CPR; warning sings--cardiac dysrhythmias as a result of decreased potassium; physical weakness, muscle cramping, hyperactive reflexes, tetany, convulsions, confusion; kidneys can't control the pH, too much base and loses H+ concentration
metabolic alkalosis
kissing disease; virus transmitted through saliva; exposure to kissing, coughing, or sneezing or by sharing a glass or food utensils with someone who has mono; adolescents and young adults; spleen
mono
transmission: direct contact; incubation period: 4 to 6 weeks; communicability: unknown; S&S: fever, sore throat, fatigue, malaise, enlarged lymph nodes, enlarged spleen; treatment: may need to restrict activities for 2-3 months; symptomatic treatment for signs and symptoms
mononucleosis Epstein-Barr virus (EBV)
heart sounds that reflect flow of blood passing through a defective valve, great vessel, or other heart structure; may occur in systole or diastole, or both; can occur in a normal heart in periods of stress: anemia, fever, or rapid growth; can reflect abnormalities in heart or vessels
murmurs
potential complications for CC
nausea, vomiting; low grade fevers; loss of pulse in the catheterized extremity; transient dysrhythmias; acute hemorrhage from entry site; apply direct continuous pressure at 2.5 cm (1 in) above the catheter entry site to localize pressure over the location of the vessel puncture; position the child flat to reduce the gravitational effect on the rate of bleeding
infection of immune serum (gamma globulin)
passive artificially acquired
antibodies pass form mother to fetus via placenta or to the infant in her milk
passive naturally acquired
CHD: decreased pulmonary blood flow: right to left shunt: cyanotic
occurs when pressure in the right side of the heart is greater than the left side of the heart; deoxygenated blood from the right side shunts to the left side; resistance of the lungs in abnormally high; pulmonary artery is restricted (tricuspid atresia, tetralogy of fallot)
lesions increasing pulmonary blood flow; acyanotic left to right shunt; oxygenated blood is shunted from the left side of the heart to the right side; this increases the work load of the ventricles
patent ductus arteriosus
normal fetal circulation conduit between the pulmonary artery and the aorta that fails to close; one of the most common benign defects; ductus normally closes within hours of birth; high risk for pulmonary hypertension; treatment: indocin-to induce ductus spasm and closure; surgery
patent ductus arteriosus (PDA)
transmission: droplet; incubation period: 6 to 20 days; communicability: catarrhal stage before paroxysms to 4 weeks after onset; nighttime cough with sudden inspirations and high pitched sound; paroxysm cough; symptomatic treatment
pertussis (bordelella or whooping cough)
continuously monitor cardiac and pulse oximetry to assess for bradycardia, dysrhythmias, hypotension, and hypoxemia; assess pulses for equality and symmetry; assess temperature and color; assess insertion site (femoral or AC area) for bleeding and/or hematoma; maintain clean dressing
post cardiac catheterization (CC)
a narrowing of the pulmonary valve or pulmonary artery; systolic ejection murmur; right ventricular enlargement; exercise intolerance; cyanosis with severe narrowing; treatment: digoxix and diuretics for heart failure; anticoagulant therapy; surgery
pulmonic stenosis
constriction of pyloric sphincter with obstruction of gastric outlet obstruction in infants; 1 in 500; more common in males clinical manifestations--projectile vomiting, visible peristaltic waves; olive shape mass in the upper abdomen to right of the midline; electrolyte imbalance management--IV therapy/correct electrolyte imbalance; comfort infant and caretakers diagnosis--straightforward if olive mass is present; upper GI or ultrasound treatment--preoperative treatment is directed toward correcting the fluid/acid base and electrolyte imbalances; NG tube is inserted for gastric decompression; surgery is the treatment of choice--Ramstedt pyloromyotomy
pyloric stenosis
spitting up with increasing frequency and projectile vomiting usually shortly after eating; continuous hunger; overly fussy behavior and later lethargy (listlessness and excessive tiredness; malnutrition: food does not move into the small intestine where it would normally be digested and used by the body; dehydration: a baby with this condition is at an increased risk for dehydration due to frequent vomiting; other symptoms that may show your child has pyloric stenosis include: decreased or infrequent bowel movements or harder stools; decreased weight; three Ps (palpable mass, peristalsis visible, projectile vomiting)
pyloric stenosis
post group A strep inflammation (acquired); clinical manifestations: poly-arthritis, carditis, subQ nodules and chorea (involuntary jerking movements); involves joints, skin, brain, rheumatic heart disease most serious complication, often mitral valve; penicillin is drug of choice; important to screen kids for Group A strep infections with throat cultures
rheumatic fever
right ventricle cannot handle the venous return--pressure backs up into the venous system; peripheral edema; jugular vein distention; ascites hepatomegaly
right sided heart failure
transmission: direct contact and droplet; incubation period: 14 to 21 days; communicability: 7 days before to 5 days after appearance of rash; low grade fever, headache, rash first appears on face and rapidly spreads downward; symptomatic treatment; isolate from pregnant women; TORCH--refers to infection of a developing fetus or newborn Toxoplasmosis, Other agents, Rubella (also known as German measles), Cytomegalovirus, and Herpes simplex
rubella or german measles
strep throat with a rash; respiratory precautions for 24 hours; oral antibiotic for 10 days; treat sore throat with analgesics, gargles, lozenges, and antiseptic throat spray; encourage fluids
scarlet fever
neonates and young infants have a higher susceptibility due to their immature immune system, inability to localize infections, and lack of IgM immunoglobulin, which is necessary to protect against bacterial infections; the prognosis for sepsis is variable and depends on the child's age and the cause signs and symptoms: child just does not look or act right; crying more than usual, inconsolable; fever; hypothermia (in the neonate and those with severe disease); lethargic and less interactive or playful; increased irritability; poor feeding or poor suck; rash (petechiae, ecchymosis, diffuse erythema); difficulty breathing, nasal congestion; diarrhea, vomiting; decreased urine output; hypotonia; changes in mental status (confused, anxious, excited); seizures; older child may complain of heart racing therapeutic management: aggressive in infants, especially neonates; infant is admitted for close monitoring along with antibiotic therapy; intravenous antibiotics are started immediately after blood culture, urine culture, cerebrospinal fluid culture
sepsis
infants with cardiac conditions often require supplemental feeding to provide sufficient nutrients for growth, while still receiving breast milk or formula
supplemental feeding
primary=no known cause; secondary=identifiable cause; pediatrics: HTN generally secondary to structural abnormality or underlying pathology such as renal disease, CV disease, endocrine or neurologic disorders
systemic hypertension
displaced aorta, right ventricle hypertrophy, opening in septum, pulmonary valve stenosis
tetralogy of fallot
lesions decreasing pulmonary blood flow; cyanotic right to left shunt; blood flows from the right side of the heart to the left side
tetralogy of fallot
four abnormalities; pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy; most common cardiac malformation responsible for cyanosis in a child over 1 year; severe dyspnea; obstruction to right ventricular outflow; murmur; failure to thrive and growth retardation
tetralogy of fallot (TOF)
GI: development and biological differences
the smaller the child, the greater the proportion of body water to weight and proportion of ECF to ICF; infants have a greater body surface area and higher metabolic rate than adults; the young infant is highly susceptible to dehydration; infants 6 weeks or younger do not produce tears
an abnormal connection (fistula) between the esophagus and the trachea; the three Cs (choking, coughing, cyanosis)
tracheal esophageal fistula
aorta connected to the right ventricle instead of the left; pulmonary artery connected to the left ventricle instead of the right
transposition of great arteries
mixed lesions (caused by blood flow in both directions); causes either cyanotic or acyanotic conditions
transposition of the great vessels
complete closure of the tricuspid valve; no blood flow from the right atrium to the right ventricle; severe cyanosis within hours after birth (increased as the PDA closes); heart failure; chronic hypoxemia; failure to thrive and growth retardation; treatment: prostaglandin E-to maintain ductal patency; then surgery
tricuspid atresia
transmission: direct contact and droplet; incubation: 10-21 days; communicability: 1 to 2 days before onset of vesicles and until the vesicles are crusted over; approx. 7 days; prodromal phase: slight fever, malaise, pruritic rash; macular to papular to vesicular management: symptomatic treatment--tepid bath, calamine lotion, clip finger nails; keep from scratching; antihistamines for itching; treat with acetaminophen or ibuprofen; no salicylates (ASA)--due to the possibility of Reye's syndrome; immunocompromised--Acyclovir IV
varicella (chicken pox)
a hole in the septum between the right and left ventricle; most common; 30% of defects; right ventricular hypertrophy; loud, harsh murmurs; CHF; failure to thrive; small, possibly asymptomatic defects; treatment: may close spontaneously; if not surgery
ventricular septal defect (VSD)
