Peds Exam 2

Foods that need to be removed from the diet of the patient with celiac disease:

gluten needs to be removed, gluten is found in wheat, oats, barley, and rye pg 1212

The first immunization a newborn receives -

hepatitis b pg 1190

Increasing intracranial pressure-

increasing irritability, bulging fontanels, and changes in eye signs or LOC. pg. 1211

The nurse is caring for a 10 yr old girl with burns covering two-thirds of her body caused by a home fire. Which chief nursing concerns in threatening this client? SATA

A. Combating shock C. Alleviating pain F.Restoration of fluid and electrolyte balance

Which food items selected by a child with celiac disease would cause the nurse to intervene? SATA

A: corn flakes cereal, skim milk, and a banana B: a bologna, lettuce, and tomato sandwich C: slice of cheese, sausage, and vegetable pizza

The nurse planning a seminar on safety for the preschooler will focus on what aspect(s)? SATA pg 115

A: poisonings B: burns C: falls D: abductions E: vehicles and pedestrians

A 15 month old has just received routine immunizations, including DTaP, IVP, and MMR. What information should the nurse give to the parents before they leave the office? SATA

"Minor symptoms can be treated with acetaminophen." "Call the office if the toddler develops a fever above 103 *F, seizures, or difficulty breathing." "Soreness at the immunization site and mild fever are common."

A mother whose infant is diagnosed with failure to thrive (FTT) asks the nurse what causes this condition and how it is treated. What is the nurse's best response?

"Most often, FTT has a psychosocial rather than congenital physical cause."

A nurse is reinforcing education on preventing injuries with the parents of a toddler. Which instructions are appropriate for the nurse to give the parents? SATA

"Place locks on cabinets containing toxic substances." "Never allow a toddler to be near water at any time without adult supervision."

Causes of Reye Syndrome:

the condition is rare and its etiology is unknown but may be associated with inherited metabolic disorders, and also be an underlying metabolic condition that is unmasked with exposure to certain toxins such as insecticides, herbicides, or paint thinners pg 1208

Foods that should be avoided for a patient with PKU and what foods are acceptable:

they need a diet very low in phenylalanine, an essential amino acid necessary for growth and repair of body cells - foods avoid: most breads, eggs, meat, milk, cheese, legumes, nuts, and some artificial sweeteners pg 1212

Precautions for RSV -

transmission based precautions pg 1194

How is Hepatitis A contracted:

transmission is by ingestion or microscopic amounts of fecal matter, close person-to-person contact, or ingestion of contaminated food or drinks pg 1194

Preventing the spread of pediculosis:

treat entire family, and wash all clothes, bedding, and stuffed animals immediately pg 1197

When and how to treat pediculosis:

treat when you first see the lice in the hair, treat with over the counter pediculicides, generally scalps and bodies need at least two separate treatments pg 1197

1. The nurse is preparing to administer immunizations to an infant. The parent states, "Won't those vaccinations give my child autism?" What is the best response by the nurse?

"Recent research shows no connection between vaccines and autism."

A nurse is interacting with a new mother, whose infant is 6 weeks old. The mother appears exhausted and anxious. Which of the following statements by the mother most indicates a potential risk for maltreatment of the child?

"She cries all the time. I don't know what to do with her. She's just a bad baby, I guess."

A child who had bacterial meningitis is scheduled to have his hearing tested before discharge. The parents ask the nurse why this test is necessary. Which response by the nurse is appropriate?

"Some children with bacterial meningitis suffer damage to the nerve responsible for hearing; this test screens for hearing loss."

3. A parent of a newborn asks the nurse, "When should I start introducing solid foods into my child's diet?" What is the best response by the nurse?

"When your child is about 4 to 6 months old."

The nurse clarifies to the parents of a 4 yr old child recovering from rheumatic fever that the child will need to receive monthly injections of penicillin G for a minimum of ___ years.

5

The mother of a newborn asked the nurse, "When will my baby get the hepatitis B vaccine?" The nurse bases a response on the knowledge that the first dose of Comvax should be given to infants born to a hepatitis B-positive mother within ___ after birth.

12 hours

A parent is concerned because her son was exposed to varicella at preschool. The nurse would tell this parent that the incubation period for varicella is _____ days?

14-21 days

When to test a baby for PKU-

A blood test obtained by a heel stick after the newborn has consumed formula or breast milk for at least 2 days detects PKU pg 1212

One reason that infants are more vulnerable to fluid and electrolyte imbalances than adults is that:

A greater percentage of body weight in infants is extracellular.

A 5-year-old arrives in the clinic for a physical to enter school. Which potential child abuse findings should be brought to the health care provider's attention? Select all that apply

A patterned bruise is noted on the back Parental description of accident does not match injury. Injuries in various stages of healing are documented

4. A child is diagnosed with chicken pox. What medication should the nurse inform the parents to avoid when treating the fever?

Aspirin

A nurse would base a response to a parent about how his child got hepatitis A on the information that the child:

Ate shrimp while they were in Mexico.

The nurse is reinforcing teaching related to treatment of pediculosis with the parent of a toddler. What should the nurse include in the teaching? SATA

All household members should be treated. Items used by an infested person can be machine washed with cold water. Items used by the toddler, such as combs, should not be shared.

A nurse is caring for a 3-year-old with viral meningitis. Which signs and symptoms does the nurse anticipate finding when gathering data? SATA

B: Fever C: Nuchal rigidity D: Irritability E: Photophobia

Possible causes of SUID and SIDS -

Causes of SUIDS may include metabolic disorders, poisonings, hypothermia, hyperthermia, neglect, abuse, and accidental suffocation, or can remain unknown. SIDS is unknown, one theory suggests that an abnormality in brain-stem functioning results in faulty respirations. Sleeping in a prone position has a strong connection to SIDS. Additional causes may include incomplete bubbling after feeding, secondhand smoke, and the use of a pillow. Small-for-gestational-age (SGA) infants are at a greater risk. Pg 1200

An infant is hospitalized for RSV bronchitis. Which type of precautions would the nurse use when caring for the infant?

Contact precautions

Which diagnostic finding supports a diagnosis of rheumatic fever?

Elevated erythrocyte sedimentation rate (ESR)

A 1-year-old infant is hospitalized with a diagnosis of eczema. Which signs and symptoms does the nurse expect to observe?

Exudative, crusty, papulovesicular, erythematous lesions on the cheeks, scalp, forehead, and arms.

A 6-year-old child with a history of varicella and aspirin intake is brought to the emergency department. The nurse suspects Reye's syndrome. Which data collection findings are consistent with this syndrome?

Fever, decreased level of consciousness (LOC), and impaired liver function

First development of the varicella rash-

Following or concurrent with a rash, a fever develops. The itchy rash develops first into papules then vesicles and finally pustules that turn into crust-like lesions that fall off in 1 to 3 weeks. A highly infectious disease, the chickenpox virus is found in the nose, throat, blisters, and crusts. Pg 1194

Issues that result from meningococcal infections -

hydrocephalus, learning disabilities, seizure disorders, and deafness 1208

Nursing considerations for the patient with developmental dysplasia-

Handle the child carefully, but pick him or her up to encourage normal social development. Protect the pillow splint or cast from soiling and wetting. Cover the perineal area with moisture-proof protection. Pg 1207

2. A child is found to be asymptomatic but tests positive as a carrier for diphtheria. What action does the nurse anticipate providing?

Informing the parents about the importance of adhering to prophylactic antibiotics

How red measles are transmitted -

It is transmitted through direct contact with an affected individual and through airborne droplets pg 1193

Initial intervention for the patient with bacterial meningitis-

Meningococcal immunizations are designed to protect individuals directly against specific forms of meningitis. Neisseria meningitides and Streptococcus pneumoniae are bacterial forms of meningitis for which there is a specific vaccine. Pg 1194 (get children vaccinated

A 16-month-old with a history of hydrocephalus is admitted with an infected ventriculoperitoneal shunt. Which assessment takes priority in this toddler?

Monitor for signs of increased intracranial pressure.

Allergies for the person with Spina Bifida:

NURSING ALERT: for some reason children with spina bifida tend to be extremely sensitive to latex pg 1210

Developmental Dysplasia-

One or both hips may be improperly located in the ball and socket joints; the head of the femur may be displaced, or the acetabulum may develop improperly. These conditions are known as dysplasia, causing hip dislocation pg. 1207

The nurse caring for a client with meningitis knows that the signs and symptoms of meningitis usually appear abruptly. Which of the following are signs of this condition? SATA

Photophobia Nuchal rigidity Change in LOC Opisthotonos

5. The nurse is caring for a child preoperatively with Wilms tumor. When following the plan of care for this child, what intervention is essential?

Place a clear warning sign over the bed

The nurse is planning to teach parents about preventing sudden infant death syndrome (SIDS). Significant information would include:

Placing infants on their backs or sides for sleep.

A 6-month-old infant is admitted with suspected bacterial meningitis. Which of the following interventions should the nurse take initially?

Placing the infant in isolation.

Poison prevention

Post the local poison control center number (1-800-222-1222) on all telephones in the house. • Label all poisonous chemicals with warning labels and store them in locked cabinets. • Keep medications and poisonous materials in their original containers. Never put any poisonous substance in a soda or drink container. • Use childproof caps whenever possible. Always close them properly. • Teach children the dangers of poisonous materials and medications. Keep medications in a locked cabinet. • Keep edibles in separate cabinets from inedibles. • Never leave children alone when poisonous materials are nearby. • Never treat medicines and vitamins as though they are candy. Do not purchase medicines resembling candy, animals, people, or cartoon characters. • Read product labels carefully and follow precautions. Never give medications in the dark. • Dispose of poisonous materials and medications carefully. Follow current guidelines for disposing of medications, which currently involve taking them to a designated drop-off. Do not throw them in the trash or flush them down the toilet. • Never smoke around children. Keep all fresh or used smoking materials, including ashtrays and butts, away from children. • Watch children when visiting relatives and friends. A new setting is frequently an invitation for children to explore. • Remain calm in an emergency. Dial the emergency number, give all information, and follow directions. • Take the container of the medicine or poison to the Emergency Department with you. If you are uncertain what was ingested, list all possible substances.

The nurse is caring for a 6 yr old boy diagnosed with the mumps. Which teaching point would be appropriate for the parents of this child?

Protect your other children from close contact with your son.

A nurse is teaching new parents about the causes of sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) and interventions to help prevent these deaths. Which information about SUID and SIDS is accurate? SATA

SUID can be caused by metabolic disorders. SIDS has been linked to sleeping in a prone position. One theory links SIDS to malfunctioning brain stem causing faulty respirations.

The nurse is assisting a child who has a malformation in which a part of the vertebral or spinal column is open or missing. The nurse recognizes this condition as which of the following?

Spina bifida

Hydrocephalus-

Spinal fluid, which circulates constantly, encloses the CNS. If this circulation is disrupted, spinal fluid collects, causing head swelling and brain damage pg. 1210

The nurse cautions parents to place their infants in the __________position to reduce the risk of sudden infant death syndrome (SIDS).

Supine

Febrile seizures priority intervention-

aimed at controlling fever with antipyretics (acetaminophen, ibuprofen), tepid sponge baths, or other measures. Medications also may include lorazepam (Ativan) or phenobarbital. Pg. 1211

When gathering data on a preschool-age child, the nurse finds multiple contusions over the body. Which statement indicates the findings that should be documented?

all lesions, including location, shape, and color, should be documented

Cause of Spina Bifida and how to help prevent it:

amniocentesis is used to check the amniotic fluid for a-fetoprotein, which if present, indicates an abnormality, folic acid taken during pregnancy helps to prevent spina bifida pg 1209

Pertussis transmission, complications and symptoms. -

Transmitted through direct contact or droplets. Symptoms - Severe cough, runny nose and apnea. Complications- Death, pneumonia. Pg 1191 (vaccine preventable diseases picture)

Reye's Syndrome-

an acute and potentially fatal childhood disease that causes swelling in the liver and brain. 3 to 5 days after the onset of a viral illness, such as a URI (a cold), influenza (the flu), or varicella (chickenpox). Pg 1208

A nurse is collecting data on a neonatal born 3 hours ago. Which finding would lead the nurse to suspect that the neonate may have developmental dysplasia of the hip?

Unequal gluteal folds

Physical abuse-

Unexplained bruises in various stages of healing, cigarette burns, scars, and numerous unexplained fractures that have healed are common indicators. Pg 1202

A child of European descent is diagnosed with celiac disease. What food should the parents be instructed to remove from their child's diet?

Whole wheat bread

Symptom of Meningitis, Nuchal rigidity - term:

symptoms include fever and nuchal rigidity, which is a stiff neck or neck stiffness pg 1209

A nurse is preparing to perform phenylketonuria (PKU) testing. Which baby is ready for the nurse to test?

a 2-day-old baby who has been breast-fed

Common causes of Developmental Dysplasia:

a family history of DDH in a parent or other close relative. gender — girls are two to four times more likely to have the condition. first-born babies, whose fit in the uterus is tighter than in later babies. breech position during pregnancy. tight swaddling with legs extended. This condition occurs more frequently in girls; it is uncommon among African Americans; and it occurs most often on one side only. It is common in breech intrauterine position, especially frank breech, and in multiple births. pg 1207

Spina Bifida - term:

a malformation in which a part of the vertebral or spinal column (usually the lower spine) is open or missing pg 1209

Eczema-

a severe atopic dermatitis, is characterized by remissions and exacerbations accompanied by vesicle formation, oozing, crusting, excoriations, and itching. Usually beginning on the cheeks, it may move to other parts of the body and usually decreases as the child ages. It appears to worsen in cold weather and tends to run in families. Pg. 1206

Chief nursing concerns in treating burns-

are combating shock, alleviating pain, and restoring fluid and electrolyte balance. Secondary interventions include the prevention of infection and contractures, and the reconstruction or repair of damage. Children who have been severely burned are best cared for in a specialized burn unit pg. 1198

Characteristics of Koplik spots:

bluish-white pinpoint spots with a red rim, found in the mouth of a person with rubeola on day 2 or 3 pg 1193

Drownings

can occur in any body of water. Keep small buckets of any fluid away from young children. Never allow children to swim alone. Constant vigilance is the key component to safety. Key concept pg 1200

Preventing the transmission of mumps -

direct and indirect contact and through salivary secretions. Pg 1193

Types of causes that contribute to failure to thrive:

familial causes: like early separation of mother and infant, major depression or mental illness of prominent caregiver early in life, serious illness of the infant - infant-related causes: prematurity, congenital malformation, malabsorption disorders pg 1206

Viral meningitis-

fever and nuchal rigidity (neck stiffness) pg 1208

The parents of a neonate diagnosed with clubfoot ask the nurse to explain talipes varus. The nurse would describe this as which condition?

inversion of the foot

Characteristics of Mongolian Spots:

irregular dark, blue-green areas generally found on the lower back, they have regular edges, almost always found in Asian infants and are frequently found in Mediterranean and African infants, usually disappear between 2-3 yrs old pg 1206

The mother of a preschooler with spina bifida tells the nurse that her daughter sneezes and gets a rash when playing with brightly colored balloons and that recently she had an allergic reaction after eating kiwifruit and bananas. The nurse would suspect that the child may have an allergy to which of the following?

latex

What are scabies -

microscopic mites that are easily transmitted among children and adults of all socioeconomic classes. The mite burrows into the epidermis where it lives and lays its eggs. Pg 1197

What to monitor with ventriculoperitoneal shunts-

observe carefully for any signs of increasing intracranial pressure, such as increasing irritability, bulging fontanels, and changes in eye signs or LOC. pg 1211

Pertussis-

or "whooping cough" is a highly contagious bacterial respiratory disease occuring most commonly in young children who have not been immunized, transmitted through direct contact and through droplets, children need close supervision because of respiratory difficulties and nutritional problems pg 1192

A child with Reye syndrome is exhibiting signs of increased intracranial pressure (ICP). Which nursing intervention would be most appropriate for this child?

position the child with the head elevated and the neck in a neutral position

Length of time to be on prophylactic antibiotics after having rheumatic fever -

prophylactic antibiotic medication may be prescribed for up to 5 years 1196

Failure to thrive-

retarded motor development, inadequate social response, and delayed language development. FTT children are withdrawn and apathetic, do not relate to their environment, and do not cry pg. 1205

Scarlet Fever-

sometimes referred to as scarlatina, is also GABHS but more often considered another type of strep infection. Symptoms develop after an incubation period of 1 to 7 days; they include the appearance of a generalized flush or redness caused by a sandpaper-like rash of pinpoint-like red spots crowded together (macular rash). Desquamation follows. The tongue becomes coated with a white substance that later disappears, leaving prominent papillae ("strawberry tongue"). Pg 1159

The best position for an infant to sleep in to prevent SIDS -

supine or on the side

Preventing injuries (trauma) in toddlers -

• Cut children's food into small pieces. • Teach children to eat slowly. • Teach children not to laugh and talk when they have food in their mouth. • Serve foods appropriate to a child's age. Avoid serving nuts, popcorn, chewing gum, hard candy, raisins, carrot sticks, and hot dogs to children younger than 4 years of age. • Keep small objects, such as coins, marbles, beads, and small toy pieces, away from children younger than 4 years of age. • Store small household items, such as pins, buttons, toothpicks, nails, screws, and thumbtacks, away from children's reach. Monitor children when they are in an area where such items are being used. Pg 1197 educating the client 72-1

Diagnostic results that may indicate rheumatic fever-

• Elevated white blood cell (WBC) count • Elevated erythrocyte sedimentation rate (ESR), commonly known as "sed rate" • Positive C-reactive protein (CRP) • Elevated antistreptolysin-O (ASO) titer pg 1195

Sexual abuse-

• Sudden behavioral changes • Abdominal pain, gastric distress, or headaches • Emotional disturbances • Avoidance of touching or physical contact • Vaginal or rectal bleeding or lesions pg 1206