Pediatric Nursing Practice 207 Questions with Verified Answers
An 18-Month-Old is discharged from the hospital after having a febrile seizure secondary
... [Show More] 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?
1. The child should be isolated at home until the vesicles have dried.
2. The child does not need to be isolated from the older siblings.
3. Administer acetaminophen to the older siblings to prevent seizures.
4. Monitor - CORRECT ANSWER . 2. The route of roseola transmission is unkown, and the disease is more commonly seen in children 6 months to 3 years of age, so siblings do not need to be isolated.
Which would be the priority intervention for a child suspected of having varicella (chickenpox)?
1. Contact Precautions
2. Contact and Droplet Respiratory Precautions?
3. Droplet respiratory precautions?
4. Universal Precautions and standard precautions. - CORRECT ANSWER 2. Varicella (Chickenpox) is highly contagious. Contact & Droplet respiratory precautions should be started immediately because the primary source of transmission is secretions of the respiratory tract (droplet) and also by contaminated objects.
Caladryl - CORRECT ANSWER A lotion containing diphenhydramine. Should not be applied if child has already been given benadryl (diphenhydramine) because it can cause toxicity.
Which s&s would the nurse expect with rheumatic fever?
1. Ankle and Knee Joint Pain.
2. Negative group A beta strep culture.
3. Large, red "bulls eye" - appearing rash.
4. stiff neck with photophobia. - CORRECT ANSWER Ankle and knee joint pain.
The parents of a 12-month old with HIV are concerned about him receiving routine immunizations. What will the nurse tell them about immunizations? - CORRECT ANSWER "You are concerned about your child receiving immunizations. Let me explain why your child will NOT receive routine immunizations today"
The nurse acknowledges a client's fears and then discusses the concerns to clarify any misconceptions. Immunizations and influenza vaccine are recommended to prevent infection. Immunocompromised HIV-infected children should not receive MMR and varicella live vaccines.
Nursing Assessment suspects the newborn has cystic fibrosis. Which interventions would the nurse begin.
1. Observe frequency and nature of stools.
2. Provide Chest PT
3. Observe for weight gain.
4. Assess parent's compliance with fluid restrictions.
5. Assess respiratory system frequently. - CORRECT ANSWER 1 & 3
Cystic fibrosis is an inherited autsomal trait, causing exocrien gland dysfunction. 7-10% present meconium ileus, so assessing stool frequency and consistency is important.
Assessing weight is important in newborns because they lose up to 10% of their birth weight, and can take 2 weeks for them to regain their birth weight.
Assessing the newborn's respiratory system frequently would be monitored as frequently as other infants if the newborn has no respiratory symptoms. Chest PT would not be initiated in a newborn without a definitive diagnosis.
Can a mother breastfeed their infant if they have PKU? - CORRECT ANSWER Yes. Breast milk has low amounts of phenylalanine, so the mother can breast as long as the infants phenylalanine level is monitored.
Vaccines given routinely at 15 months. - CORRECT ANSWER Hib & DTaP
Which priority intervention for the newborn of a mother positive for hepatitis antigen? - CORRECT ANSWER The newborn should receive both hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth to prevent hepatitis B infection.
signs of intussusception - CORRECT ANSWER bloody stools or "currant jelly stools", diarrhea, Large palpable sausage shaped mass in the abdomen, abdominal distention, grunting, dehydration Fever, and pain (legs pulled towards abdomen)!
Flat Ribbon Stools indicate - CORRECT ANSWER Hirschsprung Disease
Treatment for Intussusception - CORRECT ANSWER Barium or air enema
Nursing Care for Intussusception - CORRECT ANSWER Document I & O
Monitor for peritonitis & perforation
Monitor and record stools
Biggest complications of Intussusception - CORRECT ANSWER Peritonitis and Perforation
Risk factors for intussusception - CORRECT ANSWER Cystic Fibrosis
Ages 3 months to 3 years old.
Complication of Mal-Rotation & Valvolus - CORRECT ANSWER Pain related to rotation of intestines around the mesenteric artery can cut off circulation, leading to potential septic intestinal necrosis.
Which pediatric GI disorder presents with green bilious vomiting? - CORRECT ANSWER Mal-Rotation and Valvolus
GI disorders that present with bloody stools? - CORRECT ANSWER Mal-Rotation/Valvolus & Intussusception.
Obstructive GI disorders where a palpated sausage shaped mass is felt on the abdomen. - CORRECT ANSWER Mal-Rotation and Valvolus. Symptoms for these disorders are similar but Mal-Rotation requires surgical intervention.
Preoperative care for Mal-Rotation/Valvolus - CORRECT ANSWER Hydration, IV antibiotics, NG tube.
Post-Operative Care for Intussusception - CORRECT ANSWER Bowel sounds should return in four hours, progressive diet, hydration.
Priority nursing diagnosis for intussusception - CORRECT ANSWER Acute Pain!
Which response about safety measures is the most appropriate advice for the 2 year old's mother who had her older home remodeled to reduce the lead level? Select all that apply.
1. Wash & dry the child's hands and face before he eats.
2. it is best to use cold water to prepate the child's food to decrease lead level.
3. diet does not matter in reduce lead levels in the child.
4. Drinking two cups of milk per day helps decrease lead levels. - CORRECT ANSWER 1 & 3. Washing and drying hands and face especially before eating, decreases lead ingestion. Hot water absorbs more lead readily than hot water. Diet does matter; regular meals, adequate iron and calcium, and less fat help the child absorb less lead. Drinking 2 cups of milk per day is important for children but does not help decrease lead level.
Which would the nurse explain to parents about the inheritance of cystic fibrosis?
1. The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF.
2. The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF. - CORRECT ANSWER 2. If the child is born to a parent with CF and the other is a carrier, the child has a 50% chance of acquiring the disease and 50% chance of being a carrier of the disease.
Number 1. is wrong. If a child is born to a parents who are both carriers of the CF gene, the child has a 25% chance of acquiring the disease and a 50% chance of being a carrier of the disease.
A 2 year old has just been diagnosed with CF. The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response?
1. Barrel shaped chest
2. Chronic productive cough
3. bronchiectasis
4. wheezing - CORRECT ANSWER Wheezing respirations and a dry nonproductive cough are common early symptoms of CF.
A barrel shaped chest is a long-term respiratory problem that occurs with recurrent hyperinflation. A chronic productive cough is common as pulmonary damage increases. Bronchiectasis develops in advanced stages of CF.
Test taking hint: "chronic: implies the disease process is advanced rather than in initial stages.
The parent of a child with Cystic Fibrosis (CF) asks the nurse what will be done to relieve the child's constipation. Which is the nurse's best response?
1. Your child likely has an obstruction and will require surgery.
2. Your child will be given IV fluids.
3. Your child will be given MiraLAX
4. Your child will be placed on fluid restrictions. - CORRECT ANSWER 3. MiraLAX will be ordered.
IV fluids may be ordered if the client is NPO for any reason. however, IV fluids will not relieve the constipation. CF patient's commonly receive stool softeners or osmotic solution orally to relieve their constipation.
A school age child has been diagnosed with strep throat. The parent asks the RN when the child can go back to school. Which is the nurse's best response? - CORRECT ANSWER Children with strep are no longer contagious 24 hours after initiation of antibiotic therapy.
The RN is revieing discharge insturctuon with a parent of a child who has a tonsillectomy a few hours ago. The parents tell the nurse that the child is a big eater, and they want to know what foods to give their child for the next 24 hours. What is the nurses's best response?
1. no restrictions at all
2. clear liquids only
3. restricted to ice cream and cold liquids
4. restricted to soft foods. - CORRECT ANSWER 4. Soft foods
Which ix the nurse's best response to parents who ask what impact asthma will have on the child's future in sports?
1. As long as your child takes prescribed medications, the child will be fine.
2. The earlier the diagnosis of asthma, the more significant the symptoms.
3. The earlier a child is diagnosed with asthma, the better the chance the child has of outgrowing the disease.
4. Your child should avoid playing contact sports and sports that require a lot of running. - CORRECT ANSWER 2. When the child is diagnosed with asthma at any early age, the child is more likely to have significant symptoms on aging.
Which of the following children with asthma should the nurse see first?
1. a 12 month old who has a mild cry, is pale in color, has diminished breathe sounds, and has an O2 sat of 93%.
2. A 5 year old who is speaking in complete sentences, is pink in color, wheezing bilaterally, and has an O2 sat of 93%,
3. A 9 year old who is quiet, pale in color, wheezing biliaterally with an O2 sat of 92%,
4. A 16 year old who is speaking in short sentences, wheezing, sitting upright, and has an O2 sat of - CORRECT ANSWER 1. Diminished breathe sounds are a sign of severe asthma.
The parents of a 6 year old who has a new diagnosis of asthma ask the nurse what to do to make their home more allergy-free environment. Which is the nurse's best response?
1. use a humidifier in your child's room.
2. Have your carpet cleaned chemically once a month.
3. Wash household pets weekly.
4. Avoid purchasing upholstered furniture. - CORRECT ANSWER 4. Leather furniture is recommended rather than upholstered furniture. Upholstered furniture can harbor large amounts of dust, whereas leather may be wiped off regularly with a damp cloth.
household pets are not recommended for patient's with asthma. Humidifiers are not recommended because they may harbor mold if not cleaned properly.
Frog Like Croaking indicates - CORRECT ANSWER Epiglottitis, a medical emergency.
How to test for RSV - CORRECT ANSWER Nasal Swab
What would confirm Epiglottis - CORRECT ANSWER Xray. A CBC would only show elevated WBC count, it is non-confirmatory.
What should be the nurse's first action with action with a child who has a high fever, dysphagia, drooling, tachypnea, tachycardia, and tachypnea?
1. Immediate IV placement
2. Immediate respiratory treatment
3. Thorough physical exam
4. Lateral neck radiograph. - CORRECT ANSWER 4.
Immediate respiratory treatment may agitate the child and progress the inflammation, increasing risks.
The parent of a young child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asks the nurse why this child is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response?
1. Some children just react differently to viruses. It is best to treat each child as an individual.
2. younger children have wider airways that make it easier for bacteria to enter and colonize.
3. Younger children - CORRECT ANSWER 4. Patient's should be treated as individuals. However, most children exhibit similar symptoms when they have the same diagnosis. Younger children have worse symptoms than older children because their immune systems are less developed.
Are cough suppressants given in children? - CORRECT ANSWER No. Coughing is a protective mechanism so do not try to protect it with a suppressant.
Is exercise prohibited in patient's with CF? - CORRECT ANSWER Exercise is effective in helping CF patient's clear secretions.
What chloride level is definitive of CF? - CORRECT ANSWER The definitive diagnosis of C is made when the child has a sweat test level of 60 mEq/L or greater. A normal chloride level is <40mEq/L.
What pediatric GI Disorder may have chest tubes placed post-operatively - CORRECT ANSWER Tracheal Esophageal Fistula
Most common age for Hirschsprung's Disease - CORRECT ANSWER Usually occurs younger (infant fails to pass meconium in the first 48 hours of life). but can occur at any age.
What is Hirschsprung disease - CORRECT ANSWER A disorder related to the absence of ganglion cells that results in decreased motility; A condition that affects the large intestine (colon) and causes problems with passing stool.
Complication of Hirschsprung disease - CORRECT ANSWER enterocolitis-inflammation of colon can leadd to sepsis and death
fever, explosive, foul smelling diarrhea
worsening abd distension
Pain Scale for gastroschisis, omphalocele, mal-rotation/valvulus - CORRECT ANSWER NIPS (occurs most often in the first month of life [first 28 days]) PIPS for premature infants.
A laxative is ordered for a child for Hirschsprung disease. Why should the nurse question this order? - CORRECT ANSWER Giving a laxative to a child with Hirschsprung disease can cause perforation or rupture of the colon /large intestine, leading to peritonitis and shock.
Symptomatic & Treatment difference between Intussusception and Mal-Rotation/Valvolus is - CORRECT ANSWER Green-Bilious Vomit is only seen in mal-rotation/valvolus. Both have bloody stools. Mal-Rotation and Valvolus require surgical intervention, where intussusception should only require a barium or air enema.
Symptom of Valvulus - CORRECT ANSWER Green-Bilious Vomit, Lower GI Bleed (bloody stools)
String Sign is associated with what GI disorder - CORRECT ANSWER String sign is a symptom of Hypertrophic Pyloric. This will be seen during an upper GI series while using barium dye.
Common viral cause of Gastroenteritis - CORRECT ANSWER Rotavirus
Risk factor for TEF - CORRECT ANSWER Poly-hydramnios
Olive-Shaped mass is indicate of what GI disorder - CORRECT ANSWER Hypertrophic Pyloric Stenosis
Folic acid deficiency can cause _________ , _________, and neural tube defects - CORRECT ANSWER Cleft Lip, Cleft Palate
What maternal drug prescriptions cause a risk for CL/CP? - CORRECT ANSWER Steroids and Anticonvulsants
Non-Bilious Vomiting - CORRECT ANSWER = pyloric stenosis
Sausage shaped mass, and bloody stools - CORRECT ANSWER Volvulus/Mal-Rotation or Intussusception.
Trisomy Children (13, 18, & 21) may be at risk for: - CORRECT ANSWER Celiac Disease, Omphalocele, and Hirschprung Disease
Lactose Intolerance is associated with what GI motility disorder? - CORRECT ANSWER Celiac Disease
How to protect suture lines in Cleft Lip? - CORRECT ANSWER Prevent Crying (Cuddling), Supine position with elbow restraints, or on the side with head elevated up right. Logan's bar. No sippy cups, toothbrush, or straws.
Post-operative position for Cleft Palate Repair - CORRECT ANSWER May lie prone (on the abdomen) immediatley post-operatively
Why is a cleft lip/cleft palate child at risk for infection - CORRECT ANSWER Oropharyngeal airways are exposed and dry, making them at risk for infection.
Characteristic of Fatty Stools: - CORRECT ANSWER Greasy, pale, and foul-smelling
What congenital defect is associated with inefficient eustachian tube function, Otitis Media, and hearing loss - CORRECT ANSWER Cleft Lip & Cleft Palate
Symptom of Hirschsprung's disease? - CORRECT ANSWER constipation, vomitting, abdominal swelling, growth retardation, failure to pass meconium in first 48 hours of life, poor feeding
GI disorder requiring 1 1/2 fluid maintenance - CORRECT ANSWER Gastroschisis due to insensible fluid loss
pain scale for CP/CL - CORRECT ANSWER FLACC (Surgery is done after first month of life)
Cystic Fibrosis is associated with what other GI disorder - CORRECT ANSWER Intussusception
When can juice be introduced into the diet? - CORRECT ANSWER When the baby is at least 8 months old.
Toddler weight gain per year - CORRECT ANSWER 5-6 lbs/year (2.3-2.7 kg/year)
decreased caloric needs
What age experiences "Food Jags" - CORRECT ANSWER Toddlers experience foods jags where they only want to eat 1 type of food for every meal.
Which age group experiences appetite fluctuation? - CORRECT ANSWER Preschoolers experience appetite fluctuation. They have periods of overeating and then not eating at all. Encourage nutritious nibbling & foods they can eat on the go.
At what age is the digestive tract that side of an adult? - CORRECT ANSWER School Age
School age weight gain per year. - CORRECT ANSWER 4-6 lbs/year (1.8-2.7kg/year)
When is pincer grasp mastered - CORRECT ANSWER Between 9 and 12 months.
Normal fine motor skill at 10 months - CORRECT ANSWER Points at objects
When can a child hop on one foot? - CORRECT ANSWER 4 years of age.
Causes of Urinary Stasis - CORRECT ANSWER - reflux
- anatomic abnormalities
- voiding dysfunction
- Ureteral or bladder compression caused by constipation
Children under _______ of age are placed on daily prophylactic antibiotics and reevaluated for VUR. - CORRECT ANSWER 2 years of age.
Primary VUR - CORRECT ANSWER results from a congenital anomaly; may have familial pattern; 36% of siblings affected. Abnormal insertion of ureter into bladder.
Secondary VUR - CORRECT ANSWER intact and healthy ureters. VUR caused by acquired conditions such as overwhelmed by raised vesicular pressures associated w/ obstruction, which distorts the ureterovesical junction. underlying causes include neurogenic bladder and chronic, recurrent UTIs.
pylenophritis - CORRECT ANSWER inflammation of renal parenchyma
- fever
- vomiting
- chills
** calls for immediate administration of IV antibiotics
hydronephrosis - CORRECT ANSWER swelling of the kidney related to buildup of urine or water. Occurs when water cannot drain properly (obstruction, VUR).
- flank pain
- dysuria
- frequency & urgency
- fever
- Nausea
Treatment for VUR - CORRECT ANSWER - once daily (OD) prophylactic antibiotics
- C/S done every few months
- Surgical intervention if it persists after puberty
- check for pinworms and vaginitis
Teaching for VUR - CORRECT ANSWER - Avoid constipation and tight clothing
- void frequently, double void
- wipe front to back
- wear cotton panties
- increase fluids
Which grade(s) of VUR usually require surgical intervention? - CORRECT ANSWER Grades 4 & 5
Deflux - CORRECT ANSWER a newer treatment for VUR. A gel is injected into the ureter(s) to prevent reflux in children who would normally require surgery.
Epidydymitis - CORRECT ANSWER Inflammation of the scrotum.
Treatment of epididymitis - CORRECT ANSWER -antibiotics, scrotal elevation, scrotal ice packs, heat, scrotal support
-can result in sterility if treatment is delayed
Causes of epididymitis - CORRECT ANSWER Epididymitis is an infection of the cordlike excretory duct of the testicle, usually secondary to an infectious process-STD's or non-STD's.
It is one of the most common infections of the male reproductive tract.
The causative organisms are:
-S. aureus
-E. coli
-Streptococci
-N. gonorrhoeae
The inflamation is associated with urethral strictures, cystitis, and prostatitis.
Symptoms can occur after trauma to the genital area, after instrumentation of the urethra and cystoscopy, and after physical exertion and prolonged sexual activity.
Orchiopexy is done for - CORRECT ANSWER Testicular torsion and Cryptochordism
Cryptochordism - CORRECT ANSWER Congenital undescended tests or not formed in utero.
- surgery done at 6-12 months of age
- infertility issues, fertility increases post surgical repair.
- lifelong increased risk of testicular cancer (higher if uncorrected by puberty)
- do surgery by 12 months to prevent infertility
- may treat with HCG in older children
Phimosis - CORRECT ANSWER foreskin adheres, narrowing or stenosis. Do manual retraction & cleaning, may need circumcision if severe.
Bladder Extrophy - CORRECT ANSWER - moist non-adherent dressing
- may progress to renal failure
- eversion of the bladder through the abdominal wall.
- surgery done early to preserve renal function, prevent infection, attain continence and preserve renal function .
Nephrotic Syndrome - CORRECT ANSWER This is a clinical state or disorder, and not a single disease. May follow a previous upper respiratory condition. Usually occurs between ages 2-8.
- May be caused by several diseases or unknown.
- body is excreting too much protein. glomeruli become very permeable to protein.
- Causes change in osmotic pressure --> fluid into tissues, perioribtal edema, ascites (excess peritoneal fluid, 3rd spacing.
- Edema: swelling around eyes, hands, and feet. Facial edema subsides in the afternoon and replaced with abdominal, genital and lower extremity edema.
- decreased activity/fatigue
- foamy urine
- weight gain
- anorexia
- Labs: MASSIVE PROTEINURIA, HYPOALBUMINEMIA, HYPERLIPIDEMIA, & EDEMA, oliguria, and hypercholestermia.
Primary Nephrotic Snydrome - CORRECT ANSWER Can be from:
(1) MCNS: Minimal change nephrotic syndrome. Do renal biopsy and find that glomeruli look ok, but not functioning correctly. No scarring or damage.
(2) Inherited of from other cause of glomerular change (meds, antibiotics)
Complication of Nephrotic Syndrome - CORRECT ANSWER - hyper-coagulability leading to blood clot
- Fluid loss in vascular spaces causes hypovolemia, stimulates renin-angiotensin system. -- liquid portion of blood plasma is low. Symptoms are weakness, dizziness, decreased urine output. Treat with IV fluids, blood or both.
- Infection
Treatment of Nephrotic Syndrome - CORRECT ANSWER - steroids 1-3 weeks, then gradually tapered. (prednisone [prednisolone]). Prevents or delays loss of kidney function; may reduce protein levels.
- ACE inhibitors: "prils". can reduce proteinuria, but can cause hypotension.
- Immunosuppressive drugs if they do not respond to steroids.
- Diuretics:
(1) thiazide/loop diuretics, also called potassium sparing diuretics. Spironolactone (aldactone) & Triamterene (Dyrenium)
(2) Furosemide (Lasix): promotes diuresis, can cause dehydration, hypocalcemia and hypokalemia (low potassium)
- Regular diet with water and sodium restriction.
- Monitor I&O
- 1 1/2 X maintenance unless cardiac or renal contraindications.
- Sometimes IV albumin
Contraindications during corticosteroid therapy - CORRECT ANSWER - Live Vaccines (MMR & Varicella)
- PCV13
Relapse of Nephrotic Syndrome - CORRECT ANSWER - Common.
- If resolved by teenage years, usually no kidney damage.
- relapses may be triggered by infection.
Nursing Care for Nephrotic Syndrome - CORRECT ANSWER - Strict I&O
- testing urine protein (at least once daily)
- weights daily (same scale, time, clothing)
- skin care (will be stretched)
- V/S
- Monitor temp for infection
- Good Nutrition (low salt, low fat)
- Modified activity (no sports) until there is no more protein in the urine. Can take up to a year.
Acute Glomerulonephritis (AGN) - CORRECT ANSWER Many types & causes, but most commonly occurs post-streptoccocal hemolytic group A, in children (immune reaction)
- can also be chemical
- follows impetigo or strep
- More common in school age
- 10-21 recovery time
- Characterized by OLIGURIA, EDEMA, HYPERTENSION, INCREASED SPECIFIC GRAVITY, NEGATIVE URINE CULTURE, HEMATURIA, PROTEINURIA, & CIRCULATORY CONGESTION
Normal BUN levels in pediatrics - CORRECT ANSWER children under 2: 4-15 mg/dL
Older Individuals: 5-20 mg/dL
Good indication of renal function. Elevated in kidney disease, dehydration, hemorrhage, steroid therapy, and high protein intake.
Normal Creatinine Levels in Pediatrics - CORRECT ANSWER 0.2-1.0. Elevated in severe kidney disease
Uric Acid - CORRECT ANSWER Approximately 2-5.5 Also elevated in severe kidney disease
Normal Specific Gravity - CORRECT ANSWER of the urine in a child is <1.015 and infants <1.010. A specific gravity >1.025 in any child is suggestive of dehydration and >1.015 in infants as the infantile kidney can only maximally concentrate urine to
Diagnostics for AGN - CORRECT ANSWER - Positive ASO titer (antistreptolysin titer, indicating they recently had strep)
- mild proteinuria
- Chest X-Ray: possible cardiomegaly & pulmonary congestion
Management of Acute Glomerulonephritis - CORRECT ANSWER - Moderate Na & H2O restrictions
- AVOID HIGH K+ FOODS (bananas)
- Monitor V/S frequently
- may need seizure precautions
- check for ICP, Encephalopathy, CVA
- daily weights
- May be a standing order for an Antihypertensive if BP is highL (ACE inhibitors)
- Bedrest
- modified activity at home until no blood in urine (may take up to 6 months)
prognosis of acute glomerulonephritis - CORRECT ANSWER generally good. normal kidney function is restored after time, rest, and salt restrictions.
Prognosis of nephrotic syndrome - CORRECT ANSWER - in children due to minimal glomerular change & responds to corticosteroids = complete recovery
- in adults usually a manifestation of severe progressive renal disease
Estimating Bladder Capacity in children - CORRECT ANSWER By adding the #2 to their age. For example a 3-year old has a bladder capacity of approximately 5 fl. oz.
Which statement by a parent is most consistent with Minimal Change Nephrotic Syndrome (MCNS)?
1. My child missed 2 days of school last week because of a really bad cold.
2. After camping last week, my child's legs were covered in bug bites.
3. My child came home from school a week ago because of vomiting and stomach cramps.
4. We have a pet turtle, but no one washes their hands after playing with the turtle. - CORRECT ANSWER 1. Nephrotic Syndrome usually follows an upper respiratory infection. (around 1-3 days).
A 13-month old is discharged following a repair of his epispadias. Which statement made by the parents indicates they understand the discharge teaching.
1. If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage.
2. if a mucous plug forms in the urinary drainage tube, we will allow it to pass on its own because this is a sign of healing.
3. We will make sure the dressing is loosely applied to increase the toddler's comfort.
4. If we notice any ye - CORRECT ANSWER 1. mucous plugs should be irrigated to prevent blockage.
This dressing is usually a compression type that help prevents edema.
Which medication is mostly likely prescribed after a bladder exstrophy repair
1. Furosemide (lasix)
2. Mannitol
3. Meperidine (Demerol)
4. Oxybutynine (Ditropan) - CORRECT ANSWER 4. Oxybutynine (Ditropan) is used to help control bladder spasms.
Which two disaeases are at risk for Latex Allergy - CORRECT ANSWER - Cystic Fibrosis
- Bladder Exstrophy infants
Should stay away from playgrounds with rubber surfaces (turf), because they often contain latex.
- myelomeningocele patients
Sickle Cell Anemia & Thalassemia - CORRECT ANSWER Both developed as chromosomal mutations of normal hemoglobin, therefore both are hemoglobinopathies. Both are genetic (hereditary disease). Both provide some protection against malaria.
Genetic Inheritance of SCD - CORRECT ANSWER Autosomal recessive gene
SC trait is HgA and HbS where normal Hg is A.
- Sickle Cell C & Thalassemia are other forms of SCD.
- mild symptoms (anemia) with trait, but full life expectancy.
Pathophysiology of Sickle Cell Disease (SCD) - CORRECT ANSWER Sickle shaped RBC's obstruct flow, leading to tissue hypoxia, ischemia, infarction and necrosis. Ex:
- Vaso-occulusive crisis
- CVA
- Retinopathy
- Renal Problems
- Priapism (persistent painful erection)
- Leg Ulcers
- Ortho Changes
Body Recognizes Sickle Cell's as abnormal and destroys them faster than replacing them. - leads to fatigue & susceptibility to infection.
First action to prevent infarct in SCD - CORRECT ANSWER Increase fluids to prevent/disrupt obstruction--Assists in circulation of blood.
General Symptoms of SCD - CORRECT ANSWER - Poor growth/growth retardation
- Chronic anemia (Hg 6-9)
- Possible delayed sexual maturation.
- marked susceptibility to infection & sepsis
- risk for osteomyelitis
Blood Transfusions are done periodically for SCD when the hemoglobin is at ______ g/dL. - CORRECT ANSWER 6g/dL
Osteomyelitis - CORRECT ANSWER inflammation of bone and bone marrow.
- Treatment: is 4-6 weeks of IV antibiotic therapy for acute, and 6-8 weeks of oral antibiotic for chronic. Localized wound debridement as necessary.
Average Life expectancy for Sickle Cell Disease - CORRECT ANSWER On average is the 40's.
What produces Red Blood Cells in the Body? - CORRECT ANSWER The spleen and bone marrow.
Sequestrian Crisis - CORRECT ANSWER happens when a lot of sickled red blood cells become trapped in the spleen. Splenomegaly and damage.
- May do a splenectomy
- most common place for occlusion
- auto-splenectomy:s a negative outcome of disease and occurs when a disease damages the spleen to such an extent that it becomes shrunken and non-functional.
- patient will appear hypovolemic
- difficulty breathing because spleen is enlarged.
hyperhemolytic crisis - CORRECT ANSWER accelerated rate of RBC destruction characterized by anemia, jaundice, and reticulocytosis
increased ESR due to.. - CORRECT ANSWER increased fibrinogen (acute phase reactant)
anemia
aplastic crisis - CORRECT ANSWER A condition in which the body stops producing red blood cells; typically caused by infection. RBC count drops
chest syndrome - CORRECT ANSWER is a leading cause of death for patients with sickle cell disease (SCD) . Defined as a new radiodensity on chest radiograph accompanied by chest pain, fever and/or respiratory symptoms
- EKG to r/o MI
- REST to decrease demands!
- Then fluid
- Then oxygen
dactylitis - CORRECT ANSWER inflammation of the fingers and/or toes (hand foot syndrome)
- Painful!
- Treated with fluid and pain medication..
- FIRST clinical sign of SCD.
Diagnosis of SCD - CORRECT ANSWER - Hgb Electrophoresis
- Fetal Hg prevents symptoms until 6 months
- Prenatal D/x (Amnio, Chorionic Villi Sampling, Pre-implantation, In Vitro)
Treatment for SCD (Not in Crisis) - CORRECT ANSWER - Prophylactic Penicillin from 2 mos to age 6
- Folic acid everyday for life (1mg)
- Immunizations (especially Hib & Pneumococcal Vaccine)
- Hydroxyurea/ Butyric acid: enhance RBC production
- Erythropoietin
- Gene Therapy/Stem Cell
- Clotrimazole: helps prevent water loss from RBC's
- Nitric Oxide: helps keep blood vessels open/dilated
- Splenectomy
- Bone Marrow Transplant
Clotrimazole (Canesten) - CORRECT ANSWER Antifungal; helps prevent water loss from RBC's
Erythropoietin - CORRECT ANSWER A hormone produced and released by the kidney that stimulates the production of red blood cells by the bone marrow.
Hydroxyurea - CORRECT ANSWER - an antineoplastic drug (anti-cancer drug)
- used to reduce the number of painful crisis in sickle cell anemia and decreased need for transfusions in adult patients with a history of recurrent moderate to severe crises
butyric acid - CORRECT ANSWER increases # of RBC's
Nitric Oxide - CORRECT ANSWER vasodilator; improves oxygenation via vasodilatation of the ventilated part of the lungs, resulting in decreased shunting and improved ventilation-perfusion matching.
- Used in SCD
When to call HCP in SCD disease - CORRECT ANSWER sick with even a low-grade fever or a cold.
Nursing Care for SCD - CORRECT ANSWER - adequate hydration
- Promoting G&D
- Education (disease process, vaccines, F/U, when to call MD
- Anticipatory guidance (enuresis, delayed sexual maturation)
- Recognizing and avoiding infections
- Emotional Support of pt & family.
enuresis - CORRECT ANSWER bed wetting; normally stops at age 6, but may persist in Sickle Cell Disease.
What can cause constriction/occlusion in SCD - CORRECT ANSWER - Dehydration
- Cold Weather
- Stress
Nursing Care During SC crisis - CORRECT ANSWER - bed rest, decrease O2 demands
- hydration
- check electrolytes & maintain normal pH.
- Analgesics : opioids, PCA pump over age 6, AVOID DEMEROL, toradol (ketorolac), acetaminophen & ibuprofen when pain is less severe.
- Antibiotics
- O2 as indicated
- Comfort measures: heat , warm massage, IV fluids
Thalassemia - CORRECT ANSWER inherited defect in ability to produce hemoglobin, leading to hypochromia
- deficiency of b chain Hgb molecule from mutation of chromosome 11, increase in alpha chain, defect hgb & destruction of RBC's.
Cooley's anemia - CORRECT ANSWER Thalassemia major
If Thalassemia is left untreated - CORRECT ANSWER - chronic hypoxia (listlessness, pallor, anorexia, FTT, decreased exercise tolerance)
- bone changes (bossing/enlarged cheek bones); bones that do not normally aid in RBC production start to do so.
- Delayed sexual maturation
- Bronze discoloration of skin
- If untreated leads to death in early childhood from profound anemia & septicemia.
Thalassemia - CORRECT ANSWER
Treatment of Thalassemia - CORRECT ANSWER - Frequent blood transfusions for up to 3 weeks.
- Splenectomy in presence of severe splenomegaly.
- Monitor for iron overload.
Prevnar - CORRECT ANSWER pneumococcal conjugate vaccine
- give in sickle cell anemia unless there is a splenectomy or administer before splenectomy
Hib Vaccine - CORRECT ANSWER - give in sickle cell anemia unless there is a splenectomy or administer before splenectomy
- Prevents epiglottitis
Disease caused by Hib - CORRECT ANSWER - Pneumonia* (lung infection)
- Bacteremia (bloodstream infection)
- Meningitis (infection of the tissue covering of the brain and spinal cord)
- Epiglotittis (swelling in the throat)
- Cellulitis (skin infection)
Infectious arthritis (inflammation of the joi
Rotavirus causes what? - CORRECT ANSWER Gastroenteritis
Respiratory Syncytial Virus - CORRECT ANSWER A highly contagious virus that causes an infection of the upper and lower respiratory system.(Bronchiolitis, Pneumonia, Croup)
Palivizumab - CORRECT ANSWER There is no vaccine for RSV. This is a medication called palivizumab may prevent RSV infections and protect high-risk babies from serious complications of RSV infection.
RespiGam - CORRECT ANSWER IV immune gloulin that may be prescribed for high-risk infants to prevent complications from RSV; requires close observation for fluid overload
Risks for Repeated Transfusions - CORRECT ANSWER - Storages of excess iron = hemosiderosis & hemachromatosis
- damage to heart, liver, endocrine organs.
- Treated with Fe Chelation Therapy (Desferoxamine [Desferal]), Given with Vitamin C, Given over 12 hours OD, IV, usually after 1 year of transfusions, Exjade (Desferasirox) oral for children over 2.
Desferal (deferoxamine) - CORRECT ANSWER binds Fe and excretes in urine and stool **check renal function
Serum Ferritin test & Liver Biopsy to confirm ________ - CORRECT ANSWER Hemachromatosis and need for chelation therapy.
Ferritin - CORRECT ANSWER iron storage protein
Exjade (deferasirox) - CORRECT ANSWER oral chelation therapy for children over 2
Advanced T/x for SCD and Thalassemia - CORRECT ANSWER Bone marrow transplant. Need sibling.
Life expectancy for Thalassemia Major - CORRECT ANSWER 30's; Often die from iron overload. Important for RN's to emphasize chelation therapy and transfusion compliance. Assist client with coping skills (support groups).
What nursing care to prevent a crisis is the same for children with sickle cell disease and Celiac Disease?
1. Limit Activity
2. Protect from infection
3. Document color and consistency of stools.
4. Offer a low-carbohydrate, high protein, low-fat diet. - CORRECT ANSWER 2. Protect from infection
A low carb, low fat & high protein diet is not particularly helpful with these diseases. `
A 6 year old child with sickle cell disease is admitted for a vaso-occlusive crisis (painful episode). What are the PRIORITY nursing concerns? Select all that apply.
1. Nutrition
2. Hydration
3. Pain Management
4. Prevention from infection
5. Oxygen Supplementation - CORRECT ANSWER 2 & 3
Preventing from infection is not a priority at this time. Oxygen may be helpful to prevent further sickling, but it is not effective in reversing sickling because it cannot penetrate the sickled RBCs in the clogged blood vessels.
An adolescent in sickle cell crisis (knee pain) reports right knee pain. What should the nurse anticipate the health care provider will order?
1. Wrap the knee in a cold pack.
2. Apply a warm soak to the knee
3. Administer 0.5 mg of morphine
4. Decrease amount of IV fluids. - CORRECT ANSWER 2. Apply a warm soak to the knee.
0.5 mg of morphine would be insufficient for an adolescent.
A nurse is developing a teaching plan for a child who has anemia related to inadequate nutrition. In addition to iron, which nutrients should the nurse include that are necessary for RBC synthesis?
1. Protein
2. Calcium
3. Vitamin C
4. Vitamin D
5. Carbohydrates - CORRECT ANSWER Protein & Vitamin C.
(page 249 in nursing key terms topic review: pediatrics)
A nurse is explaining how hemophilia is inherited to the parents of a recently diagnosed child. What is the best explanation of the genetic factor that is involved?
1. The mother is the carrier of the disorder, but is not affected by it.
2. It is an autosomal dominant disorder in which the woman carries the trait.
3. A carrier can be male or female, but it occurs in the sex opposite of the carrier. - CORRECT ANSWER 1. The mother is the carrier of the disorder, but is not affected by it.
Number 3 describes sex-linked autosomal recessive disorders, but the carrier can only be a female.
Can acetaminophen be given to children with hemophilia? - CORRECT ANSWER Yes, Doctors often recommend acetaminophen, such as Tylenol, for pain relief in people who have hemophilia.
Desmopressin (DDAVP) - CORRECT ANSWER Increases circulating factor VIII, and secretion of vWF (both made by endothelial cells): Used for Mild hemophilia A
Principal Signs of Rheumatic Fever - CORRECT ANSWER Follows a strep infection.
(1) Fever
(2) Joint Pain (especially in knees, wrist or ankles) Joints become swollen, and often hot and red.
(3) Curved red lines or lumps (erythema marginatum) blanching in the middle of the lesions appear on the trunk, BUT NEVER ON THE FACE OR HANDS.
(4) Weakness, SOB, chest pain, carditis (involving mitral or aortic valve), murmur.
complication of rheumatic fever - CORRECT ANSWER rheumatic heart disease & sydenham chorea (neuro disorder - aimless movements of the face and extremities; grimacing present)
Diagnosis of Rheumatic Fever - CORRECT ANSWER - test for strep; looking for an increased AO titer, which would indicate a recent strep infection. 80% of case have had a positive strep infection in the past week or two.
- Jones Criteria
- Other S/x arthralgia, fever, elevated sedimentation rate or C-reactive protein, or a prolonged PR interval on EKG.
Treatment of Rheumatic Heart Disease - CORRECT ANSWER - Antibiotics (Penicillin, sulfdiazine, or erythromycin)
- Apsirin (ASA used for fever, arthritis, and arthralgia's(
- Corticosteroids to reduce inflammation and for severe carditis causing CHF.
Prognosis of Rheumatic Fever - CORRECT ANSWER Most children recover fully but are always at risk for another episode.
Symptoms of Kawasaki disease - CORRECT ANSWER - mild anemia
- elevated WBC count & ESR
- increase in plt's
- mild proteinuria and Pyuria (wbc in blood)
- increase in alanine aminotransferase
- hypoalbuminemia
- Strawberry Tongue!
- red, bloodshot eyes
- red swollen hands
- fever
- red cracked lips
- rash all over the body (compare with rheumatic heart disease)
Kawasaki disease - CORRECT ANSWER - (inflammation of blood vessels, hence the strawberry tongue) causes coronary artery aneurysms.
- More common in Asian and Pacific Islander children
- cause is unknown, it is an exaggerated immune response in genetically susceptible children.
Acute Phase of Kawasaki Disease - CORRECT ANSWER Lasts 1-2 weeks.
- Irritability
- High Fever
- red throat
- swollen hands & feet
- maculopapular rash on trunk, hands and feet
- enlarged cervical lymph nodes
- diarrhea
- hepatic dysfunction
Subacute phase of Kawasaki Disease - CORRECT ANSWER Lasts 2-4 weeks. Cracking of lips and fissures, desquamation of skin on the tips of fingers and toes, joint pain, cardiac disease, and thrombocytosis.
thrombocytosis - CORRECT ANSWER an abnormal increase in the number of platelets in the circulating blood
Convalescent stage of Kawasaki Disease - CORRECT ANSWER 6 to 8 weeks after the disaese child appears normal. lingering signs may appear.
Treatment of Kawasaki Disease - CORRECT ANSWER - IV immunoglobulins & ASA (Aspirin)
- Corticosteroids may be given
When may aspirin be indicated in pediatrics? - CORRECT ANSWER Rheumatic Fever and Kawasaki Disease
nursing care kawasaki disease - CORRECT ANSWER - Temp q 4 hours, bed rest, check the skin, eyes, and rash. I&O, Heart sounds, S/E of ASA, lubricate lips, and cool compresses.
atrial septal defect (ASD) - CORRECT ANSWER an opening in the wall between the upper chambers of the heart
patent ductus arteriosus - CORRECT ANSWER passageway between the aorta and the pulmonary artery remains open after birth
A newborn is Diagnosed with a congenital heart defect. The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. The defect is known as_____________> - CORRECT ANSWER patent ductus arteriosus
Tetrology of Fallot - CORRECT ANSWER DROP (Defect [VSD], septal, Right ventricular hypertrophy, Overriding aortas, Pulmonary stenosis)
Complications of Kawasaki disease - CORRECT ANSWER Thrombosis, Stenosis, and aneurysm.
"Machine like murmur" at birth - CORRECT ANSWER Patent Ductus Arteriosus (PDA)
Hypoxic spells in the infant with a congenital defect (CHD) can cause which of the following? Select all that apply.
1. Polycythemia
2.Blood Clots
3. Cerebrovascular Accident (CVA)
4. Developmental Delays
5. Viral Pericarditis
6. Brain Damage
7. Alkalosis - CORRECT ANSWER 1, 2, 3, 4, 6. Hypoxia causes polycythemia, leading to increased blood viscosity which can lead to blood clots and stroke. Developmental delays can also be caused by multiple hospitalizations and surgeries. This child usually catches up to the appropriate level. Hypoxic episodes cause acidosis, not alkalosis.
A 6-month old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called __________. - CORRECT ANSWER Tetralogy of Fallot
Supraventricular Tachycardia is associated with: - CORRECT ANSWER SVT is often above 200 bpm, resulting in dehydration. The rapid rate causes a low CO, resulting in low BP and prolonged capillary refill.
Two CHD that cause a hole in the septums - CORRECT ANSWER One is called an atrial septal defect (ASD), and the other is a patent foramen ovale (PFO). Although both are holes in the wall of tissue (septum) between the left and right upper chambers of the heart (atria), their causes are quite different.
symptoms of hypokalemia - CORRECT ANSWER muscular weakness, muscular spasms, tingling, numbness, fatigue, light headedness, palpitations, constipation, bradycardia, and, in severe cases, cardiac arrest can occur.
The nurse is caring for an 8 year old whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness?
1. Kawasaki Disease
2. Rheumatic Fever
3. Malignant Hypertension
4. Atrial Fibrillation - CORRECT ANSWER 2. Rheumatic Fever
Normal Urine Output for Children and Adults - CORRECT ANSWER - Oliguria is urine output < 500 mL in 24 h (0.5 mL/kg/h) in an adult.
- Oliguria is urine output < 1 L in 24 h (1 mL/kg/h) in a child.Children have smaller bladders and tend void more frequently.
A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in life for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest hurts, she says yes. Based on this history, the nurse suspects that she has:
1. Ventricular Septal Defect
2. Aortic Stenosis (AS)
3. Mitral Valve prolapse
4. Tricupsi - CORRECT ANSWER 2. AS can progress, and the child can develop exercise intolerance that be better when resting.
Rationale: (1) murmur and CHF are often found in infancy. VSD usually closes by 1 year of age. (3) Mitral Valve prolapse caueses a murmur and palpitations, usually in a adulthood. (4) Tricupsid Atresia causes hypoxemia in infancy.
Ventricular septal defect usually closes by ________ of life. - CORRECT ANSWER 1 year.
Other than TOF, which other CHD's causes hypoxemia in infancy - CORRECT ANSWER Pulmonary Atresia & Tricupsid Atresia
Symptoms of Coarctation of the Aorta - CORRECT ANSWER - Headache
- dizziness
- elevated BP
- Fainting
- Epistaxis
- Claudication (pain in your thigh, calf, or buttocks that happens when you walk.)
What medication is given in transposition of the great vessels? - CORRECT ANSWER Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery.
When would Transposition of the Great Vessels be repaired? - CORRECT ANSWER Transposition of the great vessels should be repaired before the toddler years. No gavage feeding will be necessary for this infant.
Which Vaccines must be delayed in must be delayed for 11 months after the administration of gamma globulin? Select all that apply.
1. Dtap
2. Hep B
3. Inactivated Polio virus
4. MMR
5. Varicella - CORRECT ANSWER 4 & 5
Normal Heart Rate for a 5 year old. - CORRECT ANSWER 80-110
Normal Heart Rate for Toddlers - CORRECT ANSWER 90-140
Normal Heart Rate for adolescents - CORRECT ANSWER 60-90
Normal Heart Rate for infants - CORRECT ANSWER 120-160
Signs of Digoxin Toxicity - CORRECT ANSWER green/yellow vision, bradycardia, nausea, vomiting
Therapeutic Digoxin Level - CORRECT ANSWER 0.8-2 ng/mL
patent ductus arteriosus (PDA) - CORRECT ANSWER passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth [Show Less]