NUR425 PEDS EXAM 2
normal urine output for older children and adolescents
1 mL/kg/hr
The nurse is caring for a child, with no previous medical history, who weighs 10 kg and is moderately dehydrated. The prescription by the provider is to give an IV bolus over 20 minutes. What would the nurse set the IV pump in at mL/hr to deliver the bolus in the prescribed amount of time?
600 mL/hour
A nurse is providing teaching to a client who has renal failure and an elevated phosphorus level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client? A. constipation B. metallic taste C. headache D. muscle spasms
A
infants will have the following presenting signs in UTI a. vomiting/poor feeding b. tea-colored urine c. proteinuria d. increased number of stool diapers
A
what are the most important signs of heart failure that a nurse would look for in an infant with coarctation of aorta
edema tachycardia tachypnea hypotension feeding difficulty prolonged cap refill ineffective peripheral circulation (cool extremities) weight gain can happen
post op care for cleft palate/cleft lip repair
elbow immobilizers (keep from putting hands in mouth) pain control (crying causes stress on suture lines) feeding when tolerated sitting upright in carseat
what is the earliest sign of dehydration in a child
elevated HR
what are some signs and symptoms of dehydration in a child
elevated HR change in LOC-- irritable, lethargic decrease in skin turgor/elasticity sunken fontanel decrease number of wet diapers/increased # of stool diapers mottling, prolonged cap refill low BP
GCS of 12
emergent neuro consultation
when to give mucosal protectants
empty stomach, QID, two hours before other drugs
what is the most serious complication of Hirschsprung disease
enterocolitis
chronic-recurrent seizures
epilepsy congenital defects
what is decerebrate posturing
extensor body hyperextended problems with midbrain or pons WORSE
clinical manifestations Hirschsprung disease in a newborn
failure to pass meconium within 24-48 hours of life feeding refusal bilious vomiting abdominal distention
T/F: a positive RAPID test is a stable patient
false a positive RAPID is an unstable patient a negative RAPID is a stable patient
acute-nonrecurrent seizures
febrile electrolyte imbalance intracranial infection drugs/toxins/lead
what is the glass test for meningitis
fever with spots or rashes that do not fade under pressure is a medical emergency
Brudzinski's sign
flexion of knees and hips when neck is flexed
what is decorticate posturing
flexor arms move in towards core problems with cervical spinal tract or cerebral hemisphere
what is ICP
force exerted by the three contents (CSF, blood, tissue) on the brain
therapeutic use of Cimetidine
gastric and duodenal ulcers heartburn dyspepsia GERD aspiration pneumonitis
therapeutic use of omeprazole
gastric and duodenal ulcers heartburn dyspepsia GERD aspiration pneumonitis
what causes isotonic dehydration
gastroenteritis with vomiting and diarrhea
what is the RAPID assessment
R = Rapid heart rate A = Altered color or capillary refill P = Peeing nonexistent I = Inability to engage in the environment D = Decreased blood pressure
what drugs can cause irregular facial spasms
Reglan (metoclopramide) because of extrapyramidal symptoms (affects dopamine)
epidural hematoma
above dura arterial blood
findings of bacterial meningitis in children and adolescents
abrupt onset fever headache seizures irritability nuchal rigidity positive Kernig sign positive Brudzinski signs petechiae/purpura
what is Hirschsprung disease
absence of ganglion cells in affected areas of intestine some nerve cells in large intestine are missing leading to stool getting blocked decreases ability of sphincter to relax, increased intestinal tone lack of peristalsis
therapeutic use of mucosal protectants
acute duodenal ulcers
signs of mild dehydration in child
alert moist mucus membranes normal urine cap refill under 2 seconds no thirst normal eyes flat fontanelle
mechanism of action of antacids
alkaline substance that neutralizes gastric acid
what drugs are likely to interact with the drugs we are studying? a. MAOI B. SSRI C. Theophylline D. warfarin E. digoxin F. tetracycline G. fluoroquinolones H. TCAs
all of them
examples of antacids
aluminum hydroxide (Amphojel) magnesium hydroxide (MOM) calcium carbonate (Tums) Magaldrate (mag and aluminum)
education for antihistamines/anticholinergics
anticholinergic effects (cant see, cant pee, cant spit, cant sh**) caution with lactation, pregnancy, glaucoma
what is MAP
average BP during one cardiac cycle
what is an adverse reaction of cimetidine a. miscarriage b. impotence c. insomnia d. heartburn
b. impotence
which one includes to check urine at home in the discharge instructions a. AGN b. NS c. UTI
b. nephrotic syndrome
CSF analysis in bacterial versus viral
bacterial - protein content: elevated - glucose content: decreased - bacteria culture: positive - color: turbid or cloudy viral - protein content: normal - glucose content: normal - bacteria culture: negative - color: clear or slightly cloudy
what are the three types of meningitis
bacterial viral (aseptic) tuberculosis
when does cleft palate repair happen
before 12 months of age (speech development)
subdural hematoma
below dura venous blood
what should pulse pressure be in peds
between 10 and 50 mmHg
when does cleft lip repair happen
between 2-3 months of age
mechanism of action of cimetidine
blocks histamine receptors (which produce stomach acid)
mechanism of action of serotonin antagonists
blocks serotonin receptors in the brain (chemoreceptor trigger zone) and vagal nerves
mechanism of antihistamines/anticholinergics
blocks the release of histamine in inner ear and brain
CoA assessment cues
bounding pulses high BP in UE nosebleeds from HTN cool skin, decreased BP in LE headaches
what are some signs of digoxin toxicity
bradycardia nausea, vomiting, anorexia vision changes blurred/yellow vision (halo effect) hold drug if infants heart rate less than 90
education for mucosal protectants
can cause constipation, increase fluids and fiber
right sided heart failure
causes increased pressure in right atrium and systemic venous circulation HTN leading to hepatosplenomegaly and sometimes edema
what is CPP
cerebral perfusion pressure pressure needed to ensure that adequate O2 and nutrients are delivered to the brain difference between MAP and ICP
what are some warning signs of a head injury
change in LOC, seizures slurred speech visual changes pupil changes projectile vomiting bleeding/clear fluid from nose or ears loss of sensation to any extremity
what to look for/ symptoms of increased ICP
changes in LOC eyes posturing (decorticate, decerebrate, flaccid) decreased motor function headache seizures changes in vitals vomiting changes in speech
what is serum sodium concentration regulated by
changes in WATER intake, movement, and excretion NOT by changes in sodium balance
what do you do if someone has blurry vision and headache
check vitals, specifically BP (hypertension)
what determines if your px will take oral or IV fluids
child's LOC and ability to keep fluids down RAPID assessment positive or negative
what is the prototype for histamine H2 antagonists
cimetidine (Tagamet)
what are some ways you would diagnose HF
clinical symptoms CXR shows enlarged heart and pulmonary blood flow ventricular hypertrophy arrhythmias ECHO
what is CoA
coarctation of the aorta obstruction to blood flow due to stenotic lesion (narrowing of portion of aorta)
care management of UTI
collection of sterile or clean specimen for diagnosis midstream clean catch of urine avoid collection of specimen in urine collection bags in diapers
education for antacids
constipation (aluminum and calcium) diarrhea (magnesium) antacids decrease absorption of many drugs (do not give within 1-2 hours of other drugs)
clinical manifestations Hirschsprung disease in an infant
constipation, abdominal distention, possibility of enterocolitis
what are some postop interventions for care of the pediatric client
continuous cardiopulmonary assessment monitor O2 sat maintain body temp promotion of fluid and electrolyte balance continuous vital signs monitoring check for bleeding, signs of infection, LOC, skin, pain
first line therapy for nephrotic syndrome
corticosteroids
mechanism of action of mucosal protectants
creates a gel that coats ulcers and is a barrier between stomach acid
care management of nephrotic syndrome
daily weight, measure abdominal girth home care is preferred children can attend school, but avoid contact with ill friends restrict some salt and fluids
management of acute glomerulonephritis
daily weights, vital signs, strict measurement of intake and output dietary restrictions, monitor electrolytes do not treat with antibiotics (post-infection disease)
mechanism of action of synthetic prostaglandins
decreases stomach acid production, increases bicarb, protective mucous in stomach
what are some meds to give for VSD
digoxin (heart failure) and Lasix (decrease BP)
what are the following signs and symptoms in an infant with hydrocephalus
dilated scalp veins high pitched cry separated skull sutures
prototype of antihistamines/anticholinergics
dimenhydrinate (Dramamine)
which drug would the nurse instruct to suck on candy while taking?
dimenhydrinate (anticholinergic can cause dry mouth)
gold standard for ICP monitoring
drain CSF as needed HOB at 15-30 degree elevation midline head position to promote drainage low stimulation environment avoid suctioning and Valsalva infection risk
pathophysiology of nephrotic syndrome
glomerular membrane becomes permeable to large proteins, especially albumin albumin and proteins leak through reduces serum albumin and causes fluid to accumulate in interstitial space and abdominal cavity (edema and ascites) stimulates RAAS system
hallmark sign of nephrotic syndrome
greater than 2+ protein in urine
assessment cues of meningeal irritation
headache photophobia nuchal rigidity (stiff neck) opisthotonic position (neck to heel arching) positive Kernig's sign (resistance to extension of leg while hip is flexed) positive Brudzinski's sign (flexion of hips and knees in response to neck flexion)
what does widened pulse pressure mean
high systolic same diastolic bigger gap between systolic and diastolic
what are some VSD assessment cues
holosystolic murmur right atrium enlarges (hypertrophy) heart failure
hypertonic dehydration
hypernatremic more water is lost than sodium fluid shifts from ICF to ECF to equalize neurologic dysfunction due to brain cells shrinking (fluid moves out of cells and they shrink)
what are the two compensatory mechanisms of the heart
hypertrophy of right ventricle-- leads to poor feeding, dyspnea, growth failure sympathetic nervous system release of catecholamines-- leads to tachycardia, sweating, increased BP
what are differences between hypotonic and hypertonic dehydration?
hypotonic: - low sodium - water moves from ECF to ICF - electrolyte loss more than water loss hypertonic: - high sodium - water moves rom ICF to ECF - water loss more than electrolyte loss
treatment for bacterial meningitis
immediate droplet isolation precautions lumbar puncture-- definitive test antimicrobial therapy maintain IV or oral hydration reduce increased ICP implement seizure precautions neuro checks anti epileptic meds
causes of hydrocephalus
impaired absorption of CSF in ventricular system malfunction of arachnoid villi obstruction of flow of CSF
what does digoxin due for cardiac function
improves contractility increase cardiac output dysrhythmia decreases serum potassium
why and when does a TET spell occur
in response to a stressor, like feeding or crying
what happens in VSD
increased blood flow to and through the pulmonary system blood being pushed to the right side of the heart and into the lungs congestion in lungs
left sided heart failure
increased pressure in left atrium and pulmonary veins lungs congested with blood increased pulmonary artery pressures and pulmonary edema
what happens in CoA
increased pressure proximal to defect (arms) decreased pressure distal to defect (legs) increased pressure load on ventricle decreased cardiac output no color change; all oxygenated blood
what are the four hemodynamic characteristics
increased pulmonary blood flow (VSD, PDA) decreased blood flow (TOF) obstruction to blood flow out of heart (CoA) mixed blood flow
what happens in PDA
increased pulmonary blood flow to the lungs
The new classification of heart defects is more descriptive regarding the flow of blood through the heart. Match the classification with the type of congenital heart disease found in that classification. Increased pulmonary blood flow: _____________ Decreased pulmonary blood flow: _____________ Obstruction of blood flow out of the heart: _____________
increased pulmonary blood flow: VSD decreased pulmonary blood flow: TOF (pulmonary stenosis = narrowing) obstruction of flow out of heart: Coarctation of aorta
what is Cushing's Triad
increased systolic BP decreased HR (bradycardia) irregular respirations (Cheyne-Stokes)
PDA assessment cues
increased work on left ventricle (extra blood) machine-like murmur increased pulmonary congestion bounding pulses
mechanism of action of dopamine antagonists
increases tone of esophageal sphincter increases peristalsis decreases dopamine receptors in the brain thus decreasing nausea and vomiting
pathophysiology of acute glomerulonephritis
inflammation of glomeruli & they become permeable to RBCs glomeruli become edematous increased interstitial fluid volume, causing edema and hypertension
mechanism of action for PPIs
inhibits an enzyme system in the stomach; suppresses gastric acid production
GCS of 8
intubate and ventilate
polycythemia can result in what
iron deficient anemia clotting thickened blood higher chance of stroke
what is the most common type of dehydration
isotonic
where will you hear the murmur for VSD
left sternal border
signs of moderate dehydration in child
lethargic, sleepy, irritable dry mucus membranes dark and diminished urine increased HR BP normal cap refill over 2 seconds thirsty slightly sunken eyes decreased tears sunken fontanelle
signs of severe dehydration in child
lethargy, unresponsive or anxious non elastic skin turgor decreased or absent urine increased HR, decreased BP cool extremities cap refill 3-4 seconds increased thirst sunken eyes decreased or absent tears sunken fontanelle
precautions with Prilosec
liver dysfunction pregnancy
education of Prilosec
long term use can cause bone loss rebound acid hypersecretion when stopping med C-diff
what is the telltale sign of dehydration in a child
low BP
list 7 assessment findings with dehydration
low BP decreased turgor sunken fontanelle (infants) decrease tears dry mouth prolonged cap refill tachypnea tachycardia
what will PDA murmur sound like
machine-like
prototype for dopamine antagonists/prokinetics
metoclopramide (Reglan)
education for synthetic prostaglandins
miscarriage, dysmenorrhea
prototype for Prostaglandin E Analog
misoprostol (Cytotec)
nursing interventions for pediatric seizure
monitor time, movements, and LOC during seizure do not restrain place side lying do not put anything in mouth evaluate postictal feedings give meds
characteristics of isotonic/isonatremic dehydration
most common equal amounts of sodium and water are lost sodium levels are still normal fluid lost from ECF decrease in blood volume
what is intussusception
most common cause of intestinal obstruction in children proximal segment of bowel telescopes into more distal segment
what are some concerns with cleft lip and cleft palate
most unable to feed using conventional methods pre surgery may need Pigeon bottle, cleft palate nurser tend to swallow excessive air with feedings-- pause frequently and burp
what structures are included in the upper GI system
mouth, esophagus, stomach, first part of small intestine (duodenum)
therapeutic use of dopamine antagonists
nausea and vomiting due to chemo, opioids, radiation increases motility in those with GERD or diabetic gastroparesis
therapeutic use of serotonin antagonists
nausea and vomiting related to chemo, radiation therapy, post op
pleural effusion and ascites is related to what
nephrotic syndrome
education for Cimetidine
no antacids within one hour no smoking, alcohol, ASA or NSAIDS (GI irritation) can cause impotence
characteristics of viral/aseptic meningitis
no bacterial growth in CSF cultures abrupt or gradual onset of symptoms not contagious
what are some clinical manifestations of pyloric stenosis
non bilious projectile vomiting after feeding (whatever went down in feeding comes right back out) infant hungry olive-shaped mass dehydration, abdominal distention
what is the best IV fluid to give for hypovolemia related to dehydration
normal saline-- isotonic flui d
prototype for PPIs
omeprazole (Prilosec) other 'zoles'
when are PPIs given
once a day, before first meal
ADH only affects the
osmolarity
medications for ICP management
osmotic diuretics like Mannitol IV thermoregulation--hyperthermia with cereal dysfunction do NOT give corticosteroids give Barbiturates as last resort
which four interventions are needed with a TET spell
oxygen morphine IV fluids knee to chest
what happens in TOF
oxygenated blood mixes with deoxygenated blood causing cyanosis
Kernig sign
pain during extension of leg while hip is flexed
what is PDA
patent ductus arteriosus left to right shunt (failure) of ductus arteriosus to close opening between the great arteries (aorta and pulmonary)
therapeutic use of antacids
peptic ulcer disease GERD
symptoms of acute glomerulonephritis
periorbital edema (both eyes) facial edema in morning may spread throughout day to extremities, genitalia, abdomen mild to severe increase in BP
treatment of intussusception
pneumoenemea (air enema) to straighten out telescoped bowel may need US-guided saline enema may require surgery
treatment of synthetic prostaglandins
prevention of ulcer when one uses NSAIDS for a long time
medication for PDA
prostaglandin inhibitor-- Indomethiacin
management of pyloric stenosis
pyloromyotomy correct dehydration correct metabolic alkalosis
what to reassess after each fluid bolus
recheck HR and BP often recheck resp rate listen to lungs recheck cap refill and skin turgor skin color wet diaper? needing to void? tears? with crying? mouth moist? membranes dry?
what do ACE inhibitors do for cardiac function
reduce after load promote vasodilation "prils"
clinical manifestations Hirschsprung disease in childhood
ribbonlike, foul smelling stool undernourished, anemia appearance
education for dopamine antagonists
sedation extrapyramidal reactions diarrhea prevents absorption of many drugs including acetaminophen, valium, digoxin, lithium
severe depletion of ECF results in
shock
HF interventions about feeding techniques
small, frequent feedings
aldosterone maintains balance of
sodium and water
hypotonic dehydration
sodium is diluted & low too much water intake more intake of water than what can be excreted fluid shifts from ECF to ICF to equalize osmolarity causes severe shock
treatment of hyper cyanotic TET spells
squatting or knee-chest position (forces more blood to pulmonary artery -> more blood to lungs -> more blood to body) oxygen morphine IV fluids
etiology of acute glomerulonephritis
streptococcal infection group A beta-hemolytic streptococci 10-21 days between infection and start of symptoms
prototype of mucosal protectants
sucralfate (Carafate)
clinical manifestations of intussusception
sudden acute abdominal pain child screaming with knees drawn to chest red currant jelly-like stools palpable sausage-shaped mass in RUQ appears comfortable during intervals
hydrocephalus signs
sunset eyes bulging fontanel dilated scalp veins Macewen's sign (cracked pot sound) thin shiny skin high-pitched cry
assessment cues of TOF
systolic murmur mild to severe cyanosis hyper cyanotic spells (TET spells) polycythemia (making too many RBC to try and compensate for lack of oxygen) anemia (iron stores being used up for RBCs)
symptoms of left sided heart failure
tachypnea dyspnea retractions nasal flaring wheezing
what is hypertrophic pyloric stenosis
thickening and elongation of pyloric sphincter muscle usually occurs in first few weeks of life
what causes hypotonic dehydration
too much water intake burns, renal disease, SIADH replacement of fluid with only tap water
what is a risk associated with a child taking Digoxin
toxicity due to hypokalemia
what will labs and urine look like in acute glomerulonephritis
urine: cloudy, smoky brown (like tea) from increased RBCs and hemoglobin BUN and Creatinine elevated at least 50% positive ASO titer (recent strep infection)
education for serotonin antagonists
use with caution with drugs that affect serotonin transmission (SSRIs, TCAs, fentanyl, lithium) dizzy, constipation, diarrhea
etiology of nephrotic syndrome
usually caused by minimal-change nephrotic syndrome (MCNS) can be caused by secondary disorder or congenital
what is VSD
ventricular septal defect left to right shunt (hole) in septum between the two ventricles increased pulmonary blood flow
therapeutic use of antihistamines/anticholinergics
vertigo (motion sickness) and nausea, vomiting
signs and symptoms of UTI in kids
vomiting, fever, poor feeding pain with urination abdominal or back pain strong smelling urine dipstick shows leukocyte esterase and nitrites
symptoms of right sided heart failure
weight gain peripheral edema periorbital edema neck vein distention ascites hepatomegaly
signs and symptoms of nephrotic syndrome
weight gain facial edema (subsides during the day) abdominal ascites pleural effusion BP normal or slightly decreased urine output decreased and frothy anorexia, diarrhea, fatigue, lethargy
Which drugs affect bone density? a. lansoprazole b. famotidine c. cal carb
a. lansoprazole (PPI can cause bone loss) also affects pregnant women, vitamin D, Cdiff monitor
why does albumin help with nephrotic syndrome? a. restores lost serum protein b. dilutes urine c. decreases inflammation d. acts as antihypertensive
a. restores lost serum protein
Patient is unstable with cardiac issues
5 to 10 mL/kg over 10-20 mins
patient is stable, mild dehydration, and can drink
50 mL/kg over 4 to 6 hours
what are three potential reasons for heart failure in the peds patient
1. secondary to structural defects in the heart 2. impaired contractility or relaxation ov ventricles (dysrhythmias, electrolyte imbalance) 3. excessive demands on normal heart muscle (sepsis or anemia)
normal urine output for infants and young children
1.5-2 mL/kg/hr
Patient is stable, moderate dehydration, cannot drink, hypertonic dehydration
10 mL/kg over 5 to 20 mins
patient is stable, mild dehydration, but cannot drink and having hypertonic dehydration
10 mL/kg over 5 to 20 mins
normal ICP for peds
10-15
Patient is stable, moderate dehydration, can drink
100 mL/kg over 4 to 6 hours
what is the normal bicarb level for newborn and infant
16-24
What is the total daily maintenance fluids for a child weighing 57 pounds?
1618 mL
The nurse is caring for a 1-year-old child who weighs 10 kg. The nurse would expect a minimum urine output of _______ mL over 12 hours. (Respond with a whole number only).
180 mL
formula for calculation of maintenance fluids
1st 10 kg # of kg x 100 mL next 10 kg # of kg x 50 mL leftover kg # of kg x 20 mL
prognosis of nephrotic syndrome
2/3 of children have relapse of MCNS in conjunction with viral or bacterial infection can cause complications such as infection, thromboembolism
Patient is unstable with no cardiac issues
20 mL/kg over 5 to 10 mins
Patient is stable, moderate dehydration, cannot drink, hypotonic or isotonic dehydration
20 mL/kg over 5 to 20 mins
patient is stable, mild dehydration, but cannot drink and having hypotonic or isotonic dehydration
20 mL/kg over 5 to 20 mins
px hypotensive, sunken fontanelles. How fast to give bolus?
200 mL over 5-10 minutes
what is the normal bicarb level for child and adult
21-28
The nurse is caring for a 7 pound newborn. The nurse would expect a minimum of _____ mL of urine over 8 hours. (Round kg to nearest 10th. Answer in mL is whole number only.)
38 mL
normal CPP for children
40-60
The nurse is caring for a 12-year-old who weighs 88 pounds The nurse would expect minimum of _______ mL of urine over 12 hours.
480 mL
A nurse is caring for a child who just experienced a generalized seizure. Which of the following is the priority action for the nurse to take? A. Position the child in a side lying position B. Try to determine the seizure trigger C. Reorient the child to the environment D. Note the time of the post ictal period
A ABC's priority to avoid aspiration
When is posturing in an unconscious client likely to occur? A. When they are in pain B. With stimulation C. When there is no brain function D. at random times
A, B, D
You are the nurse caring for a child who has been diagnosed with nephrotic syndrome. Which of the following findings should you expect to find (SATA) A. urine dipstick 2+ protein B. hyperlipidemia C. polyuria D. anorexia E. hypertension
A, B, D
You are the nurse caring for an infant who has been diagnosed with coarctation of the aorta. The child is scheduled for a repair of this defect tomorrow. When doing your assessment what deviations from normal would you expect to find? (Select all that apply) A. Poor peripheral pulses in the lower extremities B. Equal blood pressure measurements in upper and lower extremities C. Bounding pulses in upper extremities D. A normal exam
A, C
What conditions can affect the neurological response in the pediatric client? (Select all that apply) A. Infections B. eating cheerios C. traumatic brain injury D. exposure to lead
A, C, D
Which of the following interventions would the nurse expect to perform for the pediatric client with increased ICP? (Select all that apply) A. Stabilize airway, breathing, and circulation B. Suction secretions often C. Give mannitol for cerebral edema D. Place HOB elevated at 15 to 30 degrees
A, C, D B- suction if needed to clear airway but not recommended because can increase ICP
A nurse is explaining the role of gradient pressure related to congenital heart disease to a new CVICU nurse. What statement(s) would indicate an understanding of the concept by the new nurse? (Select all that apply) A. Blood flow through the heart takes the path of least resistance B. The higher the pressure gradient, the slower the flow of blood C. Blood flows from an area of high pressure to an area of low pressure in CHD D. The greater the resistance the slower the flow of blood
A, C, D blood flows from high to low pressure blood takes the path of least resistance higher pressure gradient, the faster the rate of flow higher the resistance, the slower the rate of flow
Maternal risk factors for an increased incidence in congenital heart disease in the infant include the following: (Select all that apply) A. Exposure to environmental toxins B. Taking folic acid C. Family history of congenital heart disease D. Alcohol consumption during pregnancy E. Infections during pregnancy
A, C, D, E
Digoxin is a drug that is used frequently to treat heart failure in the pediatric client. What are some signs and symptoms of digoxin toxicity? (Select all that apply) A. nausea and vomiting B. tachycardia C. bradycardia D. vision changes E. arrhythmias
A, C, D, E px will have bradycardia, not tachycardia
You are the nurse caring for an infant in the CVICU who has just been diagnosed with Tetralogy of Fallot. After speaking to the healthcare provider, the parents are still unclear as to what the defect is. You would explain that Tetralogy of Fallot is made up of which of the following defects? (Select all that apply) A. VSD B. ASD C. Overriding aorta D. pulmonary stenosis E. Left ventricular hypertrophy F. right ventricular hypertrophy
A, C, D, F
A nurse is caring for an adolescent who has a closed head injury. Which of the following findings are indications of increased intracranial pressure (ICP)? (Select all that apply) A. Report of a headache B. Increased motor response C. Alteration in pupillary response D. Increased sensory response E. Increased sleeping
A, C, E B- decreased motor response is an indicator of increased ICP D- decreased sensory response is an indicator of increased ICP
Common presentations of acute glomerulonephritis include the following findings: (SATA) A. RBCs in urine B. foamy urine C. low BP D. periorbital edema E. history of recent strep infection F. hyperlipidemia
A, D, E B, C, F are symptoms of nephrotic syndrome
You are caring for a child with heart failure in the CVICU. What are some nursing interventions that you can implement to decrease the cardiac demand of your pediatric client? (Select all that apply) A. Cluster care to promote rest B. Keep room hot C. Provide a lot of stimulation D. Provide large meals 3x/day E. Treat fevers with antipyretics
A, E avoid cold or heat stress decrease stimulation small meals or gavage feedings
A nurse is teaching a client who has a new prescription for cimetidine to treat peptic ulcer disease. Which of the following statements by the client indicates an understanding of the teaching? (SATA) A. "I can take this medication with or without food" B. "I will take this medication in the morning" C. "I should expect my stools to turn black" D. "I will take this medication with an antacid" E. "I will take this medication when I need it for pain" F. "I will eat five small meals each day"
A, F B- the client should take in evening to reduce nocturnal acid production C- The client should report black stools (GI bleed) D- The client should take an antacid 30 min to 1 hr before the cimetidine E- taken on a regular basis to relieve pain, promote healing
A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor for and report which of the following adverse reactions? A. constipation B. flatulence C. palpitations D. headache
A. Aluminum hydroxide can cause constipation
An infant, with no medical history, is in the emergency room, for moderate dehydration (8%) and weighs 5.6 kg. The parents inform the nurse that the last wet diaper was 6 hours ago and that the child had been vomiting for the past 24 hours but has had no emesis for the past 3 hours. Caregiver states that the infant is refusing to drink anything. The nurse notes that the infant's heart rate is 154 beats per minute, respiratory rate is 56 breaths per minute, blood pressure is 92/65, capillary refill is 3 seconds, skin is cool and dry, skin turgor is decreased, fontanel is slightly sunken, mucous membranes are dry, and the infant is quiet and does seem to engage in the environment with parents. What would the nurse expect for the initial intervention for this child? A. Administer 112 mL NS IV over 5 to 20 mins B. Administer 112 mL NS with 20meq of K+ IV over 5 to 10 mins C. give 280 mL of oral replacement fluids over 4-6 hours D. start IV fluids D5 NS at 23 mL/hour
A. Administer 112 mL NS IV over 5 to 20 minutes patient is moderately dehydrated, refuses to drink anything, and having isotonic dehydration
An 11-month-old infant has been admitted to the emergency room with a 4 day history of diarrhea and severe dehydration (10%). The child weighs 8.8 kg. The parents inform the nurse that the last wet diaper was more than 24 hours ago and that the child has refused all foods but had about 2 ounces of tap water 5 hours ago. The nurse notes on the child's assessment that the heart rate is 182 beats per minute, respiratory rate is 56 breaths per minute, blood pressure is 62/40, capillary refill is greater than 4 seconds, skin is cool and clammy, skin turgor is poor, fontanel is sunken, and the child is difficult to arouse or keep awake. What would the nurse expect for the initial intervention for this child? A. administer 176 mL NS over 5-10 mins B. Administer 176 mL NS over 30 mins C. Start IV fluids of D5 NS at 36 mL/hr D. Administer 880 mL oral fluids over 4-6 hours
A. Administer 176 mL NS over 5-10 mins Patient has severe dehydration, unstable, but no cardiac issues
A 21-month-old child who weighs 11.7 kg has been admitted to the emergency room with moderate dehydration. Caregiver states she has vomited twice today, the last time being about 6 hours ago. The last wet diaper was about 4 hours ago and the child last had something to drink about 4 hours ago. The nurse notes on the child's assessment that the heart rate is 142 beats per minute, respiratory rate is 38 breaths per minute, Blood pressure is 102/76, capillary refill is less than 3 seconds, skin is cool and dry, skin turgor is decreased. The child is irritable, crying, making some tears and is easily consoled. What would the nurse expect for the initial intervention for this child? A. give 1170 mL of oral replacement fluids over 4-6 hours B. Administer 234 mL NS over 5-20 mins C. Start IV fluids D5 NS at 45 mL/hr D. give 585 mL over the next 4-6 hours
A. Give 1170 mL of oral replacement fluids over 4-6 hours child has moderate dehydration, but awake and able to drink
The nurse in the CVICU has been educating a new nurse about the signs and symptoms of heart failure in a child. Which statement by the new nurse would indicate a need for further education? A. "Children with heart failure often have edema and should be weighed daily." B. "Children with heart failure should eat larger meals more often." C. "Heart failure in children can present with inappropriate sweating and fatigue with eating." D. "It is often difficult for children with heart failure to breathe well when lying flat in bed."
B these patients will have anorexia and feeding intolerance rest of answers are true
A nurse is teaching a client who has a duodenal ulcer about his new prescription for cimetidine. The nurse should include which of the following instructions in the teaching? A. "Take the medication with an antacid to minimize stomach upset" B. "Your doctor might need to reduce your theophylline dose while taking this medication" C. "Take the medication on an empty stomach for better absorption" D. "You should plan to take this medication for at least 6 months"
B (can increase medication levels)
You are the nurse caring for a school-age child who has acute glomerulonephritis. Which of the following findings should you report to the provider? A. BUN 8 mg/dl B. serum creatinine 1.3 mg/dl C. BP 100/74 mmHg D. urine output 550 mL in 24 hours
B (should not be higher than 0.7)
common presentations of nephrotic syndrome include the following findings: (SATA) A. hypertension B. 2+ protein in urine C. decreased serum lipids D. decreased serum protein E. increased risk for PE or DVT
B, D, E
A 13-year-old child has been admitted to the emergency room after collapsing during football practice with moderate dehydration (8%). The child weighs 30 kg. The coach informs the nurse that they had been practicing all afternoon and that the only water available was inside the school which had been locked up for the past 4 hours. The nurse notes on the child's assessment that the heart rate is 132 beats per minute, respiratory rate is 26 breaths per minute, blood pressure is 112/78, capillary refill is 3 seconds, skin is dry, and mucous membranes are dry. The child is able to follow commands but is lethargic and slow to respond. What would the nurse expect for the initial intervention for this child? A. Start IV fluids D5 NS at 71 mL/hr B. Administer 600 mL NS IV over 5 to 20 minutes C. Give 1500 mL oral replacement fluids over 4-6 hours D. Administer 600 mL NS IV over 5 to 10 minutes.
B. Administer 600 mL NS IV over 5 to 20 minutes px has moderate dehydration, cannot drink, isotonic dehydration
med administration for antacids
QID, drink 8 oz water after
renin produced in the kidneys is released when:
BP is low sympathetic nerve cells are activated macula dense cells in distal tubule sense lack of sodium
A nurse is teaching a client who has a new prescription for esomeprazole to manage his GERD. Which of the following statements by the client indicates an understanding of the teaching? A. "I won't pass gas as often now that I am taking this medication" B. "I will take this medication each morning with my breakfast" C. "I have an increased risk of getting pneumonia while taking this medication" D. "I will need to take a daily stool softener while taking this medication"
C
The nurse has given her patient the prescribed IVF bolus. What is the priority nursing action now? A. Obtain the prescribed blood work B. Document the current vital signs C. Assess the patient and recheck vital signs D. Ask the patient if they feel better
C
You are the nurse caring for a child in the NICU who has a history of prematurity and has just been diagnosed with a patent ductus arteriosus. What medication would be an appropriate treatment to promote the closure of this type of congenital heart defect? A. Prostaglandin E B. Morphine C. Indomethiacin D. Digoxin
C Indomethiacin inhibits prostaglandin and can be used to treat and promote closure of patent ductus arteriosus
What is the most important assessment in the pediatric client? A. urine output B. diet C. LOC D. pain
C LOC most important
A child who is arousable by a gentle shaking of the shoulder would be? A. Confused B. Lethargic C. Obtunded D. Comatose E. Stuporous
C confused = forgetful lethargic = drowsy obtunded = arousable by stimulation comatose = cannot arouse stuporous = arousable with vigorous stimulation
Which statement regarding the systolic and diastolic blood pressure of an infant less than a year of age reflects a normal finding? A. The blood pressure in the upper extremities should be higher than in the lower extremities B. The blood pressure in the lower extremities should be higher than the blood pressure in the upper extremities C. The blood pressure in the upper and lower extremities should be approximately the same. D. The blood pressure on the right side should be higher than the blood pressure on the left side of the body
C before one year, should be same after one year of age, systolic in leg is higher by 10-40 mmHg
18 kg child with vomiting diarrhea. cannot drink. how much IV bolus and how fast? A. 180 mL over 5 mins B. 180 mL over 20 mins C. 360 mL over 20 mins
C px stable, so 20 mins
if a kid comes in with dizzy spells, headaches, nosebleeds. what are you concerned about?
Coarctation of aorta
Place the correct assessment finding and intervention into the correct category: Cushing's Triad & Hydrocephalus A. mannitol IV stat B. Cheyne-Stokes respirations C. high pitched cry D. bradycardia E. increased head circumference F. bulging fontanel G. elevated systolic BP H. VP shunt placement or revision
Cushing's Triad: - A (mannitol IV stat) - B (Cheyne-Stokes respirations) - D (bradycardia) - G (elevated systolic BP) Hydrocephalus: - C (high pitched cry) - E (increased head circumference) - F (bulging fontanel) - H (VP shunt placement or revision)
discharge teaching related to baby's oxygenation with TOF. what statement made by the parents would require additional education A. monitor for wet diapers (not peeing causes fluid retention) B. crying and feeding causes TET spells C. educate on vaccinations D. wrong answer
D
What nursing actions are appropriate for a child with increased intracranial pressure (ICP)? A. Increase the head of the bed at least 45 degrees B. Avoid giving a stool softener C. Suction every 2 hours D. Maintain a quiet environment
D A- HOB should be elevated 15-30 degrees B- stool softener should be given if needed. Straining for BM increases ICP C- suctioning is too much stimulation and can increase ICP
A nurse is assessing a 4 month old infant who has meningitis. Which of the following manifestations should the nurse expect? A. Depressed anterior fontanel B. Constipation C. Presence of rooting reflex D. High pitched cry
D A- bulging fontanel is expected B- vomiting expected, not constipated C- rooting reflex normal till 12 months
A nurse is providing teaching to a client who has GERD and a new prescription for omeprazole. Which of the following instructions should the nurse provide? A. take NSAIDS if headaches occur B. Decrease intake of vitamin D C. Expect muscle cramps for several weeks D. Report diarrhea to provider
D (omeprazole is associated with C. diff)
what usually causes UTIs
E Coli viruses and fungi uncommon causes
where is fluid lost first when children are ill
ECF
what causes hypertonic dehydration
High protein NG feeds fluids with large amounts of solute seizures due to CNS changes insensible water loss
how quickly to give IVF to unstable patient with positive RAPID
IV bolus over 5 to 10 mins of 0.9% NS
how quickly to give IVF to stable patient with negative RAPID
IV bolus over 5 to 20 mins of 0.9% NS
causes of altered mental status- MITTEN
M- Metabolic (hypo/hyperglycemia, DKA) I- Infections (meningitis, brain abscess) T- Toxins (FAS, ingestion of drugs) T- Trauma (traumatic head injury) E- Endocrine issues (thyroid) N- Neurological/neoplasms (tumor, seizures)
pneumonic for nephrotic syndrome
NAPHROTIC N- Na decrease (hyponatremia) A- albumin decrease (hypoalbuminemia) P- proteinuria (>3.5 g/day) H- hyperlipidemia R- renal vein thrombosis O- orbital edema T- thromboembolism I- infection C- coagulability
interventions for child with diarrhea
ORAL rehydration-- 5-10 mL every 1-5 mins no high carb drinks, no caffeine, no fruit juice, no chicken soup, no BRAT diet
postmenopausal women should not be on what
Prilosec (PPIs)
what are the four defects in TOF
VSD (blood mixing from shunting) pulmonary stenosis (narrowed pulmonary valve) overriding aorta (aorta overlaps to R ventricle) right ventricular hypertrophy (increased workload of R vent from VSD)
what groups of drugs is given before chemo, radiation, or after surgery
Zofran (serotonin antagonists)