PEDS TEST #2
The nurse is teaching about skin care for atopic dermatitis. Which statement by the parent indicates that further teaching may be necessary?
"A hot bath will soothe my child's itching when it is severe." "We should avoid using petroleum jelly." Peanut butter and jelly sandwich
The nurse is evaluating parents' understanding of atopic dermatitis. Which statement shows their understanding?
"Flare-ups of lesions are not uncommon following therapy."
The mother of a child diagnosed with erythema infectiosum (fifth disease). is crying,and says, "I am afraid. Will my unborn baby die? I have a planned cesarean section next week." Which statement would be the most therapeutic response?
"I understand you are afraid. Can we talk about your concerns?"
A 4-year-old child is hospitalized with a high fever. While the child is in bed, the child comforts himself by sucking the thumb. The mother of the child becomes concerned because her child has not sucked his thumb for 6 months. Which nursing response to the mother's concerns is most appropriate?
"This is a form of developmental regression and can be a normal response for a child who is hospitalized. Continue to love and support your child."
A new nurse asks an experienced nurse why the first dose of MMR vaccine is given only between 12-15 months of age and not any earlier. Which explanation by the experienced nurse is correct?
"if administered earlier, the vaccine will neutralize the passive immunity to measles from the child's mother and no immunity will result" - the first dose of MMR should be given 12-15 M - SECOND DOSE = 4-6 yrs
Parent education for parents of a toddler with atopic dermatitis. A mother tells the clinic nurse she has a history of eczema, what do you assess the infant for?
- Allergies and asthma - "I feel so bad for him because he has asthma, and now he gets this rash." - Allergies to cow's milk, animal dander, and nylon - Look for other types of dermatitis in baby ( it's a skin allergy), there's a genetic competent to eczema
What is an appropriate nursing intervention to provide comfort for a child itching from chickenpox?
- Give acetaminophen (Tylenol) and benadryl. - Child is contagious until all lesions are crusted over. Educate parents regarding varicella zoster immune globulin (VZIG) vaccine at well checkups. - Prevent children from scratching lesions to avoid secondary bacterial infection from developing.
Which adverse reaction to DTaP do you report to a physician?
- Non-stop crying for 3 hours, - seizures, - high fever (103) or more, -allergic reaction, - decreased LOC, - coma, -collapsed after dose, -if the patient has ever had GBS, severe pain or swelling previously from this shot.
What are you going to do for a child who has a new diagnosis of generalized contact dermatitis?
- Remove the irritant and limit further exposure (find cause and remove it). - Remove clothing over the rash, wash it with hot water, apply calamine lotion.
What would you expect to see in a child with stage 3 lyme disease
- Stage 3, Late disseminated = 4 months after bite. - Systemic involvement and abnormal muscle movement - heart failure - confusion - decrease level of consciousness
CPR infant → up to 1 year of age (Check brachial pulse)
-1 person: 30 compressions to 2 breaths -2 person: 15 compressions to 2 breaths (thumb and circling the chest) -2 fingers at nipple line & 1 ½ inches deep & 100-120 beats -Start CPR if HR is 60 or below (Call Code) -Can use AED as long as pads don't overlap
Which instructions should a nurse include when teaching a parent with a child diagnosed with contact dermatitis from poison ivy? (SATA)
-Apply dressings moistened with either saline or water, -apply calamine or Caladryl lotion, -inspect the yard for plants with three pointed leaflets that are different shapes.
A nurse is caring for a 5 year old with rubeola. Which intervention by the nurse ensures the comfort of the child?
-Dim the lights (due to photophobia), -acetaminophen for fever/headache, -rest, -keep skin cool dry and clean, -give lots of fluids to prevent dehydration, -soft bland foods, -cool mist humidifier. -Airborne precaution
A child comes into the ER with an aspirin overdose. What do you do? (select all that apply)
-Get baseline vitals (HR,RR,BP), - activated charcoal, - gastric lavage, -give soda bicarb for acidosis, -O2 and - ventilation, - give Vitamin K to fix coagulation issues, hemodialysis.
A nurse is assessing a toddler with plumbism (lead poisoning). Which organ system is of most concern because of the condition's irreversible effects?
-Nervous System -Damaged nerve cells DON'T regenerate leading to irreversible MR Chelation therapy with calcium EDTA, (Ca disodium versenate), calcium binds to the heavy metals and helps it get excreted from the body.
Education program for parents of children 11-12, what immunizations should the nurse plan to address?
-Trivalent inactivated influenza (TIV), -Meningococcal (MCV4), -Tetanus and diphtheria toxoids and pertussis (Tdap)
A nurse is conducting a well-child visit with a child who is scheduled to receive the recommended immunizations for 11 to 12 year olds. Which of the following immunizations should the nurse administer? (select all that apply).
-Trivalent inactivated influenza(TIV), -meningococcal(MCV4), -Tetanus and diphtheria toxoids and pertussis (Tdap), -HPV
Select all the diseases that require droplet precautions.(7)
-influenza (flu), -pertussis (whooping cough), - mumps, -rubella, -respiratory illnesses, -rhinovirus (common cold), -meningitis
select all the diseases that require airborne precautions? (3)
-measles, -varicella (chickenpox), -tuberculosis
A nurse is cleansing the skin of a hospitalized child with impetigo. What is the most important action for the nurse to take?
-the nurse follows contact precautions. WEAR GLOVES -
You're documenting intake and output. How many ounces are in 1 mL.
1 ounce = 30mL
Admission assessment of a child would reveal which of the prodromal manifestations rubeola.
3 C's- Cough, coryza(runny nose), conjunctivitis After it is: fever, malaise, koplik spots, photophobia, rash starting on face and working way down, secondary bacterial infection
Child abuse, the principle reason why a child gets a skeletal survey
A skeletal survey may be performed to investigate known or suspected physical abuse in children, to look for congenital abnormalities of the skeleton
A 16-year-old is having a discussion with the nurse about the teen's recent diagnosis of lupus. In explaining the child's prognosis, the nurse uses the knowledge that adolescents are:
Able to understand and imagine possibilities for the future
The nurse is consulted when a 5 year old is burned on the hand following an incident where he put a paperclip into the electrical outlet. Which nursing action would demonstrate an unsafe nursing judgement?
Appearance of the injury may not be severe, but electrical burns can cause an increased amount of internal damage. If left untreated and not sent for further testing/evaluation, it could lead to amputation, organ failure, cardiac/respiratory arrest.
A nurse is caring for a client with superficial partial-thickness burns less than 10% of the body. What are the actions the nurse should take?
Apply cool, wet compresses to the affected area, Wear gloves mask and gown when changing dressings to decrease the risk of infecting the wound, If hands are burned wrap each finger individually, Monitor for S&S of infection (odor/drainage)
What is the priority intervention when a 10 year old comes to the nurses office with a headache and the nurse notices various stages of bruising on the inner aspects of the upper arm?
Ask the child what happened to her to her arms, and have her describe the headache
A child is admitted with chickenpox. Which prescribed medication is most important for the nurse to question?
Aspirin or aspirin-containing products- Reye syndrome has been known to occur after varicella infections and this can increase the risk NSAIDS
A 3 year old ingested a substance that may be a poison. The parent calls the neighbor who's a nurse what to do. What should the nurse tell them?
Call poison control? Call 911?
Which would be the priority nursing intervention to consider when a child is hospitalized with the diagnosis of chickenpox (varicella)?
Contact and airborne respiratory precautions
Contraindications to giving DTaP
Immune deficiency disorder, anaphylaxis, encephalopathy, severe febrile illness with child appearing ill, GBS within 6 weeks of having last vaccine, unstable neurological disorder (seizures), history of inconsolable crying after a prior immunization
An adolescent was bitten by a bug on his lower leg, its red and cellulitis. What symptoms are identifying that go along with the cellulitis? (select all that apply)
Inflammation, superficial blisters, red-streaks, swollen lymph nodes, edema, warm/tender skin, pain, Indistinct border, skin dimpling Infection → fever, malaise, chills, headache
If there's a modern? Burn which actions should the nurse take first?
Initiate a high-protein, high-calorie diet, 10% or more body surface area affected may require fluid resuscitation, (bad burns need morphine for pain)
Why is it important for parents to know adhering to immunization schedules?
It helps make sure children are protected at the right ages and times. It's important to remember mumps causes sterility in adolescents
Hospitalized child stressors:
Loss of routine, sleep disturbances, and fear of being hurt Infants: stranger anxiety, displays physical discomfort, sleep deprivation, stranger anxiety @6-8 months
SATA: Vaccinations administered to a 4 year old.
MMR, Varicella, DTap, IPV, PPSV, yearly influenza
What vaccines contain a live virus? (5)
MMR, rotavirus, shingles zoster, varicella, Nasal spray flu vaccine (LAIV)(intranasal influenza)
The nurse is developing the plan of care for a 3-year-old child diagnosed with atopic dermatitis. When reviewing the desired patient outcomes which of the following are common focuses for a child with this diagnosis? Select all that apply.
Maintenance of skin integrity, Prevention of infection, and Promotion of skin hydration
Child is admitted with burns to the lower extremities, diminished pulses, and increased capillary refill time in one leg, there's a lot of pain. What are you going to do?
Notify the doctor, could be compartment syndrome, may need a fasciotomy (Edema, lack of circulation, damage to deep tissues, decreased peripheral pulses, pain, pallor, paresthesia (numbness feeling), paralysis (weakness with movements), muscle tightness, increased capillary refill time)
An emergency department nurse prepares to treat a child with acetaminophen (Tylenol) overdose. The nurse reviews the physician's orders, expecting that which of the following will be prescribed? (Need to spell right on test, it's a fill in the blank question).
Oral N-acetylcysteine (mucomyst) or (acetadote)
Which medication prescription should the nurse question?
Oral corticosteroids- only used if other treatments fail, or for severe reactions (irritants on the face, neck, eyes, and genitals).
A child comes into the hospital with complications from mumps. The nurse knows that mumps are caused by what type of virus?
Paramyxovirus
A nurse is conducting a well-baby visit with a 4-month-old infant. Which of the following immunizations should the nurse plan to administer to the infant? (SATA)
Polio (IPV), Pneumococcal vaccine (PCV), Rotavirus vaccine (RV)
A pediatric nurse is to perform a head-to-toe assessment on a toddler who is admitted to the hospital for nausea and vomiting. Which is most important for the nurse to consider before beginning the examination?
Preparing for a physical examination based on the child's developmental age, Developmental age
SIDS:
Provide family with support. Give them an opportunity to see and hold the infant if they want. Follow up with them after they go home. Provide information on support groups. Allow the family an opportunity to express feelings (they will be in denial).
What nursing intervention should take place first prior to all vaccination administrations?
Provide the vaccine information statement handout and answer all questions.
Which assessment of an 18 month old with burns on his feet would cause suspicion of child abuse?
Symmetrical burns on both feet, (Bilateral injuries)
First sign of respiratory failure in infants
Tachypnea
Which reaction would a nurse expect when giving a preschooler immunizations.
The child cries and tells the nurse that it hurts.
An 18-month-old is discharged from the hospital after having a febrile seizure secondary to exanthem subitum (roseola). On discharge, the mother asks the nurse if her 6-year-old twins will get sick. Which teaching about the transmission of roseola would be most accurate?
The child does not need to be isolated from the older siblings. Roseola transmission is unknown and more commonly seen in children 6 months to 3 years of age, so siblings do not need to be isolated.
A 5-year-old girl has been brought to the ER for suspected child abuse. What approach should the nurse use to gather information from the child? Which approach should the nurse use to gather information from a child brought to the ED for suspected child abuse?
The nurse should tell the child that the abuse is not her fault and that she is a good person.
A mother requests that her child receive the varicella vaccine at her 9 month old well-child check up. The nurse tells the mother that:
The vaccine cannot be given at this visit, it is not usually administer prior to 1 year of age.
Which statement is true of abused children?
They will repeat the same story their parents tell
What is the telltale sign of diphtheria?
Thin tough gray membrane on the tonsils/pharynx/throat that causes neck edema. Heart and kidney damage, partial paralysis, and death.
Which statement would be most therapeutic to a child the nurse suspects has been abused?
This is not your fault, you are not to blame for this.
Where should you give an IM injection in an infant?
Vastus Lateralis
Which would be the most therapeutic response for the mother of a 6-month-old who tells the nurse she does not want her infant to have a DTaP vaccine because the infant had localized redness the last time she received this vaccination.
Would you mind if we discussed your concerns
Sign of impending respiratory failure?
grunting
A nurse is planning to give shots to a 4 year old. Which would the nurse give?
inactivated polio (IVP), MMR, varicella, DTaP
Lindane shampoo and other permethrin meds- used only once because?
it can cause central nervous system issues if used too much