Child Health + some legal/ethics

Question 1

Retinoblastoma

Answer 1

pupil has a white glow

normal= red pupil

Question 2

Strabismus (ie, ocular misalignment)

Answer 2

promoting use of the affected eye. by patching the normal eye

Question 3

Wilms tumor (nephroblastoma)

Answer 3

kidney tumor

abdomen should not be palpated

Question 4

acute postinfectious glomerulonephritis

low-sodium diet

Answer 4

risk for cerebral edema and pulmonary edema.

decreased glomerular filtration, resulting in systemic sodium and fluid retention.

Question 5

Hemolytic uremic syndrome (HUS)

Answer 5

life-threatening complication of Escherichia coli diarrhea

RBC hemolysis, AKI, and thrombocytopenia

Blood-streaked stools, dehydration, and fever are expected findings of E coli diarrhea that are treated with fluid and electrolyte replacement

Question 6

The nurse is caring for an infant who is choking. The nurse notes that the infant is kicking the legs and that the infant’s eyes are open. Which of the following actions should the nurse take?

Answer 6

5 back slaps between the shoulder blades with the heel of the hand, then turn the infant face up on the forearm and forcefully provide 5 downward chest thrusts

Question 7

In the emergency department, a pediatric client is placed on mechanical ventilation by means of an endotracheal tube. Several hours later, the nurse enters the room and finds the client in respiratory distress. It is most important for the nurse to take which of these actions?

Answer 7

auscultate lung sounds

to determine if the mechanical ventilation equipment is still properly placed in the trachea

An endotracheal tube (ET) can become displaced with movement.

Question 8

latex-free products + spina bifida
(myelomeningocele)

Answer 8

Until surgical repair is performed, the sac should be covered with a nonadherent, sterile, saline-soaked dressing to prevent drying.

Question 9

Preprocedural teaching for an electroencephalogram (EEG)

performed to identify the presence of a seizure disorder

Answer 9

washing the hair the night before

avoiding caffeinated beverages

reassuring the client that an EEG is painless.

Question 10

Babinski reflex

Answer 10

positive = toes fan outward and upward with stimuli)

is an expected finding in infants.

However, its presence after age 2 years can indicate neurologic disease.

Question 11

splenomegaly in
sickle cell crisis

Answer 11

large quantities of pooling blood in the spleen -> severe hypovolemia and shock

Question 12

Iron-deficiency anemia

Answer 12

caused by blood loss, malabsorption syndromes, or poor dietary intake of iron

perform a dietary recall and monitor stool frequency due to the risk for constipation from iron supplementation.

Question 13

Aplastic anemia

low all three

Answer 13

when the bone marrow fails to produce an adequate amount of new blood cells, resulting in pancytopenia (ie, decreased WBCs, RBCs, and platelets)

S/s
fatigue, pallor,
easy bruising/bleeding (eg, petechiae),
infections (eg, thrush).

Preparing the client for a bone marrow biopsy for diagnostic confirmation.
Hypocellular bone marrow (ie, a severe reduction in the number of cells), increased yellow marrow (ie, fat), and no evidence of blood cancer indicate AA.

Obtaining a blood specimen for blood type and crossmatch for blood product transfusions to replace both RBCs and platelets

Monitoring for signs of infection (ie, increased temperature) due to leukopenia

Monitoring for signs of bleeding (eg, hematoma) due to thrombocytopenia

Question 14

hemophilia A
“A 8”

Hemophilia B
“Ben 10-1=9”

Hemophilia C
11

Answer 14

deficiency of clotting factor VIII.

deficiency in clotting factor IX

a rare type of hemophilia, is due to a deficiency in clotting factor XI
does not cause spontaneous bleeding or hemarthrosis

Question 15

Phenylketonuria (PKU)

Answer 15

errors of metabolism

lack enzyme for converting the amino acid phenylalanine into the amino acid tyrosine

Eliminating high-phenylalanine foods (eg, meats, eggs, milk) from the diet
Feeding infants specially prepared formulas that are low in phenylalanine
Encouraging consumption of natural foods low in phenylalanine (ie, most fruits and vegetables)

Question 16

infant weight

Answer 16

should gain ≥5-7 oz (150-210 g) weekly

a decrease of 7%-10% may occur after birth, but should return to birth weight by 2 weeks

Question 17

Congenital hypothyroidism

Answer 17

Difficulty awakening, lethargy, or hyporeflexia
Dry skin
Hoarse cry
Constipation
Bradycardia

Question 18

Patent ductus arteriosus (PDA

acyanotic

loud, machine-like systolic and diastolic murmur

Answer 18

blood shunts from the aorta back to the pulmonary arteries via the open ductus arteriosus.

Many clients are asymptomatic except for a loud, machine-like systolic and diastolic murmur compared to the typical S1 and S2 heart tones

Question 19

If a single rescuer witnesses cardiac arrest in a pediatric client:

Answer 19

the rescuer should immediately activate the emergency response system,

then provide approximately 2 minutes of CPR at a rate of at least 100 compressions/min before retrieving the AED

Single rescuers performing infant CPR should use a 30:2 compression-to-breath ratio. A compression-to-breath ratio of 15:2 is used when two rescuers are involve

Question 20

atrial septal defect

a characteristic systolic murmur with a second heart sound that is split

Answer 20

abnormal opening between the right and left atria, allowing blood from the higher pressure left atrium to flow into the lower pressure right atrium

The flow of blood between the two chambers causes a vibration that is heard as a murmur on auscultation

a characteristic systolic murmur with a second heart sound that is split

Question 21

Right-to-left congenital heart defects

cyanotic defects

tetralogy of Fallot, transposition of the great vessels

Answer 21

impede pulmonary blood flow (eg, tetralogy of Fallot, transposition of the great vessels) and cause cyanosis, which is evident shortly after birth and during periods of physical exertion.

Clubbing of the fingertips is associated with chronic hypoxia caused by decreased pulmonary circulation as occurs with right-to-left heart defects.

Question 22

Left-to-right shunting results in pulmonary congestion

acyanotic defect

Answer 22

causing increased work of breathing and decreased lung compliance

Tachypnea
Tachycardia, even at rest
Diaphoresis during feeding or exertion
Heart murmur or extra heart sounds
Signs of congestive heart failure
Increased metabolic rate with poor weight gain

Question 23

Separation anxiety

106-151

Answer 23

begins around age 4-6 months and may last until age 3 years

Question 24

Involuntary bedwetting

Answer 24

Encourage the child to assist with changing soiled pajamas and linens

Awaken the child nightly at a specified time to void

Question 25

Autism spectrum disorder

Answer 25

usually apparent before age 3

Deficiency in nonverbal communication (eg, lack of spontaneous eye contact)

Underdeveloped language ranging from absent to delayed speech

Repetitive or restricted activities and interests

Language regression, which involves losing previously acquired language and/or social skills

Question 26

SIDS

sleep on the back
firm sleep surface

no loose or soft items (eg, blankets, toys, stuffed animals) to prevent suffocation

smoke-free environment
breastfeeding
updated vaccinations

Answer 26

Risk factors

Substance use (eg, cigarettes,
alcohol, recreational drugs)
Maternal age <20
Inconsistent prenatal care

Prematurity or low birth weight
Sleep environment
Prone-/side-sleep position
Soft sleep surface, loose bedding
Bed sharing
Smoke exposure

Question 27

Infant growth

Answer 27

double the birth weight by age 6 months

triple by age 12 months

Question 28

fontanels

Answer 28

posterior fontanel - normally closes by age 2 months

anterior fontanel fuses by age 18 months

temporary bulging when the infant cries, coughs, or is lying down = normal

Question 29

Occupational therapy
“above the waist”

vs

Physical therapy
“below the waist.”

Answer 29

PT focuses on mobility, ambulation, ability to transfer, and use of related equipment.

Question 30

case manager

Answer 30

assesses client needs, decreases fragmentation of care
helps to coordinate care and communication between HCPs
makes referrals
ensures quality standards are being met
arranges for home health or placement after discharge

Question 31

Adverse event

Answer 31

is an injury to a client caused by medical management rather than a client’s underlying condition.

It may or may not be preventable

ex:
Diagnostic (delay in diagnosis, failure to employ indicated tests, failure to act on results of monitoring)

Treatment (error in performance of procedure, treatment, dose; avoidable delay)

Preventive (failure to provide prophylactic treatment, inadequate follow-up/monitoring of treatment)

Other (failure of communication, equipment failure, system failure)

Question 32

circumstances in which the nurse is legally required to report to appropriate civil authorities:

report an impaired coworker, a suspicious death, and elder abuse to appropriate authorities.

reportable sexually transmitted disease

Question 33

To leave against medical advice (AMA)

Answer 33

client must be legally competent to make an educated decision to stop treatment.

Disqualifications for legal competency:
altered consciousness,
mental illness (ie, a danger to self or others),
being under chemical influence (eg, drugs or alcohol).

Question 34

Sentinel events “never events”

vs

near misses

Answer 34

Sentinel events (ie, “never events”) are unanticipated, preventable errors that cause significant client harm or death.

Surgical or invasive procedure errors (eg, wrong body site, wrong procedure, unintended foreign object retention)

Inpatient suicide

Medication errors that result in harm (eg, severe reaction to a medication that was documented as an allergy)

Unanticipated death of a full-term infant

Discharge of an infant to the wrong family

Criminal events (eg, sexual abuse, homicide)

Near-miss events are medical errors that are identified before reaching the client and do not cause harm.

Question 35

do not document that an incident report was filed, or refer to the incident report in the medical record.

Question 36

An emergent call is warranted if a client:

Falls
Deteriorates significantly or dies
Has critical laboratory results
Needs a prescription that requires clarification
Leaves against medical advice or runs away
Refuses key treatments in a relevant period

Answer 36

HCP should be called after the initiation of hospital protocols (eg, stroke, code blue) and after a concerning assessment finding (eg, significant change in vital signs, unilateral drift, change in level of consciousness, signs of trauma after a fall )

Question 37

ethical principles

Answer 37

Fidelity
is exhibiting loyalty and fulfilling commitments
It includes meeting the expected responsibilities of professional nursing practice and provides the basis of accountability (taking responsibility for one’s actions)

Nonmaleficence
do no harm
relates to protecting clients from danger when they are unable to do so themselves due to a mental/physical condition (eg, children, client with Alzheimer disease) and from a nurse who is impaired

Autonomy
the right to make decisions for oneself (eg, informed consent). Although having an advance directive is an example of autonomy, requiring one violates this principle. The client has a right to refuse even if the nurse believes it is in the client’s best interest.

Beneficence
to do good (eg, implementing interventions to promote the client’s well-being).

justice refers to treating all clients fairly (ie, without bias).

Veracity is telling the truth as a fundamental part of building a trusting relationship.

Question 38

Testicular torsion is an emergency

Answer 38

testicular ischemia and necrosis of the testis

There is a short time frame in which testicular torsion can be identified with ultrasonography and treated (to untwist the rotation), generally 4-6 hours, making this condition a priority

Question 39

Hypoglycemia > hyperglycemia during triage

Answer 39

The lack of glucose in the brain is also responsible for other symptoms, including disorientation, impaired vision and speech, seizures, and coma

Question 40

Patent ductus arteriosus (PDA)

Answer 40

when the ductus arteriosus remains open, causing blood to shunt from the aorta to the pulmonary artery (ie, left-to-right shunt).

A loud, machine-like systolic murmur is expected.

Question 41

Ventricular septal defect (VSD)

Answer 41

an opening between the ventricles results in shunting of oxygenated blood from the left to the right ventricle.

VSD =pulmonary congestion -> HF

Grunting during feeding in clients with a VSD could indicate fatigue due to cardiac compromise and decreased oxygen reserve

Question 42

Coarctation of the aorta

Answer 42

narrowing of the descending aorta

= increased blood flow to the upper extremities (eg, bounding radial pulse)

decreased blood flow to the lower extremities.

Question 43

tetralogy of Fallot

Answer 43

chronic hypoxemia due to decreased pulmonary blood flow (pulmonary stenosis) and delivery of unoxygenated blood to systemic circulation (ie, right-to-left shunt).

Chronic hypoxemia will manifest as digital clubbing

Question 44

Intrahepatic cholestasis of pregnancy (ICP)

Answer 44

liver disorder exclusive to pregnancy that typically occurs during the third trimester
causes generalized pruritus that is worse on the hands and feet; however, no rash is present.

ICP increases the risk for fetal complications.

Question 45

Intussusception

Answer 45

when one section of bowel telescopes over another.

Inconsolable crying, drawing up of the legs toward the abdomen, and “currant jelly” stools (mixed with blood and mucus)

It is an emergency and can lead to bowel obstruction, decreased blood supply, and perforation.

Question 46

Mild to moderate fever and local reactions are common after diphtheria, tetanus, acellular pertussis (DTaP) injections

Answer 46

the most serious reactions that require priority attention:

Severe allergic reaction (eg, anaphylaxis)

encephalopathy (eg, decreased level of consciousness, prolonged seizures)

Question 47

Celecoxib (Celebrex), a COX-2 inhibitor

black box warning for increased risk of cardiovascular complications

Answer 47

Myocardial infarction symptoms, which can be vague in female clients, include nausea and upper back and shoulder pain. These symptoms would be the priority to assess first, and immediate testing (ie, ECG, cardiac enzymes) would be warranted.

Myocardial infarction in an elderly woman can present with atypical symptoms (eg, shoulder pain, nausea)

Question 48

A and B

airway and breathing

Prioritizing care

Answer 48

A
Acute alcohol intoxication can cause unconsciousness and vomiting

B
-acute asthma exacerbation
-tension pneumothorax, anaphylaxis/angioedema, and flail chest need emergency evaluation.

Prioritizing care:

Anaphylactic reactions must be treated immediately

systemic symptoms are more important than local symptoms.

In prioritization, the severity of ABC is more important than absolute order. As a result, a severe “C” client comes before a stable “B” client.

Question 49

copper IUDs

Answer 49

heavier bleeding and increased cramping during menses

check for the strings at least monthly to ensure that the IUD has not been expelled

have an immediate contraceptive effect; backup contraception is not required

Question 50

medications that are contraindicated during pregnancy

Answer 50

ACE inhibitors (eg, lisinopril), ARBs

isotretinoin

doxycycline

tetracyclines

Question 51

postpartum psychosis

Answer 51

often seen in clients with bipolar disorder

move the pt to a room away from the newborn
ask about thoughts of self-harm,
assist with involuntary placement to a psychiatric hospital.

Question 52

HELLP syndrome is a life-threatening disorder of pregnancy marked by specific laboratory abnormalities

Hemolysis
Elevated Liver enzymes
Low Platelet count

Question 53

end #134