ATI Pediatrics Proctored Exam
hand preference Ans- all kids normally show hand preference by 1 year old
plaster casts Ans- -heavy
-not water
... [Show More] resistant
-dry in 10-72 hrs
fiberglass casts Ans- -light weight
-water resistant
-dry in 15-20 min
types of traction Ans- Skin traction:
-Buck
-Bryant
-Russell
Skeletal traction
Halo traction
-cervical traction
care for traction Ans- -assess pin sites
-ensure hardware is tight
-ensure bed is in correct position
-ensure weights do not touch floor
Halo: ensure wrench is readily available
surgical intervention for scoliosis Ans- -realign (2 rods on either side of spine)
-internal fixation
-fusion
The child is prescribed lanoxin (Digoxin) 75 mcg PO qd. The pharmacy supplies lanoxin (Digoxin) 0.05mg scored tablets. How many tablets will the nurse administer? Record your answer using one decimal place. Ans- 1.5 tablets
The physician orders the patient a 10-mL/kg normal saline bolus to infuse over 2 hours. The child weighs 36 kg. Calculate the infusion rate in mL/hr. Ans- 180 mL/hr
What happens to the voice during epiglottitis? Ans- it becomes hoarse
Leukotreine modifiers Ans- -Blocks leukotriene receptors or synthesis of leukotrienes (Singulair)
-Side effects: headache, nausea, abdominal pain, increase infections if over age 55, depression, suicidal, aggression
-Generally well tolerated.
-Monitor for improvement in symptoms
Cromolyn (Intal) and nedocomil (Tilade) Ans- -Anti-inflammatory agents that inhibit release of histamine, leukotrienes,
-Prevention or maintenance drugs
-Administered by inhalation, onset of action in 2-4 weeks
-Side effects: cough, headache, throat irritation, GI upset
Long acting beta-adrenergics Ans- -Salmeterol (Serevent) -used twice daily
-Added to anti-inflammatory therapy
-Not for acute symptoms due to onset of action in 20 minutes with peak in 3-4 hours
Lortab Ans- tylenol with hydrocodone
dornase alpha Ans- decreases viscosity of secretions (thins mucous) for CF patients
tobramycin Ans- aerosolized antibiotics used for CF
Norwood procedure Ans- -Treats hypoplastic left heart
-3 stages
-done shortly after birth
-Right ventricle is converted: connects aorta to right ventricle
-Between step 1&2 is highest risk for death
-bi-directional Glenn operation (stage 2, under 6 mo. old)
-superior vena cava redirected to lungs
-Fontan operation (1.5-3 yrs old)
-inferior vena cava redirected to lungs
Heart transplant is another option
Biot's respirations Ans- periods of apnea alternating with 2 or 3 shallow breaths
Cheyne-Stokes respirations Ans- periods of apnea alternating with periods of hyperventilation
What gauge needle should be used when administering an immunization to a toddler? Ans- 24 gauge
sodium normal range Ans- 135-145
Recommended play activities for infant, toddler, preschool, and school age children Ans- Infant: play pat-a-cake
Toddler: push-pull toy
Preschool: play dress-up
School age: create a scrapbook
protecting against SIDS Ans- -supine to sleep
-empty bed: firm mattress only
-breastfeeding
-use of pacifier while sleeping
manifestations of pneumonia in infants Ans- nasal flaring
increased WBCs
diarrhea
abdominal distention
steps to take during a tonic-clonic seizure Ans- **FIRST: assist child to side-lying position on the floor
then...
-apply O2 mask
-clear immediate area
-loosen restrictive clothing
A nurse is preparing to administer ibuprofen f5 mg/kg q6h PRN for temps above 38 degrees F to an infant who weights 17.6 lb. The infant has a temp of 38.4. Available is ibuprofen liquid 100 mg/5 mL. How many mL should the nurse administer to the infant per dose? Round to nearest whole number. Ans- 2 mL
What is an indication of IICP in a child with a concussion? Ans- forceful vomiting
What is an expected finding of endocarditis? Ans- headache
What is an expected finding in a school-age child with glomerulonephritis? Ans- brown colored urine
McBurney's point Ans- -lower right abdomen
-pain in appendicitis
teaching to parents of child with juvenile idiopathic arthritis Ans- -exercise large joints regularly
-encourage child to perform independent self-care
-provide a firm mattress for sleeping
-discourage daytime naps because stiffness can occur quickly
Celiac disease expected findings Ans- -steatorrhea
-distended abdomen
-weight loss
What type of vomiting is common with pyloric stenosis? Ans- projectile vomiting
management of tinea pedis Ans- -avoid wearing plastic shoes
-wear sandals as much as possible
What is used to treat scabies lesions? Ans- permethrin 5% cream
For what disease should non-washable items be sealed in a plastic bag for 14 days? Ans- pediculosis
manifestation of pertussis Ans- dry hacking cough
manifestation of acute streptococcal pharyngitis Ans- inflamed throat with exudate
manifestation of bacterial conjunctivitis Ans- purulent eye drainage
Koplik spots Ans- rubeola (measles
securing an infant's car seat Ans- lower anchors and tethers (the LATCH child safety system)
when this is available the seatbelt does not have to be used
Where should the car seat harness in rear-facing car seat be positioned? Ans- at or just below the infant's shoulders
At what angle should an infant's car seat be placed? Ans- 45 degree angle
1. Who should the FACES pain rating scale be used for?
2. Who should the numeric pain rating scale be used for?
3. Who should the CRIES pain assessment scale be used for?
4. Who should the non communicating children's pain checklist be used for? Ans- 1) 3+ yrs old
2) 5+ yrs old
3) infants
4) pediatric clients with cognitive impairments
Diabetes insipidus lab values Ans- -dilute urine/low specific gravity
-high sodium
-normal blood glucose
-polyuria (excessive urine output)
minimal change nephrotic syndrome management Ans- -dietary fluid restriction
-low sodium diet
-corticosteroids
How often should a child with asthma get pulmonary function tests? Ans- every 12-24 months
lumbar puncture nursing care Ans- -apply topical analgesic to the lumbar site 60 min prior to procedure
-place in prone position or flat in bed for up to 12 hours to prevent post procedural spinal headache
-encourage to drink extra fluids to replace CSF
care for a partial-thickness burn Ans- -wash the affected area with mild soap & water
-apply antibiotic ointment to the affected area
For what type of burn would you insert and NG tube? Ans- a major burn - to empty the contents of the stomach & maintain decompression
CF diet Ans- -well-balanced
-high in protein & calories
-unrestricted fat
-ensure adequate fluid intake
Can a child with celiac disease eat malt? Ans- no, it has gluten in it
What should be done after administering PO suspension digoxin? Ans- brush the child's teeth
manifestations of digoxin toxicity Ans- nausea, vomiting, decreased appetite
age of controlling impulsive feelings Ans- school age
age of understanding right from wrong Ans- preschool
begins to express likes and dislikes Ans- toddler
positioning to reduce the risk of IICP Ans- head elevated in a midline position
indications of brainstem herniation Ans- Cushing's triad: htn, bradycardia, decreased respirations
infant care after a cheiloplasty Ans- -clean sutures with sterile water or diluted hydrogen peroxide after each feeding
-don't put large objects in the mouth
-apply a thin layer of antibiotic ointment on the suture line daily for 3 days and then petroleum jelly for several weeks
developmental activities for school age kids, preschoolers, and toddlers Ans- school age - book about adventure
preschooler - large piece puzzle
toddler - puppets
child behaviors suggestive of physical abuse Ans- -reluctance to return home
-description of injury is vague and incompatible with the actual wounds
-denies discomfort during assessment of injuries
-withdrawn behavior and poor relationships with peers
sodium polystyrene sulfonate enema Ans- -antidote that exchanges sodium ions for potassium ions in the intestine
-treats hyperkalemia
adverse effect: diarrhea
interventions for lead toxicity Ans- -diet rich in calcium, vitamin C, and iron
-chelation therapy for lead levels 45 mcg/dL or greater
expected findings following an appendectomy Ans- -absence of peristalsis
-WBC >10,000/mm3
Meckel diverticulum Ans- passage of dark red stool with mucus
spastic cerebral palsy expected findings Ans- -positive Babinski reflex
-ankle clonus
-exaggerated stretch reflexes
-contractures
indications of early septic shock Ans- fever & chills
plan of care pre-op for a preschooler with a Wilm's tumor Ans- -avoid palpating the abdomen
-auscultate bowel sounds
-do not engage in play with other children - increases risk of injury
-do not explain about pain till post op so as not to increase anxiety
physical findings suggestive of physical abuse Ans- symmetric burns of lower extremities
physical findings suggestive of physical neglect Ans- -growth failure
-lack of subcutaneous fat
physical findings suggestive of sexual abuse Ans- recurrent UTIs
indications of SIADH Ans- -low sodium level
-high urine specific gravity
-decreased urine output
-hypoosmolality
-overhydration
-mental confusion
-bounding pulses
-increased BP
-tachycardia
An allergy to neomycin, eggs, or gelatin contraindicates what vaccine? Ans- MMR
Steps for discontinuing IV fluids Ans- 1. turn off the IV pump
2. occlude the IV tubing
3. remove the tape securing the catheter
4. apply pressure over the catheter insertion site
teaching parents to protect their children from sunburn Ans- -waterproof sunscreen with SPF of at least 15
-avoid liberal application till 6 months of age
-dress in tight weave cotton fabric
-reapply sunscreen every 2-3 hrs
wheezes Ans- high-pitched, musical, whistling-like sounds heard primarily on expiration as air passes through and vibrates narrowed airways
crackles Ans- -high-pitched, short, and noncontinuous sounds heard usually at the end of inspiration
-occur when air expands deflated alveoli or when the passage of air through small airways is disrupted
pleural friction rub Ans- -loud, rough, grating sound heard during inspiration or expiration
-occurs when the pleurae are inflamed and the surfaces rub together
rhonchi Ans- -low-pitched, continuous sounds that have a snore-like quality and are usually louder during expiration
-occur when the larger airways are obstructed
When should an infant be able to stand while holding onto furniture? Ans- 10 months
When should an infant be able to say 1-2 words? Ans- 10 months
When should an infant be able to sit unsupported? Ans- 8 months
What should an infant be able to roll a ball to someone else? Ans- 11 months
post op care following a cardiac catheterization Ans- -avoid strenuous activities but may attend school the next day
-resume regular diet
-keep site clean and dry for at least 3 days and do not take a tub bath for those 3 days
-remove the pressure dressing the day after the procedure and apply a new adhesive bandage strip daily for at least the next 2 days
interventions for a superficial minor burn Ans- -administer a tetanus toxoid if 5+ yrs since prior dose
-apply antimicrobial ointment to the burned area to prevent infection
-apply a clean-dry dressing of fine mesh gauze and a light gauze dressing that restricts movement to prevent injury to the wound
-do NOT apply ice - may impair circulation & increase tissue damage
suctioning an infant who has a tracheostomy Ans- -suction only as needed to prevent hypoxia and to maintain patency of the tube
-do NOT instill normal saline beforehand
-ensure the vacuum pressure is set between 60-100 mm Hg
-suction for 5 seconds or less to prevent hypoxia
mononucleosis Ans- -caused by Epstein-Barr virus
-no known specific txt
-monospot to diagnose
-acute s/s last approx. 10 days with fatigue lasting up to 4 wks
-complications: splenomegaly - restrict activities for 2-3 months to avoid rupturing the spleen
intussusception Ans- -bloody stools that are currant jelly-like in appearance
-vomiting
-lethargy
-diarrhea
-weight loss
-leaking blood and mucus into the intestines
VSD Ans- loud, harsh murmur
coarctation of the aorta Ans- -weak femoral pulses
-elevated BP
infant with a hypercyanotic spell r/t Tetralogy of Fallot Ans- -place infant in knee-to-chest position
-administer morphine IV to decrease infundibular spasms
-administer IV fluids
-apply oxygen at 100% via face mask
precautions for pertussis Ans- droplet
positive pressure airflow Ans- reduces risk of disease transmission to the patient
negative pressure airflow Ans- patient with airborne infection (measles, varicella)
teething s/s Ans- -pulling on the ears
-difficulty sleeping
-increased drooling
-increased fussiness
-cold teething rings
-rub infants gums with a cold cloth
-eruption of teeth begins with lower central incisors
identifies right from left hand Ans- 6 years old
uses utensil to spread butter Ans- 6 years old
using scissors to cut out a shape Ans- 4 years old
drawing a stick figure with 7 body parts Ans- 5 years old
diabetes mellitus type 1 teaching the child Ans- -avoid puncturing pads of the fingers
-give self shot of regular insulin 30 min before meals
-eat snack of 15 g of carbs such as 120 mL (4 oz) of fruit juice or 66 g (1/2 cup) of ice cream to rapidly decrease a mild hypoglycemic reaction
-increase fluids when sick
recombinant growth hormone Ans- treats hypopituitarism
desmopressin Ans- used to treat hyposecretion of ADH
luteinizing hormone-releasing hormone Ans- used in txt of precocious puberty to slow prepubertal growth in children and txt of advance prostate cancer in adult clients
Levothyroxine Ans- used to treat various hypothyroid conditions
strabismus Ans- -crossing of the eyes
-disappears at 3-4 months of age
care fora school-age child with a tunneled central venous access device Ans- -avoid use of scissors during dressing changes
-flush each lumen of the catheter with heparin solution daily when not in use
-use a semipermeable transparent dressing to reduce the risk of infection
What type of needle should you use when accessing an implanted port? Ans- a non coring angled or straight needle
bicycle safety Ans- -able to stand on balls of feet when sitting on bike
-ride single file
-wear light colored clothing with fluorescent material at night
-ride in the direction of the flow of traffic
Poor personal hygiene in a toddler is a potential indication of ________________________. Ans- physical neglect
CF diet management Ans- -administer pancreatic enzymes within 30 min of meals and snacks
-increase pancreatic enzymes if steatorrhea occurs
-encourage fluid intake
-increase fat content to 40% of total calories
priority intervention for a toddler with epiglottitis Ans- prepare the toddler for nasotracheal intubation/tracheostomy
vaccine that can prevent epiglottitis Ans- Haemophilus influenzae type B conjugate vaccine (Hib)
Kawasaki disease Ans- -increased temp lasting >4 days unresponsive to antipyretics or abx
-strawberry tongue
-cracked lips
-edema of oral mucosa & pharynx
-xerophthalmia (reddening of conjunctiva & dry eyes)
-tachycardia with a gallop rhythm
-cervical lymphadenopathy: on 1 side of the neck, nontender, >1.5 cm in size
complications:
-coronary artery aneurysms
-MI
What can phenytoin therapy cause? Ans- gingival hyperplasia
Koplik spots Ans- measles (rubeola)
hoarseness Ans- diphtheria
facial rash Ans- erythema infectiosum (fifth disease), lasts 1-4 days
splenomegaly Ans- infectious mononucleosis
increase in anterior convexity of the lumbar spine Ans- lordosis
increased curvature of the thoracic spine Ans- kyphosis
lateral flexion of the neck Ans- indication of torticollis as a result of contracture of the sternocleidomastoid muscle
can be...
-congenital: result of intrauterine fetal posturing or abnormality of cervical spine
-acquired: traumatic lesion to sternocleidomastoid muscle
unilateral rib hump Ans- -scoliosis
-S or C shaped curvature to thoracic spine resulting in asymmetry of rib, shoulders, hips, or pelvis
What should be applied to the affected area on an infant with diaper dermatitis? Ans- zinc oxide
Pavlik harness Ans- -wear continuously till hip is stable (6-12 weeks)
-parents should not adjust the harness in any way
-avoid use of powders/lotions
-place diapers under the harness straps
What kind of respirations will a child have who has a flail chest? Ans- paradoxic respirations
What kind of respirations will a child in DKA have? Ans- deep and rapid
manifestations of IICP Ans- -lethargy
-decreased activity
-decreased attention span
-bradycardia (late)
-hypertension (late)
manifestations of peritonitis (perforated appendix) Ans- -hypoactive bowel sounds
-abdominal distention
-tachycardia
What can increase the risk of perforating the appendix in case of appendicitis? Ans- -enema
-laxatives
-heat
ways to prevent acute asthma attacks Ans- -dehumidifiers
-airconditioners
-NO cough suppressants
-wet mop bare floors weekly
-keep child indoors when mowing the yard
findings associated with bacterial meningitis Ans- -increased CSF pressure
-increased WBC count
-increased protein concentration
-decreased glucose level
Where should a pulse ox monitor be placed on an infant? Ans- the great toe
rheumatic fever nursing interventions Ans- -maintain on bed rest
-administer salicylates
tobramycin side effects Ans- it is an aminoglycoside which can cause mild to moderate hearing loss
nursing interventions for a child with heart failure Ans- -small, frequent meals
-restrict play activities to minimize energy expenditure
-weigh the child daily
-maintain the bed in semi-Fowler's position
sign of a hemolytic transfusion reaction Ans- flank pain
sign of an allergic reaction to a transfusion Ans- laryngeal edema
sign of circulatory overload (complication of a blood transfusion) Ans- distended neck veins
indication of electrolyte disturbance (complication of a blood transfusion) Ans- muscle weakness
When does a child begin referring to himself/herself by the appropriate pronoun start? Ans- 30 months
When does a toddler's interest in pictures occur? Ans- 15 months
When should a child have control of bowel and bladder functions during the day? Ans- 30 months
When should a child be able to scribble spontaneously using a crayon? Ans- 15 months
When should a child be able to imitate drawing strokes? Ans- 18 months
When can a head-to-toe approach be returned to with children Ans- with preschoolers
pneymococcal polysaccharide Ans- administered to children 2-18 years old who have a specific high-risk condition that places them at risk for an infection with Streptococcus pneumococci, which causes meningitis, otitis media, and pneumonia.
meningococcal polysaccharide Ans- all incoming college students should receive this vaccine
When is the final rotavirus dose administered? Ans- before 8 months of age
When is the herpes zoster immunization given? What is it for? Ans- adults over 60 years old to prevent shingles
What is the most common food allergy in children? Ans- cow's milk
When does the stepping reflex disappear? Ans- 4 weeks
When does the Babinski reflex disappear? Ans- 1 year old
When does the extrusion reflex disappear? Ans- 4 months
When does the Moro reflex disappear? Ans- 3-4 months
What is crossed and extended legs when supine a finding associated with? Ans- cerebral palsy
What can reduce the absorption and effects of lead? Ans- adequate intake of calcium and iron
When is copying a circle achieved? Ans- 4 years
When is cutting food using a table knife achieved? Ans- 7 years
When does a child begin writing in cursive? Ans- 8-9 years old
When can a child print their first and last name clearly? Ans- 5 years
What kind of strategy is have a child hold their breath and blow it out slowly? Ans- distraction
What kind of strategy is asking the child to describe a pleasurable event? Ans- guided imagery
What kind of strategy is rocking the child in long rhythmic movements? Ans- relaxation
When should development of sexual characteristics begin to develop in boys? girls? Ans- 9 yrs in boys; 8 yrs in girls
To prevent a burn injury, temperature of water heater should not exceed what temperature? Ans- 120 degrees F
What position is used when performing a gavage feeding? Ans- semi-recumbent
What positions may be used during a lumbar puncture? Ans- -side lying position
-flexed sitting position
What position is used for a femoral venipuncture? Ans- supine with legs in a frog position
When should an infant begin vocalizing vowel sounds? Ans- 7 months
When is a crude pincer grasp demonstrated? What else is evident at that time? Ans- 9 months; use of a dominant hand
Where is a liquid oral medication administered to an infant? Why? Ans- in the side of the mouth (buccal cavity) to prevent gagging and aspiration
Which is gender is a increased risk for hospitalization related stress? Ans- males
How long can a PICC line last with proper care? Ans- several weeks
Must the client's arm be immobilized if they have a PICC line? Ans- no
Where is a PICC line inserted? Ans- the operating room using local anesthetic by trained personnel
How is Hirshprung's disease diagnosed? Ans- biopsy on a small amount of tissue from the colon
How is pyloric stenosis diagnosed? Ans- an upper GI series
nursing interventions post op following a surgical repair of cleft lip and palate Ans- -avoid placing objects in the infant's mouth
-gently suction the mouth with a bulb syringe PRN to maintain a patent airway
-position the infant upright
-clean the incision with sterile saline or sterile water after each feeding and as needed
Boston brace Ans- for scoliosis; wear 23 hrs a day
manifestation sof tracheomalacia Ans- -barking cough
-stridor
-wheezing
-cyanosis
-apnea
How many calories should 2 year old toddlers consume daily? Protein? Milk? Vegetables? Ans- -1,000 calories
-2 oz protein
-no more than 24 oz (3 cups) milk
-8 oz (1 cup) vegetables
What ages is the Word-Graphic pain rating scale used for? Ans- 4-17 yrs
What ages is the Color Tool pain scale used for? Ans- children as young as 4 yrs who know how to recognize colors
What ages is the Poker Chip Tool pain scale used for Ans- children as young as 4 yrs old who know how to use numbers
What does an ASO titer check for? Ans- a recent strep infection
What should alert the nurse that a toddler in acute respiratory distress may have epiglottitis? Ans- drooling
How should an infant be fed following a cleft palate repair? Why? Ans- clear liquids in a cup for 7-10 days to prevent trauma/injury to the suture line
What are children with hemophilia at risk for? Ans- bleeding
What kind of murmur is expected with VSD? Ans- murmur at the left sternal border?
What kind of murmur is expected with ASD? Ans- diastolic murmur
What is an expected finding in a child who has an atrioventricular canal defect? Ans- cyanosis that increases with crying
interventions for an infant with GERD Ans- -give lansoprazole 30 min before feeding
-place infant in a seat or at a 30 degree angle for 1 hr after feedings
-avoid feedings just before bedtime
-at rice cereal to the milk/formula to thicken the feedings and decrease the episodes of vomiting
phenytoin Ans- seizure medication
lab findings in a child with acute lymphocytic leukemia Ans- -low platelet count
-low RBC count
-very high WBC
count
-low Hct level
How long can a child use an opened vial of insulin? Ans- 28-30 days stored at room temp or in the fridge
What can a child with rheumatic fever take to control inflammation in the joints to decrease joint pain? Ans- aspirin
antidote for acetaminophen overdose/poisoning Ans- acetylcysteine
treatment for intussusception Ans- barium enema
What does an increased Hct level indicate? Ans- dehydration
antidote for warfarin Ans- phytonadione
oxybutynin Ans- antispasmodic used for clients 6+ yrs old who have neurogenic bladders
osteomyelitis Ans- infection in the bone
minimal change nephrotic syndrome Ans- kidney disease in which large amounts of protein are lost in urine
toddler RR normal range Ans- 24-40 rpm [Show Less]