peds exam part 2
which sign should lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation? a. hemorrhagic skin rash b. edema c. cyanosis d. dyspnea on exertion
1. DIC is characterized by skin petechiae and a purpuric skin rash caused by spontaneous bleeding into the tissues
a child with meningitis is to receive 1000mL of dextrose 5% in NS over 12 hours. at what in mL per hour should the nurse set the pump?
83mL/hr
nursing care management of the child with bacterial meningitis includes which interventions? select all that apply: a. administration of IV antibiotics b. IV fluids at 1.5x maintenance c. decreasing environmental stimuli d. neurologic checks every 4 hours e administration of IV anticonvulsants
a,c,d abx are indicated for the treatment of bacterial meningitis. frequent checks can help monitor for changing level of consciousness.
the nurse is monitoring an infant with meningitis for signs of increased ICP. the nurse should assess the infant for which signs or symptoms? select all that apply a. irritability b. headache c. mood swings d. bulging fontanelles e. emesis
a,d,e irritability, bulging fontanelle, and emesis are all signs of an increased ICP in an infant.
the emergency department nurse has admitted an infant with bulging fontanelles, setting sun eyes, and lethargy. which diagnostic procedure would be contraindicated in this infant a. lumbar puncture b. magnetic resonance imaging c. arterial blood draw d. computerized tomography scan
a. the child is exhibiting signs and symptoms of increased ICP. A lumbar puncture is contraindicated in children with increased ICP due to risk of herniation.
A history of which factors will complicate the recovery from a concussion? Select all that apply. -Asthma -Previous concussion - Migraines - Attention deficit/hyperactivity disorder (ADHD) -Depression -obesity
b,c,d,e concussion recovery can be complicated by any previous brain injury or other neurologic problem
a 7-year old with a history of tonic clonic seizures has been actively seizing for 10 minutes. the child weighs 22 kg and currently has an IV of D5 NS + 20mEq KCl/L running at 60mL/h. the vital signs are temperature 100.4, pulse 120, rr 28, and SPO2 92%. using SBAR technique for communication, the nurse calls the HCP with the recommendation for: a. rectal diazepam b. IV lorazepam C. rectal acetaminophen d. IV fosphenytoin
b. IV lorazepam is the benzodiazepine of choice for treating prolonged seizure activity.
during assessment of an adolescent who has sustained a recent thoracic spinal injury. the nurse auscultates the adolescent's abdomen. the nurse explains to the parents that this is necessary because clients with spinal cord injury often develop which problem? a. abdominal cramping b. hyperactive bowel sounds c. paralytic ileus d. profuse diarrhea
c. a thoracic spinal cord injury involves the lower extremities, bladder, and rectum. Paralytic ileus often occurs as a result of decreased gastrointestinal muscle innervation
the parents of a child in a coma with serious head injury ask the nurse if the child is going to be alright. which response by the nurse would be most appropriate? a. children usually do not do very well after head injuries like this. b. children usually recover rapidly from head injuries c. it is hard to tell this early, but we will keep you informed of the progress d. that is something you will have to talk to the healthcare provider about
c. as a rule, children demonstrate more rapid and more complete recovery from coma than do adults. however, it is extremely difficult to predict a specific outcome.
which statement obtained from the nursing history of a toddler should alert the nurse to suspect that the child has had a febrile seizure? a. the child has had a low-grade fever for several weeks b. the family history is negative for convulsions c. the seizure resulted in respiratory arrest d. the seizure occurred when the child had a respiratory infection
d. most febrile seizures occur in the presence of an upper respiratory infection, otitis media, or tonsillitis
A nurse manager on a pediatric floor is updating safety recommendations for the unit. which strategy would help reduce pediatric medication errors? select all that apply: a. eliminate the pediatric satellite pharmacy b. increase the number of steps in the medication administration procedure c. avoid using parenteral syringes when administering liquid oral medications d. limit the size of IV fluid bags that can be hung on small children e. reduce the available concentrations or dose strengths of high-alert medications to the minimum
CDE using only oral syringes to administer oral medications reduces the chance that the medication will be given IV. Using smaller IV bags can prevent fluid overload. When multiple concentrations and doses are available for a medication it increases risk of error.
when making rounds on the pediatric neurology unit, the nurse manager notes that when giving IV medications, many of the staff nurses are disconnecting the flush syringe first and then clamping the intermittent infusion device. the nurse is concerned that the nurses do not understand the benefits of positive pressure techniques and turbulence flow flush in preventing clots. after discussing the problem with the staff educator, which intervention would be the most effective way to improve the nursing practice? a. create a poster presentation on the topic with a required posttest b. send a group email discussing the importance of clamping the device first c. ask each nurse if he or she is aware that his or her practice is not current d. post an evidence-based article on the unit
a. a poster presentation is an eye-catching way to disseminate information that can be used to educate nurses on all shifts
a parent of a child with a moderate head injury asks the nurse, "how will you know if my child is getting worse?" the nurse should tell the parents that the best indicator of a child's brain function is a. vital signs b. level of consciusness c. reactions of the pupils d. motor strength
b. the level of consciousness is the best indicator of brain function. the other answers typically follow the changes in LOC
the HCP provides carbamazepine extended release for a client with a cerebral palsy who also has a seizure disorder. the client has a gastrostomy feeding tube and carbamazepine is on the hospital's "no crush" list. in order to administer the medication, the nurse should: a. cut the medication into four pieces that can be placed in the feeding tube b. dissolve the medication in 30mL of juice c. ask the pharmacist for an oral suspension d. contact the HCP to change the prescription
d. the coating on an extended-release medication helps assure slow absorption of the medication. If the nurse crushes the medication, the medication may enter the client's system too quickly and result in toxic levels.
the nurse teaches an adolescent about returning to school after a concussion. which statement by the client reflects the need for more teaching? a. i should limit my activities that require concentration b. i must slowly return to my previous activity level as my symptoms improve c. my symptom may reemerge with exertion d. time is the most important factor in my recovery
d. while recovery from a concussion takes time, adequate rest, and limiting exertion facilitates recovery.
the nurse is admitting a child who has been diagnosed with bacterial meningitis to the pediatric unit. the nurse should implement which type of isolation? a. standard or routine precautions b. contact precautions c. airborne precautions d. droplet precautions
D. bacterial meningitis is caused by one of three organisms, all of which may be transmitted through contact with respiratory droplets.
a 10-year-old with a severe head injury is unconscious and has coarse breathsounds, a temperature of 39C, a heart rate of 70, a BP of 130/60, and an ICP of 36mmHg. Which action should the nurse perform first? a. administer prescribed IV mannitol b. suction the child c. encourage the parent to talk to the child d. administer prescribed rectal acetaminophen
a. an ICP greater than 15mmHg is abnormal. Mannitol is an osmotic diuretic and will decrease the child's ICP
the parents of a child with occasional generalized seizures want to send the child to summer camp. the parents contact the nurse for advice on planning for the camping experience. which type of activity should the nurse and family decide the child should avoid? a. rock climbing b. hiking c. swimming d. tennis
a. a child who has generalized seizures should not participate in activities that are potentially hazardous.
a school age boy with a spinal cord injury is moved to the rehabilitation unit. the nurse notes that the child tends to refuse to cooperate in care and to be hostile. the nurse interprets this behavior as indicative of which response? a. a stage of grief reaction b. a phase of rebellion c. a reaction to sensory overload d. a response to too much attention
a. after a catastrophic injury, individuals commonly experience grief.
a nasogastric tube is prescribed to be inserted for a child with severe head trauma. diagnostic testing reveals that the child has a basilar skull fracture. what should the nurse do next? a. ask for the prescription to be changed to an oral gastric tubd b. attempt to place the tube in the duodenum c. test the gastric aspirate for blood d. use extra lubrication when inserting the NG tube
a. because a basilar skull fracture can involve the frontal and ethmoid bones, inserting an NG tube carries the risk of introducing the tube into the cranial cavity through the fracture.
an adolescent sustains a T3 spinal cord injury. after insertion of an IV line, an NG tube, and a foley catheter, the adolescent is admitted to the ICU. what should the nurse do next when assessment reveals that the adolescent's feet and legs are cool to the touch a. cover the adolescent's legs with blankets b. report the finding to the HCP immediately c. reposition the adolescent's legs d. lay the adolescent flat to aid circulation
a. in spinal cord injury, temperature regulation is lost below T3. Body temperature must be maintained by adjusting room temperature or bed linens.
a 3 month old infant with meningococcal meningitis has just been admitted to the pediatric unit. which nursing intervention has the highest priority? a. instituting droplet precautions b. administering acetaminophen c. obtaining history information from the parents d. orienting parents to the pediatric unit
a. instituting droplet precautions is the priority for a newly admitted infant with meningococcal meningitis
two months after an adolescent's thoracic spinal cord injury, he has a pounding headache. the nurse notes that the client's arms and face are flushed and he is diaphoretic. what should the nurse do next? a. check the patency of the urinary catheter b. lower the adolescent's head below his knees c. place the adolescent flat on his back d. prepare to administer epinephrine subcutaneously
a. the adolescent is exhibiting signs of autonomic dysreflexia, a generalized sympathetic response usually caused by bladder or bowel distention
during the acute stage of meningitis, a 3 year old child is restless and irritable. which intervention would be most appropriate to initiate? a. limiting conversation with the child b. keeping extraneous noise to a minimum c. allowing the child to play in the bathtub d. performing treatments quickly
b. a child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light.
the nurse assigned to telephone triage returns the call of a parent whose teenager experienced a hard tackle last night. the parent reports "he seemed dazed after it happened and the coach had him sit out the rest of the game, but he is fine now." what is the most appropriate instruction for the nurse to give? a. take him immediately to the emergency department b. he cannot return to play until he has been evaluated by a HCP c. if he seems fine now and had no other symptom, it probably was not a concussion d. watch him closely and call us back if you see any changes
b. appearing dazed or stunned after a head injury is a symptom of a concussion. Concussion care includes removing the athlete from play and having the injury evaluated.
the nurse is administering a nasogastric tube in a child admitted with head trauma. the nurse should explain to the parents that the NG tube will be used for what purpose? a. administer medications b. decompress the stomach c. obtain gastric specimens for analysis d. provide adequate nutrition
b. for the child with serious head trauma, a NG tube is inserted initially to decompress the stomach and to prevent vomiting and aspiration.
when interviewing the parents of a 2 year old child, a history of which illnesses should lead the nurse to suspect pneumococcal meningitis? a. bladder infection b. middle ear infection c. fractured clavicle d. septic arthritis
b. organisms that cause bacterial meningitis, such as pneumococci or meningococci, are commonly spread in the body by vascular dissemination from a middle ear infection.
What should be part of the nurse's teaching plan for a child with epilepsy being discharged on a regimen of phenytoin? a. drink plenty of fluids b. brush teeth after each meal c. have someone be with the child during waking hours d. report signs of infection
b. phenytoin can cause gingival hyperplasia. children taking phenytoin should brush their teeth after every meal and at bedtime, and visit their dentists regularly
after teaching the parents of a child with febrile seizures about methods to lower the temperature other than using medication, which statement indicates successful teaching? a. "we will add extra blankets when he says he is cold" b. "we will wrap him in a blanket if he starts shivering" c. "we will make the bath water cold enough to make him shiver" d. "we will use a solution of half alcohol and half water when sponging him"
b. shivering, the body's defense against rapid temperature decrease, results in an increase in body temperature. therefore, the parents need to take measures to stop the shivering.
a nurse, who witnesses an accident involving an adolescent being thrown from a motorcycle, stops to help. the adolescent reports that he is now unable to move his legs. while waiting for the emergency medical service to arrive, what should the nurse do? a. flex the adolescent's knees to relieve stress on his back b. leave the adolescent as he is, staying close by c. remove the adolescent's helmet as soon as possible d. assess the adolescent for abdominal trauma
b. the adolescent's signs and symptoms suggest a spinal cord injury. a client with suspected spinal cord injury should not be moved until the spine has been immobilized.
when developing the plan of care for a child who is unconscious after a serious head injury, in which position should the nurse expect to place the child? a. prone with hips and knees slightly elevated b. lying on the side with the head of the bed elevated c. lying on the back, in the trendelenburg positon d. in the semi-fowler's position, with arms at the side
b. the unconscious child is positioned to prevent aspiration of saliva and minimize intracranial pressure. the head of the bed should be elevated, and he child should be either in semi-prone or side lying
after the nurse instructs a group of school teachers about seizures, the teachers role-play a scenario involving a child experiencing a generalized tonic-clonic seizure. which action, when performed FIRST, indicates that the nurse's teaching has been successful? a. ask the other children what happened before the seizure b. move the child to the nurse's office for privacy c. remove any nearby objects that could harm the child d. place a padded tongue blade between the child's teeth
c. during a generalized tonic clonic seizure, the first priority is to keep the child safe and protect the child by removing any nearby objects that could cause injury.
the HCP pas prescribed IV mannitol for a child with a head injury. the best indicator that the drug has been effective is: a. increased urine output b. improved level of consciousness c. decreased ICP d. decreased edema
c. mannitol is an osmotic diuretic used to reduce ICP. the best indicator that the drug has worked is a reduction in ICP by improved levels of consciousness.
a nurse is developing a plan of care with the parents of a 6-year-old girl diagnosed with a seizure disorder. to promote growth and development the nurse should instruct the parents that: a. the child will need activity limitation and will be unable to perform as well as her peers b. there is a potential for a learning disability and the child may need tutoring to reach her grade level c. the child will likely have normal intelligence and be able to attend regular school d. there will be problems with social stigma and parents should consider homeschool
c. most children who develop seizures after infancy are intellectually normal. a child with a seizure disorder needs the same experiences and opportunities to develop intellectual, emotional, and social abilities as any other child.
n adolescent girl with a seizure disorder controlled with phenytoin and carbamazepine asks the nurse about getting married and having children. which response by the nurse would be most appropriate? a. "you probably should not consider having children until your seizures are cured" b. "your children will not necessarily have an increased risk of seizure disorder" c. "when you decide to have children, talk to your HCP about changing your medications" d. "women who have seizure disorders commonly have a difficult time conceiving"
c. phenytoin sodium is a known teratogenic agent, causing numerous fetal problems.
a preschooler with pneumococcal meningitis is receiving intravenous antibiotic therapy. when discontinuing the iv therapy, the nurse allows the child to apply a dressing to the area where the catheter. is removed. the nurse's rationale for doing so is based on the interpretation that a child in this age group has a need to accomplish what goal? a. trust those caring for her b. find diversional activities c. protect the image of an in tact body d. relieve anxiety on separation from home
c. preschool age children worry about having an intact body and become fearful of any threat to body integrity.
which finding should lead the nurse to decide that spinal shock was resolving in the adolescent with a spinal cord injury? a. atonic urinary bladder b. flaccid paralysis c. hyperactive reflexes d. widened pulse pressure
c. spinal shock causes a loss of reflex activity below the level of the injury. When the reflex arc returns it tends to be overactive.
a 3 year old is recovering from a concussion. the persistence of which finding would the nurse consider as being a normal finding for a 3 year old? a. lack of interest in favorite toys b. change in eating habits c. inability to hop d. increased temper tantrums
c. the inability to hop is not concerning because it is a milestone for a 4-year-old, not a 3-year old