Peds Final Exam - Student Questions + Dosage Calculations

Adolescence: A nurse is assessing a child who is mildly mentally retarded. The best indication of how a mentally retarded child is progressing can be obtained by observing him: 1. At school with his teacher 2. At home with his family 3. In the clinic with his mother 4. Playing soccer with his friends

1. At school with his teacher Watching the child relate to his teacher and school work is the best indication of how he is progressing

School-age: A 7-year-old has been diagnosed as mentally retarded. Which of the parents' expectations for their child is realistic? Select all that apply. 1. Difficulty learning 2. An IQ below 70 (average ~ 100) 3. Deficits in adaptive behavior 4. Normal intellectual property

1. Difficulty learning 2. An IQ below 70 (average ~ 100) 3. Deficits in adaptive behavior Includes deficit in intellectual functioning and behavior. Child with IQ 70 or less will have difficulties learning. Child can not adopt to situations in manner consisten with children with higher IQ

Toddler: After talking with the parents of a child with Down Syndrome, the nurse should help the parents establish which goal? 1. Encouraging self-care skills in the child 2. Teaching the child something new each day 3. Encouraging more lenient behavior limits for the child 4. Achieving age-appropriate social skills

1. Encouraging self-care skills in the child The goal is to train them to be as independent as possible, focusing on developmental skills.

1. Order Ancef 200 mg IV every 4 hours for a child weighing 22 lbs. a. The recommended dose is 80 - 160 mg / kg / day b. Is the dose safe? _______ c. Ancef is provided as 1 g in 10 mL d. How many mL would you draw up? _____ e. You are to add the Ancef to 10 mL of IV fluid and infuse over 30 minutes. f. IVAC rate? ____

1. Order Ancef 200 mg IV every 4 hours for a child weighing 22 lbs. a. The recommended dose is 80 - 160 mg / kg / day b. Is the dose safe? _Yes______(Maximum safe dosage would be 1,600 mg/day) c. Ancef is provided as 1 g in 10 mL d. How many mL would you draw up? __0.2 mL___ e. You are to add the Ancef to 10 mL of IV fluid and infuse over 30 minutes. f. IVAC rate? _0.4 mL/min___

Infant: When developing a teaching plan for the parents of a child with Down syndrome, the nurse focuses on activities to increase which of the following for the parents? 1. Affection for their child 2. Responsibility for their child's welfare 3. Understanding of their child's disability 4. Confidence in their ability to care for their child

4. Confidence in their ability to care for their child When teaching the parents of a child with Down's Syndrome, activities should focus on inreasing the parents' confidence in their ability to care for the child. Parent must continue to work daily with their child.

Preschool: The nurse discusses with the parents how best to raise the IQ of their child with Down syndrome. Which of the following would be most appropriate? 1. Serving hearty, nutritious means 2. Giving vasodilator medications as prescribed 3. Letting the child play with more able children 4. Providing stimulating, nonthreatening life experiences

4. Providing stimulating, nonthreatening life experiences Nonthreatening expriences that are stimulating and interesting to the child have been observed to help raise IQ

When developing the plan of care for an infant with a cleft lip before corrective surgery is performed, which of the following should be a priority? 1. Maintaining skin integrity to minimize crying 2. Using techniques to minimize crying 3. Altering the usual method of feeding 4. Preventing the infant from putting fingers in the mouth

ANSWER: 3. Altering the usual method of feeding Rationale: Before corrective surgery for a cleft lip, the infant needs to consume formula. Methods of feeding may need to be adjusted to fit the infant's needs, because the infant with a cleft lip experiences a decreased ability to suck, which interferes with the infant's ability to compress the nipple. A rubber-tipped syringe, medicine dropper, or special feeder is used to feed the infant ensure adequate caloric intake. Problems with infection and skin integrity in the mouth are uncommon because the areas of the defect are not open areas. Although crying may cause the infant to swallow more air because of the defect, crying poses no harm to the infant. There is no need to keep the infant's fingers out of the mouth preoperatively. The fingers will not harm the defect or cause an infection.

Infant: Parents bring a 10-month-old boy born with myelomeningocele and hydrocephalus with a VP Shunt to the Emergency Department. His symptoms include vomiting, poor feeding, lethargy, and irritability. What interventions by the nurse are appropriate? SELECT ALL THAT APPLY a. Weigh the child b. Listen to bowel sounds c. Palpate the anterior fontanel d. Obtain vital signs e. Assess pitch and quality of the child's cry

Answers: A, C, D, E Rationale: Weighing the child, palpating the anterior fontanel, obtaining vital signs, and assessing the pitch and quality of the child's cry will help indicate increased ICP along with the child's symptoms of vomiting, poor feeding, lethargy, and irritability. A high-pitched cry is indicative of increased ICP.

Preschool: When teaching a preschool-age child how to perform coughing and deep-breathing exercises before corrective surgery for TOF, which of the following teaching and learning principles should the nurse address first? A. Organizing information to be taught in a logical sequence B. Arranging to use actual equipment for demonstrations C. Building the teaching on the child's current level of knowledge D. Presenting the information in order from simplest to most complex

B. Arranging to use actual equipment for demonstrations Preschoolers are visual learners and allowing them to familiarize themselves with medical equipment will help relieve some anxiety.

Toddler: When developing the plan of care for a child with cystic fibrosis (CF) who is scheduled to receive postural drainage, the nurse should anticipate performing postural drainage at which of the following times? A. After meals B. Before meals C. After rest periods D. Before inhalation treatments

B. Before meals Rationale: Postural drainage for the CF patient is best before meals because the stomach is empty and this will reduce the risk of vomiting.

Toddler: A child is diagnosed with TOF becomes upset, crying and thrashing around with a blood specimen is obtained. The child's color becomes blue and the respiratory rate increased to 44 breaths per minute. Which of the following actions should the nurse do next? A. Obtain an order for sedation for the child B. Assess for an irregular heart rate and rhythm C. Explain to the child that it will only hurt for a short time D. Place the child in a knee-to-chest position

D. Place the child in a knee-to-chest position Rationale:The child is experiencing a "tet spell" or hypoxic episode. Therefore, the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of fallot. As a result, the blood then entering the systemic circulation has higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need sedative. Once the child is in this position, the nurse may assess for an irregular heart rate and rhythm. Explaining tho the child that it will only hurt for a short time does nothing to alleviate hypoxia.

Order: Ceclor 20 mg/kg/day for Nitesh who weighs 12lbs 3oz in divided doses Q8 hours a. How much should you give? b. Ceclor is provided as 100mg/2mL c. How many mL would you give?

Give 36.86mg per dose 12lbs 3oz is equal to 5.53kg 20 x 5.53 = 110.6 110.6/3 = 36.86 Ceclor is provided as 100mg/2mL 2/100 = 0.02mL per mg How many mL would you give? 2.2mL per day 110.6 x 0.02 = 2.2 0.73mL Q8 hours 2.2/3 = 0.73

Order: Cefadyl 5 mg qid IM for a child weighing 44 lb. a. The drug book recommends 1-3 mg / kg/ day. b. Is this order safe? _________________

Order: Cefadyl 5 mg qid IM for a child weighing 44 lb. a. The drug book recommends 1-3 mg / kg/ day. b. Is this order safe? _________________ 1st step is to convert pounds to kilograms 44/2.2=20kg Calculate the order 5mg X4(amount of times given daily)= 20 mg daily The drug book allows 1mg X 20 = 20mg daily to 3mg X 20 =60 mg  This order is safe: Yes the order is safe the child can receive between 20-60mg daily.

Order: Tylenol suspension ½ tsp po every 4 hours as needed for fever for a child weighing 32 lb. a. Tylenol is supplied as 325 mg / 10 mL b. Recommended dose is 25 - 35 mg / kg / day q4h prn c. How many mg of Tylenol in a ½ teaspoon? ____ d. Is this a safe dose? ____

Order: Tylenol suspension ½ tsp po every 4 hours as needed for fever for a child weighing 32 lb. a. Tylenol is supplied as 325 mg / 10 mL 1 tsp = 5 ml 10mL = 2.5 mL = 812.5 = 81.25 mg x Q4 (6) = 487.5 325 mg x mg 10 b. Recommended dose is 25 - 35 mg / kg / day q4h prn 32 lb = 14.5 kg 25 x 14.5 = 362.5 mg; 35 x 14.5 = 507.5 mg 2.2 c. How many mg of Tylenol in a ½ teaspoon? 81.25 mg d. Is this a safe dose? YES

1. Order: Claforan IM q8h for a child weighing 8 kg. a. The drug guide recommends Claforan 100 mg / kg/ day as a safe dose. Is this a safe dose?______ b. What is the dose? c. Claforan is provided as 250 mg / 5 mL d. How many mL would you give?____

1. Order: Claforan IM q8h for a child weighing 8 kg. a. The drug guide recommends Claforan 100 mg / kg/ day as a safe dose. 100 x 8= 800 /3= 266.6 or 267 ( if rounded) b. Give 267 mg per dose. c. Claforan is provided as 250 mg / 5 mL 250mg 267mg 5ml ?ml 267/250 x 5= 5.34 or 5.3 ml d. How many mL would you give? _5.34 or 5.3ml_______

School-age: After surgery to correct TOF, the child's parents express concern to the nurses that their 6 year-old child wants to be held more frequently than usual. The nurse recommends: A. Introducing a new skill B. Play therapy C. Encouraging the behavior D. Having the volunteer hold the child

A. Introducing a new skill Rationale: School aged children are in the phase of "Industry vs. Inferiority" and feel a need to feel accomplished in something. After surgery, Suzanna may feel different from the other children and seek comfort in her parents. Her self-esteem will likely be heightened if she feels accomplished and has something she feels proud of to occupy her time and thought.

School- age: A school-age child with CF asks the nurse what sports she can become involved in as she becomes older. Which of the following activities would be appropriate for the nurse to suggest? A. Swimming B. Track C. Baseball D. Javelin throwing

A. Swimming Rationale: The best answer is swimming because it coordinates breathing and movement of all muscle groups and can be done on an individual basis or on a team. Track events, baseball and javelin throwing usually are performed outdoors; the child would be breathing in large amounts of dust and dirt, which would be irritating to her mucous membranes and pulmonary system. The activities that expose the child to dust and heat would play a role in placing the child at risk for an upper respiratory tract infection and compromising her respiratory function.

On the second postoperative day after repair of a cleft palate, which of the following should the nurse use to feed a toddler? 1. Cup 2. Straw 3. Rubber-tipped syringe 4. Large-holed nipple

ANSWER: 1. Cup Rationale: Prevention of sucking will help to protect suture line trauma. Straws should definitely be avoided, because they could rub along the suture line. A rubber-tipped syringe or large holed bottle is more likely used for an infant.

Your 15-year old son was born with a bilateral cleft lip and palate and while sitting at the dinner table tells you he is regularly teased and shunned by other kids at school because of the way he looks. You are a pediatric nurse and know that which one of the following is most important to someone at his stage of development. 1. Peer acceptance 2. Teacher acceptance 3. Sibling acceptance 4. Parental acceptance

ANSWER: 1. Peer acceptance At this stage of development, peers and peer acceptance are extremely important. Peer relationships develop into support systems and best friend relationships. Peers provide a sense of belonging and feeling of strength and power. Peers also form a transitional world between dependence and autonomy.

Infant: A 9-month-old child with cystic fibrosis does not like taking pancreatic enzyme supplement with meals and snacks. The mother does not like to force the child to take the supplement. The most important reason for the child to take the pancreatic enzyme supplement with meals and snacks is: A. The child will become dehydrated if the supplement is not taken with meals and snacks B. The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins. C. The child needs the pancreatic enzymes to aid in liquefying mucus to keep the lungs clear D. The child will experience severe diarrhea if the supplement is not taken as prescribed

B. The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins. Rationale: CF patients have pancreatic fibrosis, which causes blockage of the pancreatic ducts, thus pancreatic enzymes cannot reach the duodenum. Thus, these enzymes must be added with their meals to facilitate proper digestion and absorption of nutrients.

Adolescence: A client's diagnosis of CF was made 13 years ago, and he has since been hospitalized several times. On the latest admission, the client has labored respirations, fatigue, malnutrition, and failure to thrive. Which nursing actions are most important initially? A. Placing the client on bed rest and ordering a blood gas analysis B. Ordering a high-calorie, high-protein, low fat, vitamin-enriched diet and pancreatic granules C. Applying an oximeter and initiating respiratory therapy D. Inserting an I.V. line and initiating antibiotic therapy

C. Applying an oximeter and initiating respiratory therapy Rationale: A pulse oximetry is used for a variety of situations in which quick assessments of a child's respiratory status are needed. Children who present with the following signs and symptoms will benefit from pulse oximetry: increased work of breathing, wheezing, coughing and cyanosis.

Toddler: A 2-year-old with hydrocephalus is scheduled to have a VP Shunt in the right side of the head. When developing the child's postoperative plan of care, the nurse should place the preschooler in which of the following positions after surgery? a. On the right side, with the foot of the bed elevated b. On the left side, with the head of the bed elevated c. Prone, with the head of the bed elevated d. Supine with the head of the bed flat

d. Supine with the head of the bed flat Rationale: The child is placed in the supine position with the head of the bed flat to avoid complications resulting from too-rapid reduction of CSF

Infant: Discharge teaching for a 3-month-old infant with a cardiac defect who is to receive digoxin should include which of the following? Select all that apply 1. Give the medication at regular interval 2. Mix the medication with a small volume of breast milk or formula 3. Repeat the dose one time if the child vomits immediately after administration 4. Notify the primary care provider of poor feeding or vomiting 5. Make up any missed doses as soon as realized 6. Notify the primary care provider if more than 2 consecutive doses are missed 7. Keep medication in a safe place, preferably a locked cabinet 8. Induce vomiting if there is an accidental overdose

1. Give the medication at regular interval 4. Notify the primary care provider of poor feeding or vomiting 6. Notify the primary care provider if more than 2 consecutive doses are missed 7. Keep medication in a safe place, preferably a locked cabinet Rationale: The correct amount of digoxin should be administered at regularly scheduled times to maintain therapeutic blood levels. If the infant has teeth, the dose should be followed by water to prevent tooth decay. Vomiting and sight alteration are signs of digoxin toxicity. If the infant vomits after the dose it should not be re-administered because there is no way to know if the infant received any of the medication.

A 11-year-old girl tells the nurse she is constantly being teased by kids at her school about the appearance of her lip. She further explains that she doesn't feel good about her appearance when she looks in the mirror. The nurse knows that the girl had a cleft lip and palate repair when she was a baby. Based on the girl's statements, the nurse knows that this teasing has resulted in which of the following 1. Thoughts of suicide 2. Signs of regression 3. Impaired body image 4. Bullying

ANSWER: 3 Rationale: During the rehabilitation of individuals with cleft lip palate most children become very aware of the differences between themselves and other children. With good support from parents/family and trained psychiatric intervention many children are able to develop a healthy body image, but if that support is not there and/or if a child's self esteem is low then teasing or bullying will be able to affect how they see themselves. *it can be difficult for children with no health issues to maintain a healthy body image*

The parents of a 3-year-old child tell the nurse they believe their child is exhibiting signs of hearing loss since the repair of the cleft palate 12 months ago. The nurse knows that the child's hearing loss is likely the result of 1. damage caused during the cleft palate surgery 2. child not wanting to respond to her parents 3. numerous ear infections related to the cleft palate 4. child being distracted

ANSWER: 3 Rationale: Children with a cleft palate experience more ear infections compared to children born without any problems. Fluid accumulation leads to the development of infections because the middle ear space is not adequately ventilated due to the muscles of the soft palate not being able to work properly and open the tube for ventilation to occur. Even after the palate is repaired it can still have impaired functioning and these patients will continue to have recurrent ear infections even into their adult life. Fluid accumulation in the ears can lead to hearing loss and possible verve-type hearing loss, but most of the hearing loss related to fluid accumulation is temporary. Medication therapy and/or the placement of tubes in the middle ear can help resolve this problem.

Preschool: When developing a recreational therapy plan of care for a 3-year-old child hospitalized with pneumonia and cystic fibrosis, which of the following toys would be appropriate? A. 100 piece jigsaw puzzle B. Child's favorite doll C. Fuzzy stuffed animal D. Scissors, paper, and paste

B. Child's favorite doll Rationale: The child's favorite doll is an appropriate choice for a toy. The doll provides support and is familiar to the child. Although a 3-year-old may enjoy puzzles, a 100-piece jigsaw puzzle would be too complicated for an ill 3-year-old child. Because of the child's lung and respiratory issues, a fuzzy stuffed animal would not be an appropriate choice because of its potential as a reservoir for dust and bacteria, which could possibly predispose the child to additional respiratory problems. Scissors, paper, and paste are not appropriate for a 3-year-old unless the child is supervised closely.

Adolescence: As part of the preoperative teaching for the family of a child undergoing a TOF repair, the nurses tells the family upon returning to the pediatric floor that the child may: A. Be placed on a reduced sodium diet B. Have an activity restriction for several days C. Be assigned to an isolation room D. Have visits limited to a select few

B. Have an activity restriction for several days Rationale: Limiting activity and limiting the workload and strain on the heart is the number one priority right after surgery.

School-Age: A nurse evaluates discharge teaching as successful when the parents of a school-age child with a VP Shunt insertion identify which sign as signaling a blocked shunt? SELECT ALL THAT APPLY a. Decreased urine output with stable intake b. Tense fontanel and increased head circumference c. Elevated temperature and reddened incisional site d. Irritability and increasing difficulty with eating

b. Tense fontanel and increased head circumference d. Irritability and increasing difficulty with eating Rationale: A tense fontanel and increased head circumference indicate increased fluid within the skull. Irritability and increasing difficulty with eating indicate an increased ICP. Both indicate a blockage within the shunt system.

Preschool: A Preschooler with a history of repaired lumbar myelomeningocele is in the Emergency Department with wheezing and skin rash. Which of the following questions should the nurse ask the mother first? a. "Is your child taking any medications?" b. "Who brought your child to the Emergency Department?" c. "Is your child allergic to bananas or milk?" d. "What are you doing to treat your child's skin rash?"

c. "Is your child allergic to bananas or milk?" Rationale: Kids with myelomeningocele are at higher risk for development of allergies to latex because they are so often exposed to it during surgeries and frequent catheterizations. Cross reactions, such as allergies to kiwi, milk products, bananas, chestnuts and avocados are also common.

School-Age: Which action should the nurse take when providing postoperative nursing care to a child after insertion of a VP Shunt? a. Administer narcotics for pain control b. Check urine for glucose and protein c. Monitoring for increased temperature d. Test CSF leakage for protein

c. Monitoring for increased temperature Rationale: The major concern for a post-operative patient who has received a shunt is infection with temperature being a priority assessment