final exam Flashcards
2
Q
Malabsorption d/t decreased mucosal area?
A
SBS
2
Q
Barrel chest indicates?
A
Severe obstructive lung disease (CF, asthma)
2
Q
When does heart begin to form in utero?
A
4th week
3
Q
Initial management after delivery of infant with omphalocele?
A
InspectionIf bowel covering is intact, a nonadherent dressing is placed over the defect. If exposed, the contents are covered with a bowel bag or moist dressings and plastic drape to prevent excessive fluid loss, drying, and temp instability.IVF and ABXgastric bowel decompression - with silastic double-lumen cath (NG-OG)
3
Q
Diaphragmatic differences in infants under 5 years of age?
A
Diaphragmatic abdominal breathing
3
Q
When is heart completely formed in utero?
A
8th week
4
Q
Most common cause of intestinal obstruction in children b/w ages 3 months and 3 years?
A
Intussusception
4
Q
When are respirations (ventilations) best to assess and best determined in a child/infant?
A
While sleeping or quietly awake
4
Q
Fetal circulation
A
Brain-needs highest O2 concentrationLungs - nonfunctionalLiver - partially functional*Fetus needs < blood in liver/lungs
5
Q
The DX of HPS is PRIMARILY based on?
A
H&P - PRIMARY -projectile vomiting, olive shaped massU/S - 2nd choiceUpper GI radiography - 3rd choice
5
Q
When should an infant be able to hold their head up?
A
4-5 mo
6
Q
Most common manifestation of GER during infancy?
A
Passive regurgitation or emesis
6
Q
Tachypnea often occurs with?
A
AnxietyElevated tempSevere anemiaMetabolic acidosisMAY be assoc. w/resp alkalosis d/t psychoneurosis and w/CNS disturbances.
7
Q
Occurs when the abd contents herniate through the umbilical ring, usually with an intact sac?
A
Omphalocele
7
Q
Hyperpnea is assoc. with?
A
FeverSevere anemiaRespiratory alkalosis assoc. w/psychosisCNS disturbancesResp acidosis that accompanies DKA/diarrhea
7
Q
Leading cause of death in children under the age of 15?
A
CA
8
Q
Most common site of intussusception?
A
Ileocecal valve (ileocolic)
8
Q
Head bobbing in a sleeping or exhausted infant is a sign of ?
A
Dyspnea
9
Q
When does GER most frequently occur?
A
After meals and at night
9
Q
COMMON causes of stridor?
A
CroupEpiglottitisFBTracheitis
10
Q
Clinical manifestations of Intussusception?
A
Sudden acute abd painchild screaming and drawing knees to chestchild appearing normal & comfortable b/w episodesvomitinglethargypassage of red, currant jelly-like stoolsTender distended abdpalpable sausage shaped mass in RUQEmpty RLQeventual s/s of peritonitis (fever, prostration, etc)
10
Q
Grunting in older children is frequently a sign of?
A
Pain, suggesting pneumonia or pleural involvement.
11
Q
SBS prognosis?
A
Improved with advances in PN and enteral nutrition.Intact Ileocecal valve improves prognosis
11
Q
GRUNTING from an infant or newborn is a characteristic sign of?
A
Respiratory distress
12
An infant with SBS will be discharged home on TPN and gastrostomy feedings. Nursing care should include which of the following?
A. Prepare family for impending death.
B. Teach family how to calculate caloric needs.
C. Ensure that family can identify signs of central venous catheter infections.
D. Secure TPN and gastrostomy tubing under diaper to lessen risk of dislodgment.
C. RATIONALE: During TPN therapy care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis for patients with SBS depends in part on the length of residual small intestine. It has improved with advances in TPN. Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. The tubes should not be placed under the diapers because of the risk of infection. p. 1328
12
What causes wheezing in infants?
Increased airway resistance and a compliant chest wall.Inflammatory mediators (histamines, leukotrienes, interleukins)
13
An infant who was born yesterday is scheduled for surgery tomorrow. Which of the following interventions in the pre-op period will be the most helpful in assessing post-op pain in this neonate?A. Assess neonate’s behavior. B. Interview mother about neonate’s behavior. C. Ask mother what measures comfort neonate. D. Assess neonate’s response after inducing pain.
A. A pre-op assessment of the infant's behavior is essential. This provides a baseline against which to measure post-op behavior. Changes may indicate pain or unstable condition. The mother will not have had an opportunity to learn the infant's response to pain and comfort measures.
13
Older children often have wheezing because of?
A LRI as a result of inflammation, bronchospasm, and secretions
14
Why is Necrotizing Enterocolitis so serious?
Because it occurs in infants, who cannot describe their pain level -- so it can be missed or overlooked
14
Criteria for the presence of clubbing?
Angle \> 160 degrees and decided curvature of the nail
15
Pre-op care for infant with HPS undergoing a pyloromyotomy?
Decompression with NGHydration and Lyte balanceNPOIVF of glucose and Lytes
15
8. Of the following resp system structures, the one that does not distribute air is the:a. bronchialb. alveolusc. bronchusd. trachea
B
16
DX of Hirschspung Disease?
Neonate: Clinical signs or failure to pass meconiumInfants & children: H&PRectal BX confirms DXBarium enema
16
9. The general shape of the chest at birth is:a. relatively roundb. flattened from side to sidec. flattened from front to backd. the same shape as an adult's
A
17
Mr. and Mrs. Wilson have a newborn with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. The nurse's intervention should include which of the following?A. Explain the disorder so they can explain it to others. B. Help parents understand that this is a minor problem. C. Encourage parents not to worry while the tests are being done. D. Suggest that parents avoid family and friends until the gender is assigned.
A.Although ambiguous genitalia may appear as one entity, there are many causes. It is essential that the parents understand the complex issues that are involved in gender assignment as they work with the multidisciplinary team. Depending on the etiology, this can be a life-long problem. Gender assignment should be a slow, deliberative process. Telling the parents not to worry negates their concern about their child. Suggesting that parents avoid family and friends until the gender is assigned is not realistic.
17
10. The infant relies primarily on:a. mouth breathingb. intercostal muscles for breathingc. diaphragmatic abdominal breathingd. all of the above
C
18
Biliary Atresia Management?
Nutritional support Kasai procedureliver transplant
18
11. Because of the position of the diaphragm in the newborn:a. there is additional abd dist from gas and fluid in the stomach.b. the diaphragm does not contract as forcefully as that of an older infant or child.c. diaphragmatic fatigue is uncommond. lung volume is increased
B
19
HPS has GREATEST risk of recurrence in which individual?
First-born boy of a mother who was affected.
19
12. Which of the following is true in regard to the anatomy of an infant's nasopharyngeal area?a. the glottis is deeping in infants than older childrenb. the laryngeal reflexes are weaker in infants than older childrenc. the epiglottis is longer and projects more posteriorly in infants than adults.d. the infant and youg child are both less susceptible than adults to edema formation in the nasopharyngeal region.
C
20
The nurse is caring for a neonate born with an omphalocele. Initial mgmt after delivery includes:A. Beginning breast-feeding B. Supine positioning with nasogastric feedings C. Covering the omphalocele with saline-soaked gauze and plastic drape D. Using radiant warmer to dry sac and maintain neutral thermal environment
C.The sac is covered to prevent drying and excessive fluid loss from the neonate. The child will not be fed. With the abdominal contents outside of the infant, the stomach is decompressed and the infant is maintained with parenteral nutrition.
20
13. List four anatomic factors that significantly affect the development of respiratory disorders in infants.
Fewer # of alveoliSmaller size of alveoliMore shallow air sacksDecreased surface area for gas exchange
21
Biliary atresia is not seen in the _________ or _______ or _________ infant.
fetusstillbornnewborn
21
14. The condition that is most likely to reduce the # of alveoli in the newborn is:a. maternal heroin useb. increased prolactinc. hyperthyroidismd. kyphoscoliosis
D
22
Primary source of nutrition in children with SBS?
PN
22
15. As a child grows, chest wall comopliance:a. increasesb. decreases
B
23
Which of the following is an important nursing consideration in the care of a child with celiac dz?A. Refer to a nutritionist for detailed dietary instructions and education. B. Help child and family understand that diet restrictions are usually only temporary. C. Teach proper hand washing and Standard Precautions to prevent disease transmission. D. Suggest ways to cope more effectively with stress to minimize symptoms.
A: RATIONALE: The main consideration is helping the child adhere to dietary management. Considerable time is spent in explaining to the child and parents the disease process, the specific role of gluten in aggravating the condition, and those foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible. Celiac disease is not stress related. pp. 1326, 1327
23
16. As the child grows, elastic recoil of the lungs:a. increasesb. decreases
A
24
Nursing Care for SBS?
NUTRITIONAL THERAPYPrevent complications r/t central venous device
24
17. Relaxation of the bronchial smooth muscles occurs in response to:a. parasympathetic stimulationb. inhalation of irritating substancesc. sympathetic stimulationd. histamine release
C
25
Which of the following is the earliest clinical manifestation of biliary atresia?A. Jaundice B. Vomiting C. Hepatomegaly D. Absence of stooling
A.Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until ages 2-3 wks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.
25
18. Room air (ambient air) consists of:a. 7% O2b. 21% O2c. 50% O2d. 79% O2
B
26
True or False:HPS is a congenital disorder.
FALSEIt is NOT a cong disorder
26
19. A child with anemia tends to be fatigued and breathe more rapidly, b/c the majority of O2 is carried through blood as:a. a solute dissolved in the plasma and the H2O of the RBCsb. bicarbonate and hydrogen ionsc. carbonic acidd. oxyhemoglobin
D
27
Passage of red, currant jelly-like stools occurs with?
Intussusception
27
21. In a child, cough may be absent in the early stages of:a. CFb. measlesc. pneumoniad. croup
C
28
Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies, which are now being successfully treated with antihistamines. In this situation, the constipation is most likely caused by which of the following?A. Diet B. Puberty C. Allergies D. Antihistamines
D. Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known change in her habits, the addition of antihistamines is the most likely cause of the constipation. A: With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. B: With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. C: With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. p. 1303
28
A sign of dyspnea in the infant who is sleeping or exhausted?
Head bobbing
29
Which of the following reflexes appear at about 7 to 9 months of age?A. Moro B. Parachute C. Neck righting D. Labyrinth righting
B: The parachute reflex appears at 7 to 9 months of age and persists indefinitely. The Moro reflex is one of the primitive reflexes present at birth. Neck righting appears at 3 months of age and persists until 24 to 36 months. Labyrinth righting appears at 2 months and is strongest at 10 months.
29
Respirations are too deep?
Hyperpnea
30
Dx of Intussusception?
Frequently made on subjective data alone.Definitive DX-Barium enema (MUST do abd XR 1st)Rectal exam - reveals mucus
30
Respirations are too shallow?
Hypopnea
31
Clinical manifestations of Hirschspung Disease during childhood?
ConstipationRibbonlike, foul-smelling stoolsAbd distentionvisible peristalsiseasily palpable fecal massUndernourished, anemic in appearance
31
May be a complaint of older children; may be caused by disease of any of the chest structures?
Chest pain
32
The RN should assess a child DX with HPS for which of the following?? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis
C. Metabolic alkalosis
32
May be referred to the base of the neck posteriorly and anteriorly or to the abdomen?
Diaphragmatic pleural irritation
33
Pica refers to which of the following? A. Overeating of nonnutritive food substances B. Refusal to eat proper amts of food despite its availability C. Obsessive ingestion of unusual foods that persists over time D. Compulsive and excessive ingestion of both food and nonfood substances
D. Pica is the compulsive and excessive ingestion of both food and nonfood substances. Food picas include the excessive eating of ordinary foods or unprepared food substances, such as coffee grounds or uncooked cereals. Nonfood picas include the ingestion of substances such as clay, soil, stones, laundry starch, paint chips, ice, hair, paper, rubber, and feces. A: Pica also includes the eating of nonfood substances. B: Eating, not refusing to ingest, is the issue in pica. C: Nonfood substances are also involved. p. 1298
33
Significant finding in an infant; helps reduce resistance and maintain airway patency?
Nasal flaring
34
Transfer of gastric contents into the esophagus?
Gastroesophageal reflux (GER)
34
Proliferation of tissue at the terminal phalanges; associated with chronic hypoxia; does NOT reflect disease progression?
Clubbing
35
Acute inflammatory disease of the bowel with increased incidence in preterm and other high-risk infants.
Necrotizing Enterocolitis (NEC)
35
Frequently associated with hypertrophied adenoidal tissue, choanal obstruction, polysps, or foreign body in the nasal passages?
Noisy breathing
36
Pica refers to which of the following?
A. Overeating of nonnutritive food substances
B. Refusal to eat proper amounts of food despite its availability
C. Obsessive ingestion of unusual foods that persists over time
D. Compulsive and excessive ingestion of both food and nonfood substances
Biliary atresia
36
Usually localized over the affected area and aggravated by respiratory movement?
Parietal pleural pain
37
DX of biliary atresia is confirmed by?
Exploratory lap & intraoperative cholangiogram
37
Frequently a sign of chest pain; suggests acute pneumonia, pleural involvement, pulmonary edema, or respiratory distress syndrome; increases end-respiratory pressure and prolongs gas exchange?
Grunting
38
Manifestations of Malrotation?
Bilious vomitingAbd painAbd distentionGI bleeding
38
Performed to assess adequacy of collateral circulation?
Allen test
39
Cong anomaly resulting in mechanical obstruction from inadequate motility of part of the intestine?
Hirschspung Disease (Cong Aganglionic Megacolon)
39
HgB saturated with O2?
Oxyhemoglobin
40
The nurse is assessing a 6-month-old infant who has head lag. The nurse should recognize which of the following?A. This is normal. B. Child is probably cognitively impaired. C. Developmental-neurologic evaluation is needed. D. Parent needs to work with infant to stop head lag.
C: Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months head control is well established. Developmental-neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. A 6-month-old infant with head lag is a sign of delay. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified.
40
A noninvasive method of continuously monitoring partial pressure of O2 in arterial blood; may also be used to measure CO2?
Transcutaneous monitoring
41
Which of the following is an important consideration in understanding the reactions of parents when their infant is born with physical defects?A. Grief lasts until the defects are repaired. B. Denial is a common maladaptive reaction. C. The psychologic reaction is similar to that with the death of an infant. D. Reactions of health professionals to the birth of an infant do not affect parents’ reactions.
C. Parents need to grieve for the loss of the expected child. They also must adapt to the needs of a child with physical defects and the additional demands this will place on the family. The grief usually consists of several stages, including shock, frustration, and anger. The grief response may last for years. Denial and disbelief during the shock phase are not maladaptive. They can serve to protect the parents as they begin to deal with the impact of the initial stress. Parents are sensitive and responsive to the behaviors of others. Health professionals' interactions w/the infant and parents provide cues to the parents that can greatly influence their reaction to the infant.
41
HgB capable of carrying O2?
Functional HgB
42
According to Erikson, infancy is concerned with acquiring a sense of which of the following?A. Trust B. Industry C. Initiative D. Autonomy
A: During the first year of life, the infant focuses on the task of developing a sense of trust of self, of others, and of the world. This presents challenges for infants who are separated from parents or consistent caregivers. Industry is the focus of school-age children. Preschoolers are engaged in acquiring initiative. Autonomy is a developmental task during the toddler years.
42
HgB that is not saturated with O2?
Deoxyhemoglobin
43
NEC PATHO?
Damage to mucosal cells lining the bowel wallDiminished blood supply to mucosal cells causes their deathUnable to secrete protective, lubricating mucusThin, unprotected bowel wall is attacked by proteolytic enzymesGas-forming bacteria produce intestinal pneumatosis (presence of air in submucosal/subserosal surfaces of bowel)
43
Reduced blood oxygenation?
Hypoxemia
44
Which of the following vaccines is recommended for administration at birth?A. MMR B. Hepatitis B C. Hepatitis A D. Haemophilus influenzae type b
B: Hep B immunization is recommended early. Hep B virus infections that occur during childhood can lead to fatal consequences from cirrhosis or liver cancer during adulthood. MMR is recommended for children ages 12 to 15 months. The hep A series should begin between 12 and 23 months. Hib is administered beginning at age 2 months.
44
A hazard of O2 therapy; may occur in persons with chronic pulmonary disease; seldom encountered in children except those with CF?
Oxygen-induced CO2 narcosis
45
Abdominal pain, abdominal mass, and bloody stools are the classic triad of ________ symptoms?
Intussusception
45
Examples: Passy-Muir, Kistner, and Tucker; not appropriate for use in seriously ill children, children using a trach cuff, or children with copious secretions?
Speaking valves
46
Nursing Interventions for GER?
· Position with head elevated 30-45 º· Small, frequent feedings with adequate burping· Provide client teaching and discharge planning· Teach parents how to position and feed infant· Administration of medications
46
Used to help move secretions toward the head during exhalation?
Vibration
47
HPS may be associated with other disorders such as?
Intestinal malrotationEsophageal and duodenal atresiaAnorectal anomalies
47
A new type of MDI that does NOT require a spacer device?
Rotahaler or Turbuhaler
48
A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be which of the following?A. Encourage her to express her feelings. B. Suggest holding baby but without eye contact. C. Restate what the physician has told her about plastic surgery. D. Recognize that attachment usually does not occur until after initial surgery.
A. For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must emphasize not only the infant's physical needs but also the parents' emotional needs. The mother needs to be able to express her feelings before she can accept her child. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The child's normalcy is emphasized, and the mother is assisted in recognizing the child's uniqueness. Although this will be addressed, it is not part of the initial therapeutic approach. Maternal-infant attachment usually is not negatively affected at this stage.
48
A form of CPB; provides both pulmonary and cardiac support?
ECMO
49
Labs associated with HPS?
Metabolic alterations d/t dehydration.Decreased Cl Increased pH & HCO3 (Metabolic alkalosis)Increased BUN
49
Techniques that are useful with older motivated children with kyphoscoliosis, CF, asthma, or bronchiectasis?
Breathing and postural exercises
50
Most serious type of intestinal obstruction? Why?
Malrotation!Because, if the intestine undergoes complete volvulus (twisting around itself), it will lead to intestinal necrosis, peritonitis, perforation, and death.
50
The method of O2 administration that is BEST tolerated by infants?
O2 hood
51
The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. Which of the following should the nurse suggest to help them deal with this problem?A. Let her cry herself back to sleep. B. Put her in parents’ bed to cuddle. C. Start putting her to bed while still awake while the parent is present. D. Give her a bottle of formula instead of breast-feeding her so often at night.
C: Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Cobedding could be unsafe at this age. The type of feeding will not affect the child's sleep pattern.
51
A generic term for devices that use a rapid cycling rate and deliver small tidal volumes with each cycle?
High-frequency ventilation
52
DX of GER?
H&PUpper GI 24 hr intraesophageal pH - GOLD STANDARD!!!Scintigraphy-detects radioactive sub feeding comp.
52
A method of O2 administration that is NOT usually well tolerated by children?
Oxygen mask
53
The nurse is caring for a boy with probable intussusception. He had diarrhea before admission, but while waiting for a barium enema, he passes a normal brown stool. The most appropriate nursing action is which of the following?A. Notify physician. B. Measure abdominal girth. C. Auscultate for bowel sounds. D. Take vital signs, including blood pressure.
A. RATIONALE: Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic and therapeutic care plan. The first action would be to report the normal stool to the practitioner. p. 1325
53
Absence of airflow (or absence of breathing that lasts for more than 20 seconds?)
Apnea
54
Pyloric stenosis can best be described as which of the following?A. Dilation of pylorus B. Hypertrophy of pyloric muscle C. Hypotonicity of pyloric muscle D. Reduction of tone in the pyloric muscle
B. RATIONALE: Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of pylorus, hypotonicity of pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis. p. 1322
54
Occurs in 2 conditions: (1) when there is increased work of breathing with near-normal gas exchange function, and (2) when hypoxemia and acidosis develop secondary to CO2 retention?
Respiratory insufficiency
55
Leads to cirrhosis, liver failure, and eventually death if untreated?
Biliary atresia
55
Absence of air flow that occurs when no respiratory efforts are present?
Central apnea
56
This condition usually develops in the first few weeks of life, causing projectile vomiting, dehydration, metabolic alkalosis, and failure to thrive (FTT)??
Hypertrophic pyloric stenosis (HPS)
56
Condition in which components of central and obstructive apnea are present?
Mixed apnea
57
When assessing an infant, the nurse notes the infant to be hungry and irritable. The mother states the her child has been vomiting a lot which explains why the infant is dehydrated and has lost weight. The nurse should suspect?
HPS
57
The cessation of respiration?
Respiratory Arrest
58
Occurs when the intestine herniates lateral to the umbilical ring, usually to the right of the umbilicus and without a sac?
Gastroschisis
58
Disease involving increased resistance to airflow?
Obstructive lung disease
59
Biliary atresia manifestations?
Healthy @ birth JAUNDICE (after two wks needs testing!!) CLAY colored stool d/t no bile pigmentDark urineLiver is firm on palpation Enlarged liver early in the DZ
59
Disease involving impaired lung expansion?
Restrictive lung disease
60
occurs in approx. 1 in 10,000 - 15,000 live births?
Biliary atresia
60
May be caused by cerebral trauma, intracranial tumors, CNS infection, tetanus?
Respiratory center depression
61
Clinical manifestations of Hirschspung Disease during the newborn period?
Failure to pass meconium w/in 24-48 hr after birthRefusal to feedBilious vomitingAbd distention
61
Includes pulmonary edema, fibrosis, embolism?
Pulmonary diffusion defect
62
Manifestations associated with HPS in infants?
Vomiting begins at 3 wk (may start @ 1 wk to 5 wk)PROJECTILE VOMITINGVisual peristalsisMETABOLIC ALKALOSISNonbilious vomiting (early stages)Projectile and progressiveBrown in later stages if gastritis develops
62
Used to relieve FB obstruction in infants; involves hand placement over the spine b/w the shoulder blades?
Back blows
63
What is the primary TX for biliary atresia?
Kasai portoenterostomy
63
Involves a series of nondiaphragmatic abdominal thrusts; recommended for children over 1 y/o?
Heimlich maneuver
64
Projectile vomiting is associated with?
HPS
64
25. When an infant's digits are connected to a pulse ox, the part of the sensor that is placed on the top of the nail is called the:a. photodetectorb. microprocessorc. Light-emitting diode (LED)d. electrode
C
65
Nursing care for Intussusception?
NPOPain mgmt.Check for jelly like stoolIf stool is normal, Intussusception has resolved
65
31. In children, O2-induced CO2 narcosis is encountered most frequently with:a. prematurityb. asthmac. CFd. congenital heart disease
C
66
The biggest single reason why children need a liver transplant is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Biliary Atresia
66
32. For a child under 5 y/o who needs intermittent delivery of an aerosolized med, the nurse should consider using a:a. hand-held NEBUb. MDI with a spacer devicec. humidified mist tent with low-flow O2d. MDI w/o a spacer device
B
67
GER symptoms in infants?
Spitting up, regurgitation, vomitingExcessive crying, irritability, arching of backWt. loss, FTTResp (cough, wheeze, stridor, gagging, choking)HematemesisApnea or apparent life-threatening event
67
33. Postural drainage should be performed:a. before meals but after other respiratory therapyb. after meals but before other respiratory therapyc. before meals and before other respiratory therapyd. after meals and after other respiratory therapy
A
68
The nurse assesses the neonate immediately after birth. EA or TEF is suspected if which of the following is present?A. Jaundice B. Absence of sucking C. Hyperactive bowel sounds D. Excessive amount of frothy saliva in the mouth
D.Frothy saliva in the mouth and nose, drooling, choking, and coughing in a newborn are associated with esophageal atresia and TEFs. Jaundice in a neonate is indicative of a hematologic problem. Absence of sucking and hyperactive bowel sounds are not signs of esophageal atresia or TEF.
68
35. Which of the following pts is likely to benefit from CPT that includes forced expiration combined with postural drainage?a. pts with pneumoniab. uncomplicated surgical ptsc. pts with increased sputum productiond. all of the above
C
69
abnormal rotation of intestine during embryonic development?
Malrotation
69
36. Chest percussion is being performed correctly if:a. it makes a slapping soundb. it is painfulc. a soft circular mask is usedd. it is performed over the rib cage & diaphragm
C
70
What is the Kasai procedure?
surgery that involves dissecting the porta hepatis to promote bile drainage. A Roux-en-Y jejunal limb is then anastomosed to the porta hepatis.Highly successful if done before 8 wk of age.
70
37. The BEST method to stimulate deep breathing in a child is to:a. have child cover mouth & suppress coughb. have child cough repeatedlyc. use games that extend expiratory time& pressured. leave some balloons at the bedside for the child to blow up
C
71
Olive-like mass in the upper abdomen is associated with?
HPS
71
38. To avoid barotrauma when using the bag-valve-mask device, the nurse shoulda. use the type without a reservoirb. use the type with a pop-off valvec. use a low O2 concentrationd. hyperextend the infant's neck
B
72
Therapeutic management of most children with Hirschsprung dz is primarily which of the following?A. Daily enemas B. Low-fiber diet C. Permanent colostomy D. Removal of affected piece of bowel
D. Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. A: Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. B: Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. C: The colostomy that is created in Hirschsprung disease is usually temporary. p. 1306
72
40. The MOST severe complication that can occur during intubation is:a. infectionb. sore throatc. laryngeal stenosisd. hypoxia
D
73
The parent of a 10-week-old infant tells the nurse, "She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed." The most appropriate nursing intervention is which of the following?A. Reassure parent that nothing is wrong. B. Explain how to better interpret infant cues. C. Evaluate for failure of parent to bond with infant. D. Reassure parent that periods of "unexplained fussiness" are normal.
D: A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent's concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.
73
41. Of the following vacuum pressures, the MOST acceptable pressure to use to suction the trach of a child is:a. 30 mm hgb. 50 mm hgc. 70 mm hgd. 120 mm hg
C
74
Associated with trisomies 13, 18m and 221 (down syndrome), and with advanced maternal age (\>30 years)?
Omphalocele
74
44. For a trach dressing, it would be INCORRECT to use:a. DuoDERM CGFb. Allevyn dressingc. a wet 4X4 gauze pad cut into the needed shape.d. Hollister Restore
C
75
Clinical manifestations of Intussusception?
Sudden acute abd painchild screaming and drawing knees to chestchild appearing normal & comfortable b/w episodesvomitinglethargypassage of red, currant jelly-like stoolsTender distended abdpalpable sausage shaped mass in RUQEmpty RLQeventual s/s of peritonitis (fever, prostration, etc)
75
45. After the initial post-op change, the trach tube is usually changed:a. Weekly by the surgeonb. Weekly by the nurse or familyc. Monthly by the surgeond. Monthly by the nurse or family
B
76
Initial Management of Gastroschisis involves?
Covering exposed bowel with transparent bowel bag or loose, moist dressings.IVF and ABXLARGE amt of IVFsSURGICAL REPAIR!!
76
47. A trach with a speaking valve:a. decreases secretionsb. decreases child's sense of taste and smellc. limits gas exchanged. has no effect on the ability to swallow
A
77
A PPI is ordered for an infant with GER. The nurse should include in the drug teaching that:A. drug should be given 30 min before bedtime. B. three times a day dosing has maximum effect. C. drug can be stopped once sxs have resolved. D. several days may pass before full effect
D. RATIONALE: PPIs require several days to achieve the max effect. A: Optimum admin time is 30 min before breakfast. This allows for peak plasma levels at mealtime. B: Once daily dosing is usually recommended. C: Continued admin is necessary to maintain effect. p. 1309
77
50. Of the following strategies, the one that is LEAST likely to decrease the O2 demand of the child with respiratory distress is:a. maintain child's body temp WNLb. place child in supine positionc. control paind. maintain a warm room temp
B
78
Management of Intussusception?
Radiologist guided air enema with or w/o water soluble contrast or U/S-guided hydrostatic (saline) enema.IVF, NG decompression, & ABX before hydrostatic reduction.Surgery if procedures are not successfulRecurrence is RARE
78
51. Cardiac arrest in the pediatric population is MOST often a result of:a. atherosclerosisb. congenital heart diseasec. prolonged hypoxiad. undiagnosed cardiac conditions
C
79
Complications after Kasai procedure?
ascending cholangitiscirrhosisportal HTNGI bleeding
79
53. The nurse should place the bag-valve-mask over both the mouth & nose for individuals whose age is:a. birth to 1 yrb. 1 to 3 yrsc. birth to 3 yrsd. birth to 2 yrs
A
80
3 MAJOR signs of entercolitis that MUST be reported STAT?
Explosive watery diarrheaFeverSevere Lethargy
80
54. The brachial pulse is the preferred site to use to assess circulation in the:a. infantb. school-aged childc. adolescentd. adult
A
81
NEC is most common in?
Premies
81
55. In a child who is conscious & choking, the RN should attempt to relieve the obstruction if the child:a. is making soundsb. has an effective coughc. has stridord. all of the above
C
82
Occurs when the proximal segment of the bowel telescopes into a more distal segment?
Intussusception
82
Increases CO and HR by blocking vagal stimulation in the heart?
Atropine
83
Main cause of death in children with SBS?
INFECTION
83
The first choice for V-Tach that is refractory to defibrillation is ?
Amiodarone
84
In terms of fine motor development, what should the infant of 7 months be able to do?A. Transfer objects from one hand to the other B. Use thumb and index finger in crude pincer grasp C. Hold crayon and make a mark on paper D. Release cubes into a cup
A: The ability to transfer objects from one hand to another occurs about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.
84
Used for hypermagnesemia; needed for normal cardiac contractility?
Calcium chloride
85
DX evaluation of biliary atresia is based on?
HXphysical findingsLabs
85
Causes vasoconstriction and increases CO?
Dopamine
86
GER symptoms in Children
Heartburnabd painnoncardiac chest painchronic coughdysphagianocturnal asthmarecurrent pneumonia
86
Used for ventricular dysrhythmias?
Lidocaine
87
Management of Intussusception?
Radiologist guided air enema with or w/o water soluble contrast or U/S-guided hydrostatic (saline) enema.IVF, NG decompression, & ABX before hydrostatic reduction.Surgery if procedures are not successfulRecurrence is RARE
87
Acts on alpha and beta receptors, causing contraction, especially at the site of the heart, vascular, and other smooth muscle?
Epinephrine
88
Two common forms of cong abd wall defects?
Gastroschisis and omphalocele
88
Administered rapidly; causes a temporary block through the AV node?
Adenosine
89
When are feedings begun and how are they initiated for an infant after a pyloromyotomy (surgery for HPS)?
4 to 6 hrs post-op - start w/small, frequent feedings of glucose, water, or Lyte soln.If clear liquids are retained - formula is started 24 hrs after surgery.
89
Used to buffer the pH?
Sodium bicarbonate
90
Clinical manifestations of Hirschspung Disease during the Infancy period?
FTTConstipationAbd distentionEpisodes of diarrhea and vomitingSigns of entercolitis
90
The Heimlich maneuver is recommended for children over the age of:a. 4 yrsb. 3 yrsc. 2 yrsd. 1 yr
D
91
Sara, age 4 months, was born at 35 weeks of gestation. She seems to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was full term. The nurse should explain that:A. infants tend to become more difficult over time. B. Infants become less difficult if they are kept on scheduled feedings and structured routines. C. Sara's behavior is suggestive of failure to completely bond with her parents. D. Sara's difficult temperament is the result of painful experiences in the neonatal period.
B: Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.
92
Incidence of HPS?
First born childrenBoys 5 times \> girlsMore Caucasians than African American'sFull-term infants more than premiesSiblings and offspring of affected persons.
93
Passage of red, currant jelly-like stools occurs with?
Intussusception
93
The causative agent of acute epiglottitis is?
bacterial, usually H. influenzae
94
3 MAJOR signs of entercolitis that MUST be reported STAT?
Explosive watery diarrheaFeverSevere Lethargy
94
The primary management goal of epiglottitis is to?
stabilize the airway by intubation or tracheostomy.
95
Malformations associated with biliary atresia?
PolyspleniaIntestinal atresiaMalrotation of the intestine
95
The presence of daily symptoms or nighttime symptoms, more than once per week, but not nightly, places a child over 5 years of age in which category of asthma?
Moderate persistent asthma
96
Which of the following is a major long-term problem for a child with cleft lip and palate?A. Faulty dentition B. Nutritional deficits C. Aspiration pneumonia D. Abnormally small maxilla
A. A comprehensive team approach is used for children with cleft lip and palate. Extensive orthodontics and prosthodontics are usually required to correct the malposition of the teeth and other bony structures. The child can be adequately nourished before and after surgical repair takes place. Aspiration is a possibility before repair of the cleft palate, but it is not a long-term problem. The nonunion of the maxilla usually requires surgery and possible bone grafts to close.
96
Bill needs instructions about using a metered-dose inhaler (MDI). The nurse should explain that the MDI is used to: A. improve circulation. B. distribute med directly to airways. C. assess severity of breathing difficulty. D. distribute med systemically w/o the need for inj.
B
97
The clinic is loaning a federally approved car seat to a 10-pound (4.5 kg) infant's family. The nurse should explain that the safest place to put the car seat is in the:A. back seat facing forward. B. Middle of the back seat facing rearward. C. front seat with airbags on passenger side. D. front seat if there is no air bag on the passenger side.
B: The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck. The middle of the back seat is the safest position for the child. The infant must be rear facing to protect the head and neck in the event of an accident. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.
97
Instructions for using the MDI include:
A. breathe medication in slowly.
B. avoid breathing too deeply.
C. hold inhaler at about a 45-degree angle to the mouth.
D. breathe in through nose and out through mouth.
Instructions for using the MDI include:
breathe medication in slowly.
avoid breathing too deeply.
hold inhaler at about a 45-degree angle to the mouth.
breathe in through nose and out through mouth.
**A**
A slow, deep inspiration held for 5 to 10 seconds will allow the medication to reach the narrow, deep airways.
Rapid inspirations cause the medication to move through the unobstructed bronchioles to patent airways, where they are less needed.
The inhaler should be held upright with the mouthpiece in the mouth.
98
The nurse is guiding parents in selecting a daycare facility for their child. Which of the following is especially important to consider when making the selection?A. Health practices of facility B. Structured learning environment C. Socioeconomic status of children D. Cultural similarities of children
A: Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not consistently used. A structured learning environment is not the highest priority for this age child. Socioeconomic status of the children should have little effect on the choice of facility. Cultural similarities may be important to some families, but the facility's health care practices are more important.
98
Bill's father asks the nurse if his son can still participate in sports. The nurse's response should be based on an understanding that:
A. exercise should be encouraged.
B. avoid breathing too deeply.
C. organized sports are too strenuous for children with asthma.
D. quiet activities such as reading are best for children with asthma.
A
It has been found that moderate or even strenuous exercise is advantageous for children with asthma, provided the asthma is under control.
Restrictions on exercise are invoked only when the child's condition makes it necessary.
Prophylactic TX with β-adrenergics or cromolyn before exercise will usually permit full participation in strenuous exercise.
99
What information should the nurse give a mother regarding the introduction of solid foods during infancy?A. Fruits and vegetables should be introduced into the diet first. B. Foods should be introduced one at a time, at intervals of 5 to 7 days. C. Solid foods can be mixed in a bottle to make the transition easier for the infant. D. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear.
B: One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant's diet.3. Mixing solid foods in a bottle has no effect on the transition to solid food.4. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months.
99
What is the most prevalent etiologic agent causing bronchiolitis in young infants?
RSV
Rationale: RSV is responsible for at least 50% of children admitted for bronchiolitis.
100
Pre-op care for infant with HPS undergoing a pyloromyotomy?
Decompression with NGNPOIVF of glucose and Lytes (NaCl & K)Strict I&Os and urine spec gravityVS, Daily Wt., assess skin & mucous membranes
100
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_is a croup syndrome with paroxysmal attacks of laryngeal obstruction that occur chiefly at night; it is usually caused by a viral agent.
Acute spasmodic laryngitis
101
The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse should expect the infant to now weigh approximately how many kilograms?A. 5.2 B. 6.3 C. 8.7 D. 9.6
B: Birth wt doubles at about ages 5-6 mo. At 6 mo, a child who weighed 3.2 kg at birth would weigh approx 6.3 kg. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 5.2 kg is too little. The infant would have tripled the birth wt by 6 mo; 8.7 kg to 9.6 kg is too much. The infant would have tripled the birth weight by 6 mo; 8.7 - 9.6 kg is too much.
101
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_is an acute viral infection that occurs primarily in the winter and spring. The symptoms begin with rhinorrhea and fever, often spreading to a lower respiratory tract infection.
Bronchiolitis
102
Which of the following behaviors indicates that an infant has developed object permanence?A. Secures objects by pulling on a string B. Actively searches for a hidden object C. Recognizes familiar face, such as mother D. Recognizes familiar object, such as bottle
B: During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. The ability to understand cause and effect is part of secondary schema development, which is a later developmental task. B/w ages 8-12 weeks, infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence.
102
How is the diagnosis of RSV established?
ELISA of nasal secretions
Rationale: Either the rapid immunofluorescent antibody (IFA) or the ELISA technique for RSV detection can be used.
These techniques are rapid and have sensitivities and specificities of about 90%
103
Labs associated with HPS?
Metabolic alterations d/t dehydration.Decreased Cl Increased pH & HCO3 (Metabollic alkalosis)Increased BUN
103
Repeated episodes of bronchiolitis not associated with RSV in young children require follow-up testing for which disorders?
Asthma, cystic fibrosis.
Rationale: Because of the nature of asthma and CF, the airways are more reactive and/or mucus production is increased, causing a perfect medium for bacterial growth. Children with asthma/CF are more likely to display repeated sxs of bronchiolitis before the dx of a chronic disorder.
104
A mother tells the nurse that she is discontinuing breast-feeding her 5-month-old infant. The nurse should recommend that the infant be given:A. skim milk. B. whole cow's milk. C. commercial formula without iron. D. Commercial iron-fortified formula.
D: For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breast-feeding has been discontinued, then iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.
104
What type of isolation measures are indicated for health personnel when caring for a child with RSV?
Good hand-washing; use of gowns and gloves to prevent cross contamination.
Rationale: RSV is highly virulent, and health care personnel should take precautions to avoid spreading the virus to uninfected hospital personnel, visitors, and patients in the hospital.
105
Distended abdomen, Gastric residuals, Blood in stools are highly indicative of?
NEC
105
Discuss the guidelines for use of ribavirin aerosol therapy.
It is used for infants at high risk because of other abnormalities, especially chronic lung disorders and immunodeficiency; infants less than 6 months old; and severely ill infants.
Special precautions such as mask and goggles are required for caregivers; no pregnant personnel should be involved.
Rationale: Because of the potential toxic effects of the drug to health care workers and the unclear evidence of the drug's benefit, the American Academy of Pediatrics recommends the preceding criteria for use of ribavirin.
106
Nutritional management for infants with biliary atresia?
Medium chain triglycerides and essential fatty acids.Vitamins - A, D, E, KmultivitaminMinerals - iron, zinc, seleniumContinuous gastrostomy feedings or TPN
106
What disease is inherited as an autosomal recessive gene; requiring inheritance of the defective gene from both parents?
CF
107
Prognosis of HPS?
Excellentmortality rate is LOW15% will have GER
107
Can fertility therapy contribute to the newborn developing CF?
NO
108
Primary source of nutrition in children with SBS?
PN
108
What is the significance of sodium and chloride in diagnosing CF?
A clinical feature of CF is a striking elevation of sweat electrolytes. Although sodium and chloride are affected, the defect appears to be primarily a result of abnormal chloride movements.
109
Incidence of intussusception?
More common in:maleschildren with cystic fibrosis
109
What are the effects of increased viscosity of mucous gland secretions on each of the following?
A. Bronchi
B. Small intestine
C. Pancreatic ducts
D. Bile ducts
A. Chronic pneumonia and emphysema
B. Meconium ileus
C. Malabsorption syndrome
D. Portal hypertension
Increased mucous gland secretion and mucus viscosity result in mechanical obstruction, which leads to chronic complications of the bronchi, small intestine, pancreatic ducts, and bile ducts.
These complications are outlined in Fig. 32-14.
110
Complication after surgery for malrotation?
Short bowel syndrome (SBS)
110
David is the 3-year-old son of parents who are 38 and 40 y/o. They have been married for 15 years and underwent fertility therapy to have a child. David has a HX of frequent colds increasing in severity during the past year. He also has been losing wt although he eats well. David has been having large loose bowel movements during the past year. David is admitted to the pediatric unit for a workup for CF.
**List seven nursing diagnoses appropriate for David.**
Ineffective Airway Clearance r/t secretion of thick, tenacious mucus
Ineffective Breathing Pattern r/t mechanical airway obstruction
Altered Nutrition, Less Than Body Requirements, r/t inability to digest nutrients
High Risk for Infection r/t impaired body defenses
Activity Intolerance r/t imbalance between oxygen supply and demand
Altered Growth and Development r/t chronic illness
Altered Family Processes r/t child with chronic illness
111
Diarrhea Incidence
111
Lisa is 7 y/o & has CF. She lives w/both parents & a 4 y/o sister who also has CF.
Lisa's mother tearfully tells the RN that she is pregnant & worried that this child will also have CF. The nurse should understand that:
A. CF is usually not inherited.
B. CF can be diagnosed prenatally.
C. there is a 50% chance this child will be affected.
D. there is a 100% chance this child will be affected if it is a female.
**B**
**_Rationale:_**
CF is inherited as an autosomal recessive trait; the affected child inherits the defective gene from both parents.
Genetic discoveries have allowed for better screening techniques, and prenatal testing continues to be studied.
The autosomal recessive defective gene is inherited from both parents with an overall incidence of 1:4 (25% chance a child will be affected).
The autosomal recessive defective gene is inherited from both parents with an overall incidence of 1:4 (25% chance a child will be affected). The defective gene is not sex linked; therefore CF can occur in any sex.
112
Abd pain or cramping manifested by loud cryinng and drawing legs up to the abd?
COLIC
112
Lisa tells the RN that she would like to play soccer like her friends. The RN's recommendation should be based on knowledge that physical exercise is:
A. important because it encourages effective breathing.
B. important because it stimulates underactive sweat glands.
C. contraindicated because it causes coughing.
D. contraindicated because it causes forced expiration.
**A**
Physical exercise is an important adjunct to daily chest physical therapy to maintain pulmonary hygiene. It stimulates mucus secretion and provides a sense of well-being and increased self-esteem in the child.
113
Colic etiology?
• Rapid feeding • Overeating • Swallowing excessive air • Improper feeding technique (esp in positioning and burping) • Emotional stress or tension b/w parent & child
113
Lisas father calls the clinic and tells the RN that Lisa must be very sick. Her sx's include tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The RN should recognize that this is:
A. suggestive of pneumothorax.
B. suggestive of bronchospasms.
C. terminal stage of the disease.
D. normal progression of the disease.
**A**
Pneumothorax is often caused by rupture of sub-pleural blebs through the visceral pleura and usually causes nonspecific sxs, which include tachypnea, tachycardia, dyspnea, pallor, and cyanosis.
114
Other potential causes of colic?
Smoking strained parent-infant interaction lactase deficiency difficult infant temperament CNS immaturity
114
Symptoms of bronchospasm usually include?
dyspnea, wheezing, and pallor
115
How much crying is considered colic in healthy baby?
\>3 hours/day \>3 days/week
115
Supplementation of vitamins A, D, E, & K are important for people with CF because:
A. pancreatic enzymes are administered with meals.
B. children with CF cannot receive a well-balanced diet.
C. uptake of fat-soluble vitamins is decreased in CF.
D. excretion of water-soluble vitamins is increased in CF.
**C**
The uptake of fat-soluble vitamins is decreased because of pancreatic insufficiency.
116
When does colic usually onset, how long might it persist?
Onset after 2-4 weeks30% might persist until 4 months
116
Ms. Drew is admitted to the hospital to prevent the spread of mono. Which of the following precautions should be taken by the nurses caring for her?
A. Respiratory isolation
B. Enteric isolation
C. Strict isolation
D. Good hand-washing techniques only
D
117
What is the MOST LIKELY cause of colic?
GI related etiology:
Lactose intolerance
Intolerance to proteins in mom's diet (eg cow's milk)
117
**Tommy is 5 years old and is hospitalized for a tonsillectomy and adenoidectomy.**
In completing a nursing care plan for Tommy, which of the following interventions would be **_inappropriate_** to include?
A. Applying an ice collar
B. Administering acetaminophen elixir
C. Offering cool liquids as tolerated
D. Suctioning the posterior pharynx
**D**
Suction equipment should be available in the event a hemorrhage occurs. However, the posterior pharynx should **NOT** be suctioned due to the potential trauma to the operative site.
An ice collar may provide relief of pain from the soreness in the throat after surgery (although many children find it bothersome and prefer not to have it).
Most children experience moderate pain after a tonsillectomy and should receive pain medication for at least the first 24 hours.
When the child is alert with no signs of hemorrhage, cool water and crushed ice are given, progressing to clear liquids as tolerated (avoiding fluids with a red or brown color to distinguish fresh or old blood in emesis from the ingested liquid).
118
If colic approaching 4 months, what disease might be considered?
GERD
118
Nursing considerations r/t the admin of O2 in an infant include which of the following?
A. Discontinue during feedings so child can be held.
B. Assess infant to determine how much oxygen should be given.
C. Ensure uninterrupted delivery of the appropriate oxygen concentration.
D. Direct oxygen flow so that it blows directly into the infant’s face in a hood.
C
119
What are 5 management strategies for parents of infant with colic?
1) Parent reassurance - self-limting, no long term sequelae, nobody's fault
2) Keep a diary
3) Relief and support
4) Regular schedule and routine
5) \*\*DIET change in MOM (avoid diary, green veggies)
119
The RN is teaching a mother how to perform CPT and postural drainage on her 3 y/o child, who has CF. To perform percussion, the RN should instruct her to:
A. strike the chest wall with a flat-hand position.
B. percuss before and after positioning for postural drainage.
C. percuss over the entire trunk anteriorly and posteriorly.
D. cover the skin with a shirt or gown before percussing.
**D**
The child should wear a light shirt to protect the skin from the percussion.
The hand is cupped when the child's chest wall is struck.
Percussion is done after the position change.
There are identified positions and sequence for postural drainage.
120
What are 3 nonpharm measures for colic?
1) Rocking, music, patting, car, burping
2) Check bottle nipple; feed baby more upright
3) If formula fed, switch formulas
120
Which of the following situations places infants at risk for developing vitamin D–deficiency rickets?
A. Exclusively formula fed
B. Exposure to daily sunlight
C. Mothers who are lacto-ovovegetarians
D. Families using yogurt as primary source of milk
D
Yogurt does not contain adequate amounts of vitamins A and D.
121
What is a pharmacological measure for colic that is SAFE?
Simethicone (Ovol)
0.25-0.5ml drops with meals
but no proven efficacy
121
Deficiency of which of the following vitamins correlates with increased morbidity and mortality in children with measles and increased complications from diarrhea and infections?
A. Vitamin A
B. Vitamin C
C. Niacin
D. Folic acid
A
Vitamin A deficiency contributes to increased morbidity in measles, diarrhea, and infections. The American Academy of Pediatrics recommends supplementation be considered in children with measles and related disorders.
122
What pharm measure for colic might be effective but has safety concerns?
Antispasmodics
dicyclomine (Bentyl)
122
Which of the following foods should the nurse recommend as a good source of potassium for a child receiving diuretics?
A. Grains
B. Grains and legumes
C. Dairy products
D. Dark green vegetables
B
One combination of foods that provides the appropriate amounts of essential amino acids is grains (cereal, rice, pasta) and legumes (beans, peas, lentils, peanuts).
123
What are 2 safety concerns with antispasmodics, therefore should not be recommended?
Seizures
apnea
123
Although infants may be allergic to a variety of foods, the most common allergens are:
A. fruit, eggs, and rice.
B. fruit, vegetables, and wheat.
C. Eggs, cow's milk, and peanuts.
D. cow's milk and green vegetables.
C
Milk products, eggs, and peanuts are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction.
124
What is the recommendation for probiotics for treatment of colic?
Insufficient evidence to recommend for or against
## Footnote
124
Parent guidelines for relieving colic in an infant include which of the following?
A. Avoid using a pacifier.
B. Avoid touching abdomen.
C. Change infant’s position frequently.
D. Place infant where family cannot hear the crying.
C
Changing the infant's position frequently may be beneficial. The parent can walk holding the child face down and with the child's abdomen across the parent's arm. The parent's hand can support the child's abdomen, applying gentle pressure.
125
What is the problem with gripe water?
Has alcohol, Effect is likely to sedate infant
125
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it:
A. liquefies secretions.
B. improves oxygenation.
C. promotes less labored ventilation.
D. Soothes inflamed mucous membranes.
D
Warm or cold mist is useful to soothe the inflamed mucous membranes. Humidification is most useful when hoarseness or laryngeal involvement occurs.
Normal saline nose drops should be used to liquefy secretions. The mist particles do not penetrate in sufficient amounts to accomplish this.
126
Most common infections in the world?
Intestinal parasitic diseases
126
What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature?
A. Give tepid water baths to reduce fever.
B. Encourage food intake to maintain caloric needs.
C. Have child wear heavy clothing to prevent chilling.
D. Give small amounts of favorite fluids frequently to prevent dehydration.
D
Preventing dehydration by small, frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting.
127
Two most common parasitic infections amoung children in the U.S.?
giardiasis & pinworms
127
When planning care for a 4-mo-old child admitted with respiratory distress caused by RSV and bronchiolitis, it is essential to include which of the following?
A. Give antibiotics.
B. Ensure adequate hydration.
C. Administer cough syrup.
D. Feed 4 oz of formula every 4 hours.
B
When respiratory distress is present, hydration is an essential consideration. Usually infants cannot take fluids by the oral route b/c of the difficulty breathing. IVF’s may be necessary. RSV is a virus. Antibiotics are not beneficial. Although fluid and calories are important, the infant with respiratory distress is usually unable to drink this amount of fluid.
128
MOST important nursing intervention for the cjild with a parasitic infection?
HYGIENE & HEALTH EDUCATION for the child and family
128
Which statement accurately expresses the genetic implications of CF?
A. It is inherited as an autosomal dominant trait.
B. It is a genetic defect found primarily in non-Caucasian population groups.
C. If it is present in a child, both parents are carriers of this defective gene.
D. There is a 50% chance that siblings of an affected child will also be affected.
C
CF is an autosomal recessive gene inherited from both parents. CF is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected, but a 50% chance a sibling will be a carrier.
129
Most important precautionary method to teach a child with a parasitic infection as well as the family?
Thorough hand washing before eating or handling food and after using the toilet!!
129
In providing nourishment for a child with CF, which of the following factors should the nurse keep in mind?
A. Fats and proteins must be greatly curtailed.
B. Diet should be high in calories and protein.
C. Most fruits and vegetables are not well tolerated.
D. Diet should be high in easily digested carbohydrates and fats.
B
Children with CF require a well-balanced, high-protein, high-calorie diet b/c of impaired intestinal absorption. Fats and proteins are a necessary part of a well-balanced diet. A well-balanced diet containing fruits and vegetables is important. Enzyme supplementation helps digest foods; other modifications are not necessary.
130
The single most common intestinal parasitic pathogen in the U.S.?
Giardiasis
130
Bacterial or viral infection that puts person at risk for serious sequelae (AGN, acute rheumatic fever, Scarlet fever ), and may cause skin manifestations (impetigo, pyoderma)?
Acute Streptococcal Pharyngitis
131
Cheif modes of giardiasis transmission?
Person to person
Food
Animals (esp puppies)
131
A child with acute streptococcal pharyngitis develops an **erythematous sandpaper like rash**. The RN knows this is a characteristic symptom indicative of what complication?
Scarlet fever
132
Clinical Manifestations of GIARDIASIS in infants and young children?
Diarrhea
Vomiting
Anorexia
Growth failure (FTT) - If chronic
132
What other complications/disease can strep pharyngitis cause?
rheumatic fever
glomerulonephritis
scarlet fever
133
How is giardiasis diagnosed?
Microscopic exam of stool specimens or duodenal fluid, Or ID of G. lamblia antigens in these specimens by EIA
Aspiration, BX, string test
Repeated microscopic exams of stool specimens may be req to id trophjozoites or cysts
133
After the onset of GABHS, when would you suspect the following complications to occur if they happened to:
1. AGN
2. Rheumatic fever
1. ) 10 days
2. ) 18 days
134
What is the "String Test" and what is it used to diagnose?
Used to DX giardiasis
Child swallows gel cap with a nylon string attached, then several hours later it is withdrawn to analyse the contents
134
Why is it so important not to administer PCN-G procaine/benzathine by IV SUSP? How should they be administered?
Can cause PE or toxic reaction with death in minutes!!
Administer deep into large muscle (vastus lateralis/ventrogluteal)
135
DRUGS used for Giardiasis?
metronidazole (**Flagyl**)
tinidazole (**Tindamax**)
nitazoxanide (**Alinia**)
135
When can a child who has a streptococcal infection return to school?
24 hours After antibiotics are initiated
136
Which 2 drugs used for giardiasis that have a metallic taste and GI side effects?
metronidazole (Flagyl)
Tinidazole
137
Most common helminthic infection in the U.S.?
Enterobiasis (PINWORMS)
138
\_\_\_\_\_\_\_\_\_\_\_\_\_ persist in the indoor environment for 2 to 3 weeks, contaminating anything they contact, such as toilet seats, doorknobs, bed linen, underwear, and food.
Pinworm eggs
139
The typical hand-to-mouth activity of infants and children makes them especially prone to reinfection with?
Pinworms
140
How long do pinworm eggs persist indoors?
2-3 weeks
140
MAX amount of air that can be expired after maximum inspiration?
Forced vital capacity (FVC) (peak flow)
141
How long do the giardiasis cysts survive?
MONTHS
141
Amount of air that can be forced from lungs after max inspiration in 1 and 3 sec?
Forced expiratory volume (FEV1) or (FEV3)
142
Clinical Manifestations of pinworms?
Perianal ITCHING!!!
irritability
restlessness
bed-wetting
distractibility
142
Amount of air inhaled and exhaled during any respiratory cycle?
TV or V1
143
How is the DX of pinworms made?
TAPE TEST
143
Volume of air remaining in lungs after passive expiration?
Functional residual volume (FRV): functional residual capacity (FRC)
144
Details about the tape test?
Used to DX PINWORMS -
A loop of transparent tape, sticky side out, is placed around a tougue depressor and pressed against perianal area.
Specimens are Collected in the morning asap and before child has BM or bathed
May need to repeat 3 or more consecutive days
144
Skin electrodes heated and applied to well-perfused areas of trunk; measurements in mm Hg?
Transcutaneous O2/CO2 monitoring (TCM)
145
Drug of choice for pinworms?
Vermox
145
When is FVC:Reduced?Normal?
REDUCED: obesity, obstructive airway diseaseNORMAL: restrictive diseases
146
When is Vermox is not recommended in the TX of pinworms?
AGE \< 2 years
147
Drug regimen for children with pinworms?
DRUGS:(Vermox, pyrantel pamoate (Pin-Rid, Antiminth), or albendazole
REGIMEN: 1 dose initially, and a 2nd dose during the 2nd week
148
Details about Ascariasis (Roundworm)
Transferred to mouth by way of food, fingers, toys
Largest of intestinal helminths
Affects young children 1-4 y/o
Warm climates
148
Group A beta-hemolytic streptococcus (GABHS) infection of the upper airway?
Strep throat
149
C/M of Roundworms
LIGHT INFECTIONS - asymptomatic
HEAVY - anorexia, irritability, nervousness, enlarged abd, wt loss, fever, intestinal colic
SEVERE - intestinal obs., appendicitis, perforation w/peritonitis, obs. jaundice, lung involvement (pneumonitis)
149
Determines the extent to which the pt's serum will agglutinate sheep RBCs; used to DX infectious MONO (titer of 1:160 required for DX); rapid, sensitive, inexpensive, and easy to perform?
Heterophil antibody testing
150
Most cases of poisoning occur in children of what age group?
\< 6 years of age
150
Barrel chest indicates?
Severe obstructive lung disease (CF, asthma)
151
What is the FIRST action parents should initiate when their child is poisoned?
Call the poison control center (PCC)!!!
151
An inflammation of the middle ear and mastoid; characterized by perforation and discharge (otorrhea) lasting up to 6 mo?
Chronic suppurative OM
152
Harmful substances commonly ingested?
Analgesics (acetaminophen!)
Plants (poison ivy, apple, apricot, etc.)
Cosmetics
Cough syrup
Hydrocarbons (gas, kerosene, lamp oil, lighter fluid, paint thinner/remover)
152
Diaphragmatic differences in infants under 5 years of age?
Diaphragmatic abdominal breathing
153
Where do MOST (90%) of harmful ingestions occur?
HOME
153
Assesses the mobility of the tympanic membrane, using air transmission?
Pneumatic otoscopy
154
What decreased children poisoning drastically and when?
Poison prevention packaging act of 1970
154
When are respirations (ventilations) best to assess and best determined in a child/infant?
While sleeping or quietly awake
155
C/M of acetaminophen poisoning?
Occurs in 4 stages:
1. INITIAL (2-4 hr) - N/V, sweating, pallor
2. LATENT (24-36)- patient improves
3. HEPATIC involvement (may last up to 7 days) - RUQ pain, jaundice, confusion, stupor, coagulation abnormalities
4. Patients who do not die in hepatic stage gradually recover
155
The test to assess mobility of the tympanic membrane using sound transmission?
Tympanometry
156
Most common accidental drug poisoning in children?
Acetaminophen
156
When should an infant be able to hold their head up?
4-5 mo
157
What is the toxic dose of acetaminophen in children?
150 mg/kg or more
157
An acute viral infection with MAX effect at the bronchiolar level?
Respiratory syncytial virus (RSV)
158
Therapeutic management of acetaminophen poisoning?
Antidote - Mucomyst
Give orally but dilute in fruit juice or soda (offensive odor)
Given as one loading dose and 14 maintenance doses
158
Tachypnea often occurs with?
AnxietyElevated tempSevere anemiaMetabolic acidosisMAY be assoc. w/resp alkalosis d/t psychoneurosis and w/CNS disturbances.
159
C/M of Acute aspirin poisoning versus chronic aspirin poisoning?
ACUTE: nausea, disorientation, vomiting, dehydration, diaphoresis, hyperpnea, oliguria, tinnitus, coma, convulsions, hyperpyrexia
CHRONIC: Same as above but subtle onset. Dehydration, coma, seizures may be more severe, bleeding tendencies.
159
The type of pneumonia in which the inflammatory process is confined w/in the alveolar walls and the peribronchial and interlobular tissues?
Interstitial pneumonia
160
ASA Toxicity TX?
Hospitalization if severe
Emesis, lavage, activated charcoal, or cathartic may be used
Lavage will not remove concretions of ASA
Activated charcoal is important early in ASA tox
Sodium bicarb transfusions are used to correct metabolic acidosis
Monitor for any fluid overload
External cooling
anticonvulsants
O2 & ventilation for resp depression
Vit K for bleeding
HD (NOT PD) in severe cases
160
Hyperpnea is assoc. with?
FeverSevere anemiaRespiratory alkalosis assoc. w/psychosisCNS disturbancesResp acidosis that accompanies DKA/diarrhea
161
C/M of hydrocarbon ingestion?
Gagging, choking, coughing
N/V, lethargy
Tachypnea, cyanosis, retractions, grunting
IMMEDIATE DANGER is ASPIRATION
161
NEBU epinephrine; used in children with stridor at rest, retractions, acute epiglottitis, or difficulty breathing?
Racemic epinephrine
162
TX of hydrocarbon ingestion?
Inducing Emesis is contraindicated
If gastric lavage must be performed, a cuffed ETT MUST be in place before lavage
Symptomatic TX of chemical pneumonia includes: HIGH humidity, O2, hydration, & ABX
162
Head bobbing in a sleeping or exhausted infant is a sign of ?
Dyspnea
163
What are some examples of corrosives?
Drain, toilet, and oven cleaners
Liquid dishwasher detergent
Mildew remover
Batteries
Clinitest tablets
Denture cleaners
Bleach
163
A sx complex characterized by hoarseness, a resonant cough described as "barking" of "brassy", inspiratory stridor, and respiratory distress from swelling in the region of the larynx?
Croup
164
TX of corrosive ingestion?
Dilute with water or mild usually no more than 120 mL
**DO NOT NEUTRALIZE!!!**
Airway mgmt
Analgesics
Keep NPO
164
COMMON causes of stridor?
CroupEpiglottitisFBTracheitis
165
ANTIDOTE for Benzodiazepines (diazepam [Valium], midazolam [Versed])?
flumazenil (Romazicon)
165
An antiviral agent; the only specific therapy approved for hospitalized children with RSV?
Ribavirin
166
ANTIDOTE for cyanide?
amyl nitrate
166
Grunting in older children is frequently a sign of?
Pain, suggesting pneumonia or pleural involvement.
167
ANTIDOTE for certain poisonous bites?
antivenin
167
RSV monoclonal antibody; the only product available in the U.S. for prevention of RSV; administered monthly IM; used to prevent RSV in HIGH-RISK infants?
Palivizumab
168
MOST cases of acute childhood lead poisoning are from?
Paint in older home
lead contaminated bare soil in the yard
168
GRUNTING from an infant or newborn is a characteristic sign of?
Respiratory distress
169
Acute signs of lead poisoning include?
N/V
Constipation
Anorexia
Abd pain
169
Inflammation of the large airways, frequently associated with an URI; primarily caused by VIRAL agents?
Tracheobronchitis
170
What is the level of concern for an elevated blood lead level (BLL)?
10 mcg/dl
170
What causes wheezing in infants?
Increased airway resistance and a compliant chest wall.Inflammatory mediators (histamines, leukotrienes, interleukins)
171
Lead poisoning is a high concern in individuals that repaint and renovate homes built before?
1978
171
6. The largest percentage of respiratory tract infection in children are caused by?
Viruses
172
Term used for removing lead from circulating blood and, theoretically, some lead from organs and tissues?
Chelation
172
Older children often have wheezing because of?
A LRI as a result of inflammation, bronchospasm, and secretions
173
The MAJOR principles of TX for poisoning include?
Assessment, ABCs
Minimization of poison absorption
Prevention of complications
Family support
Prevention of recurrence
173
7. The most likely reason that the respiratory tract infection rate increases drastically in the age range from 3 to 6 months is that the:
a. infant's exposure to pathogens is greatly increased during this time
b. viral agents that are mild in older children are severe in infants
c. maternal antibodies have disappeared and the infant's own antibody production is immature.
d. diameter of the airways is smaller in the infant than in the older child.
C
174
Chealating agents for lead poisoning include?
Calcium disodium edetate (EDTA)
succimer (DMSA)
British antilewisite (BAL)
D-penicillamine
174
Criteria for the presence of clubbing?
Angle \> 160 degrees and decided curvature of the nail
175
NURSING CARE for children who undergo chelation therapy?
Prep for injections
REDUCE injection pain (the injections are admin deep into large muscle)
Inject procaine with the drug
ROTATE SITES
I&Os & U/A results!!! Lead and chelation are TOXIC to kidneys!!
175
8. A febrile seizure is least likely to be associated with:
A. fever in a 2 y/o child
B. a family HX of febrile seizures
C. fever in an 8 y/o child
D. all of the above
C
176
What are the classic FIRST symptoms of appendicitis?
Periumbilical pain, followed by nausea, RLQ pain, and then later vomiting with fever
176
8. Of the following resp system structures, the one that does not distribute air is the:a. bronchialb. alveolusc. bronchusd. trachea
B
177
The 4 general mechanisms of diarrhea are?
Secratory
Cytoxic
Osmotic
Dysenteric
177
10. Bobby is a child w/a respiratory disorder who needs BR but who is not cooperating. The RN's best choice is to:
A. be sure his mother takes the advice seriously
B. allow him to play quietly on the floor
C. insist that he play quietly in bed
D. allow him to cry until he stays in bed
B
178
PRIMARY TX of acute diarrhea?
Oral rehydration and provision of adequate diet
178
9. The general shape of the chest at birth is:a. relatively roundb. flattened from side to sidec. flattened from front to backd. the same shape as an adult's
A
179
LEADING cause of illness in children \< 5 years of age?
ACUTE DIARRHEA
179
11. For an older child who can tolerate decongestants & who is having difficulty breathing through his stuffy nose, the RN should recommend:
A. dextromethorphan nose drops
B. phenylephrine nose drops
C. dextromethorphan cough squares
D. steroid nose drops
B
180
Chronic diarrhea is an increase in stoll frequency and increased water content with a duration of more than?
14 days
180
10. The infant relies primarily on:a. mouth breathingb. intercostal muscles for breathingc. diaphragmatic abdominal breathingd. all of the above
C
181
Treat infants and children with acute diarrhea and dehydration FIRST with?
Oral rehydration therapy (ORT).
181
12. Children w/nasopharyngitis may be treated with:
A. decongestants
B. antihistamines
C. expectorants
D. all of the above
A
182
What are the major goals in the management of acute diarrhea?
(1) assessment of fluid and electrolyte imbalance
(2) rehydration
(3) maintenance fluid therapy
(4) reintroduction of an adequate diet.
182
11. Because of the position of the diaphragm in the newborn:a. there is additional abd dist from gas and fluid in the stomach.b. the diaphragm does not contract as forcefully as that of an older infant or child.c. diaphragmatic fatigue is uncommond. lung volume is increased
B
183
What is intractable diarrhea?
**_Diarrhea that:_**
Occurs in the first few months of life
Persists for longer than 2 weeks with no recognized pathogens
AND is refractory to TX
183
13. The best technique to prevent spread of nasopharyngitis is:
A. prompt immunization
B. to avoid contact with infected persons
C. mist vaporization
D. to ensure adequate fluid intake
B
184
12. Which of the following is true in regard to the anatomy of an infant's nasopharyngeal area?a. the glottis is deeping in infants than older childrenb. the laryngeal reflexes are weaker in infants than older childrenc. the epiglottis is longer and projects more posteriorly in infants than adults.d. the infant and youg child are both less susceptible than adults to edema formation in the nasopharyngeal region.
C
185
14. Group A β-hemolytic streptococci infection is usually a:
A. serious infection of the upper airway
B. Common cause of pharyngitis in children over the age of 15 years.
C. brief illness that leaves the child at risk for serious sequelae.
D. disease of the heart, lungs, joints, & CNS.
C
186
Most common cause of UTI?
Urinary stasis
186
13. List four anatomic factors that significantly affect the development of respiratory disorders in infants.
Fewer # of alveoliSmaller size of alveoliMore shallow air sacksDecreased surface area for gas exchange
187
S/S of UTI in infants and children under two y/o?
NON-SPECIFICFTTVomitingFeeding problemsAbd distFeverHypothermiaDiaper rash
187
15. The diagnosis of group A β-hemolytic streptococcus should be based on:
A. antibody responses
B. antistreptolysin O responses
C. CBC
D. throat culture
D
188
S/S of UTI in children older than two?
EnuresisIncontinenceFoul smelling urineUrgencyFrequencyDysuriaFeverChills
188
14. The condition that is most likely to reduce the # of alveoli in the newborn is:a. maternal heroin useb. increased prolactinc. hyperthyroidismd. kyphoscoliosis
D
189
S/S of UTI in adolescence?
MORE SPECIFICFrequencyFeverChillsDysuria
189
17. Offensive mouth odor, persistent dry cough, & a voice with a muffled nasal quality are commonly the result of:
A. pneumonia
B. otitis externa
C. tonsillitis
D. OM
C
190
MGMT of UTI?
Eliminate infectionPrevent recurrencePrevent systemic spreadPreserve renal FXN
190
15. As a child grows, chest wall comopliance:a. increasesb. decreases
B
191
A 2 y/o comes to the clinic for a well-baby checkup. The RN suspects a UTI based on the following sxs (select all that apply)A. Poor FeedingB. EnuresisC. Back PainD. FeverE. Vomiting
ADE
191
18. An adenoidectomy would be contraindicated in a child:
A. with recurrent OM
B. with malignancy
C. with thrombocytopenia
D. under the age of 3 years
C
192
How should a clean catch urine specimen be taken from a young girl?
Child should sit on toilet facing the tank
192
16. As the child grows, elastic recoil of the lungs:a. increasesb. decreases
A
193
Girls between what ages are considered HIGH-RISK groups for UTI?
2-6
193
19. In the post-op period following a tonsillectomy, the child should be:
A. placed in Trendelenburg position
B. encouraged to C&DB
C. suctioned vigorously to clear the airway
D. observed for signs of hemorrhage
D
194
Which of the following urine tests of renal function is used to estimate glomerular filtration?A. pH B. Creatinine C. Osmolality D. Protein level
B
194
17. Relaxation of the bronchial smooth muscles occurs in response to:a. parasympathetic stimulationb. inhalation of irritating substancesc. sympathetic stimulationd. histamine release
C
195
A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually results in:A. incontinence. B. urinary obstruction. C. Recurrent urinary tract infections. D. infarction of renal vessels
C
195
20. Pain meds for the child in the post-op period following a tonsillectomy should be administered:
A. PO at regular intervals
B. PO PRN
C. PR or IV at regular intervals
D. PR or IV PRN
C
196
Which of the following best describes the cause of most cases of acute glomerulonephritis?A. Renal vascular anomalies B. Antecedent streptococcal infection C. Results from a urinary tract infection D. Structural anomalies of genitourinary tract
B
196
18. Room air (ambient air) consists of:a. 7% O2b. 21% O2c. 50% O2d. 79% O2
B
197
In acute glomerulonephritis, the nurse is aware that an early warning sign of encephalopathy is which of the following?A. Seizures B. Psychosis C. Dizziness D. Transient loss of vision
C
197
21. Of the following foods, the most appropriate to offer 1st to an alert child in the post-op period following a tonsillectomy would be:
A. ice cream
B. red gelatin
C. flavored ice pops
D. all of the above
C
198
The clinical manifestations of nephrotic syndrome include which of the following?A. Hematuria, bacteriuria, weight gain B. Gross hematuria, albuminuria, fever C. Hypertension, weight loss, proteinuria D. Proteinuria, hypoalbuminemia, edema
D
198
19. A child with anemia tends to be fatigued and breathe more rapidly, b/c the majority of O2 is carried through blood as:a. a solute dissolved in the plasma and the H2O of the RBCsb. bicarbonate and hydrogen ionsc. carbonic acidd. oxyhemoglobin
D
199
Therapeutic management of nephrotic syndrome includes which of the following?A. Corticosteroids B. Long-term diuretics C. Antihypertensive agents D. Fluid and salt restrictions
A1. Most children with nephrotic syndrome respond to corticosteroids, making this group the drug of choice. Corticosteroid therapy is begun as soon as the diagnosis has been determined.2. Children with nephrotic syndrome usually do not respond to diuretics. Furosemide, in combination with metolazone, is useful for severe edema.3. Antihypertensive agents are not indicated in the management.4. Fluids are rarely restricted. The child is placed on a no-added-salt diet.
199
23. In about half of all cases of infectious mono, there will be:
A. skin rash
B. OM
C. splenomegaly
D. FTT
C
200
Dialysis or transplantation becomes necessary for chronic renal failure when:A. anemia develops. B. acidosis develops. C. glomerular filtration rate falls below 50% of normal. D. Glomerular filtration rate falls below 10% to 15% of normal.
D4. TX with dialysis or transplantation is required when the glomerular filtration rate falls below 10% to 15% of normal.1, 2. Anemia and acidosis may be present as part of the underlying disorder. The glomerular filtration rate determines the need for dialysis.3. The kidneys are able to maintain the chemical composition of fluids within normal limits until more than 50% of functional renal capacity is destroyed by disease or injury.
200
21. In a child, cough may be absent in the early stages of:a. CFb. measlesc. pneumoniad. croup
C
201
Which of the following is an advantage of continuous cycling peritoneal dialysis or continuous ambulatory peritoneal dialysis for adolescents who require dialysis?A. Dietary restrictions are no longer necessary. B. Hospitalization is only required several nights per week. C. Adolescents can carry out procedures themselves. D. Insertion of a catheter does not require surgical placement.
C
201
24. DX of infectious mono is established when the:
A. RBC count is depressed
B. leukocyte count is depressed
C. heterophil agglutination test is positive
D. heterophil agglutination test is negative
C
202
Which of the following is the primary clinical manifestation of acute renal failure?A. Oliguria B. Hematuria C. Proteinuria D. Bacteriuria
A1. Oliguria is the primary clinical symptom of acute renal failure. Generally, urinary output is less than 1 ml/kg/hr.2. Hematuria, proteinuria, and bacteriuria may be present in renal disease, but they are not the primary manifestations of acute renal failure.3. Hematuria, proteinuria, and bacteriuria may be present in renal disease, but they are not the primary manifestations of acute renal failure.4. Hematuria, proteinuria, and bacteriuria may be present in renal disease, but they are not the primary
202
A sign of dyspnea in the infant who is sleeping or exhausted?
Head bobbing
203
Common features of acute glomerulonephritis are?
oliguria, edema, HTN, circulatory congestion, hematuria, and proteinuria
203
25. Infectious mono is usually a:
A. disease complicated by pneumonitis & anemia.
B. self-limiting disease
C. disabling disease
D. difficult and prolonged disease
B
204
Most common of the noninfectious renal diseases in childhood, it is easiest to identify cause with this disease?
APSGN
204
Respirations are too deep?
Hyperpnea
205
APSGN primarily affects who? Peak age of onset?
Schoolage children6-7 y/o
205
26. Clinical manifestations of influenza usually include all of the following EXCEPT:
A. N/V
B. fever and chills
C. sore throat & dry mucous membranes
D. photophobia and myalgia
A
206
When do sxs of AGN occur?
10-14 days after infection
206
Respirations are too shallow?
Hypopnea
207
C/M of AGN?
Good health till infectionPeriorbital edemaAnorexiaCola-colored urineDecreased urine o/pMild-moderate HTNPale, irritable, lethargicH/A, abd discomfort, dysuria
207
27. The infant is predisposed to developing OM because the eustachian tubes:
A. lie in a relatively horizontal plane
B. have a limited amount of lymphoid tissue.
C. are long and narrow
D. are underdeveloped
A
208
DX evaluation of AGN?
Hematuria, proteinuria, increased spec gravityDiscolored urine, RBC, WBC, C&S negativeElevated BUN/CreatinineSerum lytes WNL
208
May be a complaint of older children; may be caused by disease of any of the chest structures?
Chest pain
209
MASSIVE proteinuria occurs with?
NEPHROTIC SYNDROME
209
28. List at least 5 complications of OM.
Tympanic membrane retractionTympanosclerosisTympanic perforationAdhesive OMChronic suppurative OMLabyrinthititsMastoiditisMeningitisCholesteatoma
210
The MAJOR complications of AGN include?
HTN encephalopathyAcute cardiac decompensationAcute renal failure
210
May be referred to the base of the neck posteriorly and anteriorly or to the abdomen?
Diaphragmatic pleural irritation
211
Primary signs of encephalopathy?
H/ADizzinessAbd discomfortVomiting
211
29. The clinical manifestations of OM include:
A. purulent discharge in the external auditory canal.
B. clear discharge in the external auditory canal
C. enlarged axillary lymph nodes
D. enlarged cervical lymph nodes
D
212
Progression of encephalopathy causes what S/S?
Transient loss of vision HemiparesisDisorientationGeneralized Tonic-Clonic Seizures
212
Significant finding in an infant; helps reduce resistance and maintain airway patency?
Nasal flaring
213
Most common presentation of glomerular injury in children?
Nephrotic syndrome
213
30. An abnormal otoscopic exam would reveal:
A. visible landmarks
B. a light reflex
C. Orange tympanic membrane
D. mobile tympanic membrane
C
214
What are the 3 types of nephrotic syndrome?
PRIMARY - restricted to glomerular injurySECONDARY - develops as part of a systemic illness. (drug toxicity, AIDS, Sickle cell, GN, TB)CONGENITAL - Recessive gene, infants are small for gestational age) - require transplant
214
Proliferation of tissue at the terminal phalanges; associated with chronic hypoxia; does NOT reflect disease progression?
Clubbing
215
NURSING MGMT of nephrotic syndrome?
BR with edemaTX infectionLow salt dietCorticosteroidsDiureticsI&O & Daily WtExamine urine for albuminAbd measurements
215
16. A strategy for the prevention of strep disease would be for the RN to recommend that children w/strep infection:A. not return to school until after 48hr of abx TXB. discard & replace toothbrush after 24hr of abx TXC. not return to school until after 36hr of abx TXD. discard & replace toothbrush as soon as the streptococcus is identified
B
216
Most common presenting sx of Wilm's tumor?
PAINLESS swelling or mass within abd mass is: - Firm- Nontender- Confined to one side- Deep w/in flank)
216
Frequently associated with hypertrophied adenoidal tissue, choanal obstruction, polysps, or foreign body in the nasal passages?
Noisy breathing
217
TESTICULAR TUMOR
RARE in adolescents but usually malignant
Hard painless mass, smooth or nodular
TX: orchiectomy, chemo and radiation
217
31. ABX most likely to be prescribed for uncomplicated OM?
Amoxicillin
218
The most common solid tumor in males 15 to 34 years of age is?
Testicular cancer
218
Usually localized over the affected area and aggravated by respiratory movement?
Parietal pleural pain
219
SX of UTI often observed in children over age 2 years include: (Select all that apply)
A. incontinence in a child previously toilet trained
B. abd pain
C. strong or foul odor to the urine
D. frequency of urination
E. diarrhea
A, B, C, D
219
32. To help alleviate the discomfort & fever of OM, the nurse may administer:
A. acetaminophen or ibuprofen
B. antihistamines and decongestants
C. analgesic ear drops
D. all of the above
A
220
Frequently a sign of chest pain; suggests acute pneumonia, pleural involvement, pulmonary edema, or respiratory distress syndrome; increases end-respiratory pressure and prolongs gas exchange?
Grunting
221
34. Children with tympanostomy tubes should:
A. swim only in freshwater lakes w/o earplugs
B. keep bath water out of the ear
C. notify Dr. immediately if a grommet appears
D. never allow any water to enter their ears
B
222
Performed to assess adequacy of collateral circulation?
Allen test
223
36. Most children with croup syndromes:
A. require hospitalization
B. will need to be intubated
C. can be cared for at home
D. are over 6 years old
C
224
HgB saturated with O2?
Oxyhemoglobin
225
37. Of the following croup syndromes, the one that is potentially life-threatening is:
A. spasmodic croup
B. laryngotracheobronchitis
C. acute spasmodic laryngitis
D. epiglottitis
D
226
A noninvasive method of continuously monitoring partial pressure of O2 in arterial blood; may also be used to measure CO2?
Transcutaneous monitoring
227
38. The RN should suspect epiglottitis if the child has:
A. cough, sore throat, and agitation
B. cough, drooling, and retractions
C. drooling, agitation, and absence of cough
D. hoarseness, retractions, and absence of cough
C
228
HgB capable of carrying O2?
Functional HgB
229
39. If a child is suspected of having epiglottitis, the nurse should:
A. have intubation equipment available
B. prepare to immunize the child for H. influenzae.
C. obtain a throat culture
D. all of the above.
A
230
HgB that is not saturated with O2?
Deoxyhemoglobin
231
40. Since the advent of immunization for H. influenzae, there has been a decrease in the incidence of:
A. laryngotracheobronchitis
B. epiglottitis
C. Reye syndrome
D. croup syndrome
B
232
Reduced blood oxygenation?
Hypoxemia
233
41. Of the following children, the one who is most likely to be hospitalized for TX of croup is:
A. a 2 y/o whose croupy cough worsens @ night
B. a 5 y/o whose croupy cough worsens @ night
C. a 2 y/o using the accessory muscles to breath
D. a child w/inspiratory stridor during physical exam
A
234
A hazard of O2 therapy; may occur in persons with chronic pulmonary disease; seldom encountered in children except those with CF?
Oxygen-induced CO2 narcosis
235
42. The primary therapeutic regimen for croup usually includes:
A. vigilant assessment, racemic epinephrine, & corticosteroids.
B. vigilant assessment, racemic epinephrine, & abx.
C. intubation, racemic epinephrine, & corticosteroids.
D. intubation, racemic epinephrine, & abx.
A
236
Examples: Passy-Muir, Kistner, and Tucker; not appropriate for use in seriously ill children, children using a trach cuff, or children with copious secretions?
Speaking valves
237
43. The condition that is most likely to require intubation is:
A. acute spasmodic laryngitis
B. bacterial tracheitis
C. acute laryngotracheobronchitis
D. acute laryngitis
B
238
Used to help move secretions toward the head during exhalation?
Vibration
239
44. RSV is:
A. an uncommon virus that usually causes bronchiolitis.
B. an uncommon virus that usually does not require hospitalization.
C. a common virus that usually causes severe bronchiolitis.
D. a common virus that usually does NOT require hospitalization.
D
240
A new type of MDI that does NOT require a spacer device?
Rotahaler or Turbuhaler
241
45. In the infant who is admitted with possible RSV, the RN would expect the lab to perform:
A. the ELISA antibody test on nasal secretions
B. a viral culture of the stool.
C. a bacterial culture of nasal secretions.
D. an anaerobic culture of the blood.
A
242
A form of CPB; provides both pulmonary and cardiac support?
ECMO
243
46. Nursing care for pts with severe acute respiratory syndrome predominantly involves:
A. ABX
B. antivirals
C. supportive care
D. steroids
C
244
Techniques that are useful with older motivated children with kyphoscoliosis, CF, asthma, or bronchiectasis?
Breathing and postural exercises
245
47. What is the most common cause of pneumonia in EACH of the following age groups:
1. ) Over 5 years of age
2. ) 3 months to 5 years old
3. ) Under 3 months
1.) M. pneumoniae 2.) H. influenzae 3.) Streptococcus pneumoniae
246
The method of O2 administration that is BEST tolerated by infants?
O2 hood
247
48. Closed chest drainage is most likely to be used with the type of pneumonia that is caused by:
A. H. influenzae
B. M. pneumoniae
C. S. pneumoniae
D. Staphylococcus pneumoniae
D
248
A generic term for devices that use a rapid cycling rate and deliver small tidal volumes with each cycle?
High-frequency ventilation
249
Two of the more serious sequelae of strep throat?
Acute Rheumatic FeverAGN
250
A method of O2 administration that is NOT usually well tolerated by children?
Oxygen mask
251
Absence of airflow (or absence of breathing that lasts for more than 20 seconds?)
Apnea
252
Occurs in 2 conditions: (1) when there is increased work of breathing with near-normal gas exchange function, and (2) when hypoxemia and acidosis develop secondary to CO2 retention?
Respiratory insufficiency
253
Absence of air flow that occurs when no respiratory efforts are present?
Central apnea
254
Condition in which components of central and obstructive apnea are present?
Mixed apnea
255
The cessation of respiration?
Respiratory Arrest
256
Disease involving increased resistance to airflow?
Obstructive lung disease
257
Disease involving impaired lung expansion?
Restrictive lung disease
258
May be caused by cerebral trauma, intracranial tumors, CNS infection, tetanus?
Respiratory center depression
259
Includes pulmonary edema, fibrosis, embolism?
Pulmonary diffusion defect
260
Used to relieve FB obstruction in infants; involves hand placement over the spine b/w the shoulder blades?
Back blows
261
Involves a series of nondiaphragmatic abdominal thrusts; recommended for children over 1 y/o?
Heimlich maneuver
262
25. When an infant's digits are connected to a pulse ox, the part of the sensor that is placed on the top of the nail is called the:a. photodetectorb. microprocessorc. Light-emitting diode (LED)d. electrode
C
263
31. In children, O2-induced CO2 narcosis is encountered most frequently with:a. prematurityb. asthmac. CFd. congenital heart disease
C
264
32. For a child under 5 y/o who needs intermittent delivery of an aerosolized med, the nurse should consider using a:a. hand-held NEBUb. MDI with a spacer devicec. humidified mist tent with low-flow O2d. MDI w/o a spacer device
B
265
33. Postural drainage should be performed:a. before meals but after other respiratory therapyb. after meals but before other respiratory therapyc. before meals and before other respiratory therapyd. after meals and after other respiratory therapy
A
266
35. Which of the following pts is likely to benefit from CPT that includes forced expiration combined with postural drainage?a. pts with pneumoniab. uncomplicated surgical ptsc. pts with increased sputum productiond. all of the above
C
267
36. Chest percussion is being performed correctly if:a. it makes a slapping soundb. it is painfulc. a soft circular mask is usedd. it is performed over the rib cage & diaphragm
C
268
37. The BEST method to stimulate deep breathing in a child is to:a. have child cover mouth & suppress coughb. have child cough repeatedlyc. use games that extend expiratory time& pressured. leave some balloons at the bedside for the child to blow up
C
269
38. To avoid barotrauma when using the bag-valve-mask device, the nurse shoulda. use the type without a reservoirb. use the type with a pop-off valvec. use a low O2 concentrationd. hyperextend the infant's neck
B
270
40. The MOST severe complication that can occur during intubation is:a. infectionb. sore throatc. laryngeal stenosisd. hypoxia
D
271
41. Of the following vacuum pressures, the MOST acceptable pressure to use to suction the trach of a child is:a. 30 mm hgb. 50 mm hgc. 70 mm hgd. 120 mm hg
C
272
44. For a trach dressing, it would be INCORRECT to use:a. DuoDERM CGFb. Allevyn dressingc. a wet 4X4 gauze pad cut into the needed shape.d. Hollister Restore
C
273
45. After the initial post-op change, the trach tube is usually changed:a. Weekly by the surgeonb. Weekly by the nurse or familyc. Monthly by the surgeond. Monthly by the nurse or family
B
274
47. A trach with a speaking valve:a. decreases secretionsb. decreases child's sense of taste and smellc. limits gas exchanged. has no effect on the ability to swallow
A
275
50. Of the following strategies, the one that is LEAST likely to decrease the O2 demand of the child with respiratory distress is:a. maintain child's body temp WNLb. place child in supine positionc. control paind. maintain a warm room temp
B
276
51. Cardiac arrest in the pediatric population is MOST often a result of:a. atherosclerosisb. congenital heart diseasec. prolonged hypoxiad. undiagnosed cardiac conditions
C
277
53. The nurse should place the bag-valve-mask over both the mouth & nose for individuals whose age is:a. birth to 1 yrb. 1 to 3 yrsc. birth to 3 yrsd. birth to 2 yrs
A
278
54. The brachial pulse is the preferred site to use to assess circulation in the:a. infantb. school-aged childc. adolescentd. adult
A
279
55. In a child who is conscious & choking, the RN should attempt to relieve the obstruction if the child:a. is making soundsb. has an effective coughc. has stridord. all of the above
C
280
Increases CO and HR by blocking vagal stimulation in the heart?
Atropine
281
The first choice for V-Tach that is refractory to defibrillation is ?
Amiodarone
282
Used for hypermagnesemia; needed for normal cardiac contractility?
Calcium chloride
283
Causes vasoconstriction and increases CO?
Dopamine
284
Used for ventricular dysrhythmias?
Lidocaine
285
Acts on alpha and beta receptors, causing contraction, especially at the site of the heart, vascular, and other smooth muscle?
Epinephrine
286
Administered rapidly; causes a temporary block through the AV node?
Adenosine
287
Used to buffer the pH?
Sodium bicarbonate
288
The Heimlich maneuver is recommended for children over the age of:a. 4 yrsb. 3 yrsc. 2 yrsd. 1 yr
D
291
Hernial protrusion of a saclike cyst, containing meninges, spinal fluid, and nerves?
Myelomeningocele
292
Defect characterized hy retroposition of the tongue and mandible?
Pierre Robin sequence
293
Condition that results from disturbances in the dynamics of CSF absorption and flow?
Hydrocephalus
294
Cong malformation in which both cerebral hemispheres are absent?
Anencephaly
295
Any malformation of the spinal canal and cord?
Myelodysplasia
296
Marked by eyes rotated downward with sclera visible above the iris?
Setting-sun sign
297
Herniation of brain and meninges through a defect in the skull, resulting in a fluid-filled sac?
Encephalocele
298
Total exposure of the brain through a skull defect?
Exancephaly
299
Fissure in the spinal column that leaves the meninges and spinal cord exposed?
Rachischisis or spina bifida
300
Hernial protrusion of saclike cyst of meninges filled with spinal fluid?
Meningocele
301
Skull defect with tissues protruding?
Cranioschisis
302
The major anomaly associated with myelomeningocele is?
Hydrocephalus
303
Two methods by which prenatal neural tube defects can be diagnosed?
When is the best time to perform these tests?
U/S of Uterus
Elevated AFP
16-18 wks of gestation
304
Management goal for GU FXN in the infant with myelomeningocele?
Goal for older child with same condition?
Preserve renal FX
Preserve renal FX & achieve max continence
305
Drug class used in pts with myelomeningocele to reduce detrusor muscle tone and bladder pressure?
Anticholinergics
306
The PRIMARY DX tool for detecting hydrocephalus in older infants and children is:
A. CT or MRI
B. Measuring head circumference
C. EEG
D. U/S
A
307
What is the preferred shunt for infants with hydrocephalus?
A. Ventriculoperitoneal shunt
B. Ventriculoatrial shunt
C. Ventricular bypass
D. Ventriculopleural shunt
A
308
Post-op care of a pt with a shunt should include:
A. positioning the pt in head-up position
B. continuous pumping of shunt to assess FX
C. monitoring for abd or peritoneal distention
D. positioning pt on side of op site
C
309
The MAJOR complicaitons of Ventriculoperitoneal shunts are?
Infection
Malfunction
310
Posterior fontanel is closed by age?
6-8 wks (2 mos)
311
Anterior fontanel is closed by?
7-19 mo
312
The primary disorder of the upper motor neuron dysfunction is?
CP
313
Characteristic manifestations of upper motor neuron lesions?
Weakness
Spasticity
Increased DTRs
Abnormal superficial reflexes
314
Characteristic manifestations of lower motor neuron lesions?
Weakness
Atrophy of skeletal muscles
Hypotonia
Flaccidity
Contractures
315
Prominent etiologic agents affecting the anterior horn cells?
Enteroviruses
316
CP is the primary disorder of ?
Upper motor neuron dysfunction
317
In most instances the sudden appearance of flaccid paralysis in a previously healthy child is attributed to?
Infectious process
318
What 2 things are more responsible for muscular weakness and atrophy of gradual onset?
Hereditary factors and metabolic diseases
319
What are the 4 MAJOR movement disorders of CP?
Spastic
Dyskinetic
Ataxic
Mixed
320
Characteristics of DTRs in:
1. Upper motor neuron disease
2. Lower motor neuron disease
1. briskly active
Diminished or absent
321
Delayed gross motor development is a universal manifestation of?
CP
322
3 steps involved in transmitting nerve impulses (in order)?
Acetylcholine released
Then diffuses across the junction and causes muscles to contract
Removed by cholinesterase
323
Examples of toxins that cause neuromuscular junction disease are those that produce the paralysis of?
Botulism and tick paralysis
324
The etiology of CP is most commonly related to?
Existing prenatal brain abnormalities
325
The RN is preparing the long-term care plan for a child with CP. Which of the following is included in the plan?
A. No delay in gross motor development is expected.
B. The illness is not progressively degenerative.
C there will be no persistence of primitive infantile reflexes.
D. all children will need genetic counseling as they grow older before planning for a family.
B
326
What are the major complications of Duchenne muscular dystrophy?
Contractures
Scoliosis
Disuse atrophy
Infections
Obesity
cardiopulmonary problems
327
What is the eventual cause of death in those with DMD?
Respiratory infection Cardiac failure
328
Characteristics of DMD?
Early onset b/w 3 – 5 y/o
Progressive weakness,
wasting, contractures
Calf muscle hypertrophy
Loss of independent ambulation by 9 – 12 yrs
Slowly progressive, generalized weakness during adolescence
Relentless progression until death from resp or cardiac failure
X – Linked recessive trait?
330
DMD management?
No cure
Maintain optimum function in all muscels for as long as possible
Prevent contractures
Must have cardiac status assessment prior to ANY SURGERY
331
Child with this disorder attains Standing posture by kneeling, then gradually pushing his torso upright (with knees straight) by walking his hands up his legs. Marked lordosis in upright position. What is this known as?
What disorder does the child have?
Gower sign
DMD
332
DMD age of ONSET?
3-5 yr
333
DMD initial manifestations?
Lordosis
Waddling gait
Frequent falls
Toe walking
Difficulty in rising from floor (Gower sign) and climbing stairs
Fat deposits replace wasted gastrocnemius muscles
334
DMD progression?
Rapid
Ultimately involves all voluntary muscles
Death usually occurs at 15-30 yrs
335
An uncommon acute demyelinating polyneuropathy with progressive, usually ascending flaccid paralysis?
Guillain-Barre syndrome (GBS)
336
Hallmark of GBS?
Acute peripheral motor weakness
337
When does GBS usually occur?
10 days after nonspecific viral infection
338
Who does GBS affect more?
Adults more often than children
Child b/w 4-10 y/o (more susceptible)
Late adolescence and young adulthood (peak periods)
339
Although cong GBS is rare, if it occurs what does is consist of?
Hypotonia
Weakness
Decreased or absent reflexes
340
When do symptoms of GBS gradually subside and then dissapear?
Subside: first few mo of life
Disappear: by 12 mo
341
An immune-mediated disease often associated with a number of viral or bacterial infections or the administration of vaccines?
GBS
342
Previous infection with what organism is associated with a severe form of GBS?
C. *jejuni*
343
Three phases of GBS?
1. Acute or progressive
2. Plateau
3. Recovery
344
How long may the acute/progressive phase of gbs last?
until new sx stop appearing or deterioration ceases
**MAY LAST UP TO 4 WKS**
345
Clinical manifestaions of gbs?
Mild influenza-like sore throat precedes paralytic manifesations
Onset: rapid (reaching peak in 24 hr) or gradual over days - weeks
Neuro: initially involve muscle tenderness sometimes accompanied by paresthesia and cramps.
Paralysis ascends from lower extremities or trunk to upper extremities
Depressed/absent tendon reflexes
Lower limb & back pain common in children
Urinary incontinence/retention
Constipation
Abd pain & fatigue
Ortho hypo
HTN
Bradycardia, asystole, heart block
346
Which cranial nerve is often affected by gbs?
CN 7 (facial)
347
DX of gbs?
Based on parylitic manifestations and on EMG
Motor nerve conduction velocities are greatily reduced
CSF analysis reveals elevated protein and normal glucose
348
gbs TX?
Priamrily supportive
In acute phase pt is hospitalized bc resp and pharyngeal involvement may require ventilation or trach.
Aggressive vent support
IV immunoglobulin (IVIG)
Steroids
Plasmapherisis
LMWH, mild laxative, acetaminophen, h2ra
349
Side effects of plasmapheresis?
Hypotension, bradycardia
fever
bleeding
chills, urticaria
350
Nursing mgmt of the child with Tetanus?
Supportive with particular attention to Airway and breathing
Assess location and extent of muscle spasms and the severity
CNS depression, apnea, resp failure (MAY be d/t opioids, muscle relaxants, sedative)
May need to paralyse pt because of the intensity of the spasms.
HYDRATION & NUTRITION (monitor IVF, NG or gastrostomy feeding), ORAL HYGIENE, suction secretions
CONTROL/ELEMINATE stiulation from sound, light, touch (dim light NOT DARK room)
If paralytic (rocuronium, vecuronium) is used - admin anxiolytics (fentanyl/versed)
Have parent stay with child
351
Tetanus is characterized by?
Painful muscular rigidity involving masseter and neck muscles
352
Would the child who reports to the ER with a clean minor wound who has completed tetanus shot in the last 10 years need a tetanus booster shot now?
NO
353
A child admitted to the ER with a burn and puncture wound and had a tetanus booster in the past 10 years should recieve?
Tetanus toxoid booster
354
A child who is unprotected and/orinadequatly immunized sustains a "tetanus prone" wound contaminated with dirt reports to the ER. What should he be administered?
Tetanus immunoglobulin (TIG)
AND tetanus toxoid at a separate site
355
4 requirements to the development of tetanus?
1. presence of tetanus spores or vegetative forms of the bacillus
2. injury to tissues
3. wounds that encourage multiplication of the organisms
4. A susceptible host
356
Of the 2 exotoxins from tetanus, _______ is the potent toxin that affects the CNS causing sxs while ______ has no significance.
tetanospasmin
tetanolysin
357
Most cases of tetanus occur within ___ days; in neonates it is usually ___ to ____ days.
14
5-14
358
Difficulty in neonates sucking ability is the first manifestation of?
Tetanus
359
The characteristic difficulty opening the mought d/t tetanus is known as?
trismus
360
Spsm of facial muscles produces the so/called sardonic smile known as?
risus sardonicus
361
Survival of tetanus beyond how long usually indicates complete recovery?
4 days
362
Drug of choice in tetanus pts for seizure control?
diazepam
363
Autoimmune disorder associated with the attack of circulating antibodies on the acetylcholine receptors on the muscle end plat, which blocks their function?
Myasthenia gravis (MG)
364
MG incidence?
Uncommon in childhood
Onset after age 10 usually but may appear at 2 y/o
Girls 3x \> boys
365
With this disease, the most common sx are general paralysis of the optic muscles with ptosis and diplopia. Difficulty swallowing, chewing, and speaking are also prominent and accompanied by weakness and paralysis of all skeletal muscles?
MG
366
Involves more prounounced sx in the late afternooon and eveening. Rest can releive the sx but exercise and stress worsen them?
MG
367
DX of MG?
Based on characteristic distribution of muscle weakness and progressive weakness
EMG: decrease in muscle potentials with repetitive nerve stimulation
Tensilon test
368
Thereapeutic management of MG?
Cholinesterase INHIBITING drugs (Prostigmin IV or PO)
Mestinon
Observe child for parasympathetic stimulation d/t overmedication (lacrimation, salivation, abd cramps, sweating, diarrhea, vomiting, bradycardia, resp weakness)
Thymectomy
IVIG
Plasmapheresis
369
Antidote for neostigmine and pyridostigmine given for MG?
Atropine!!
370
Drugs that MUST be AVOIDED in pts with MG?
***_Neuromuscular-blockers_*** (**pancuronium**, **succinylcholine**) -may induce paralysis for wks
***_Aminoglycosides_*** (**gentamicin**) - potentiate MG sx
371
Nusing mgmt for MG?
_**MINIMIZE STRESS** & **MAXIMIZE REST**_
_**DON'T** admin panteronum or succinylcholine!!_
_Teach parents importance of accurate med admin &_ _side effects: choking, aspiration, resp distress_
_Warn them of possibility of sudden exacerbation of sx during times of physical/emotional stress (**myasthenia crisis**) - REQUIRES STAT medical attention_
372
What are the 7 Major Complications of DMD? **(MUST KNOW!!)**
Contractures
Disuse atrophy
Resp infections
Scoliosis
Obesity
Resp compromise
Cardiac failure
373
1. Infants are more likely to suffer SCI as a result of?
2. Toddlers and school-aged children up to 9 years?
1. Motor vehicle crashes (MVCs)
2. Falls
374
What accounts for the high majority of SCIs in adolescents who live in the U.S.?
FOOTBALL!!
375
How many nerves (spinal processes) are there in the following segments of the spinal cord:
1. cervical
2. Thoracic
3. Lumbar
4. Sacral
5. coccygeal
**_7_**
**_12_**
**_5_**
**_5_**
**_1_**
376
Complete SCI?
**_Absence of sensory & motor fxn below level of injury_**
**Paraplegic** - lower thoracic (waist down)
**Tetraplegic** - C1-T1
**Quadriplegic**
377
The most common cause of serious SCI in children is trauma involving?
MVCs
sports
Birth trauma
Child abuse
378
SCI w/o radiographic abnormality (SCIWORA) is likely to occur in an?
MCV when safety restraints are not used
379
Various degrees of sensory/motor loss below the LOI; partial damage to spinal cord?
Incomplete SCI
380
Neonatal MG:
A. occurs in approx 30% to 50% of infants born to mothers with MG
B. produces elevated moro reflex and shrill cry in the infant
C. may require admin of cholinesterase inhibitors to improve feeding ability
D. produces strength changes in infant even after maternal acetylcholine receptor antibodies have cleared infant's system
C
381
A group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occured in the developing fetal or infant brain?
CP
382
Abnormal muscle tone and coordination are the primary disturbances in pts with?
CP
383
Most common permanent physical disability of childhood?
CP
384
a nonprogressive injury to the motor centers of the brain, which can cause spastic and involuntary movements, and can also be associated with developmental delays and seizure activity?
CP
385
Persistence of tonic neck reflex and Moro reflex beyond 4 months indicates?
CP
386
ETIOLOGY OF CP?
Brain injury/insult during prenatal period
maternal and perinatal infections
Premies of ELBW and VLBW
Periventricular leukomalacia & intracerebral hemorrhage in LBW infants
Perinatal ischemic stroke, White matter abnormalities (focal lesions)
Shaken baby syndrome, Bacterial meningitis, Viral encephalitis, MVCs, Child abuse
387
SINGLE MOST IMPORTANT RISK FACTOR FOR CP?
Preterm birth of extremely low-birth wt (ELBW) and very low-birth weight (VLBW)
388
What are the classifications of CP?
Spastic (pyramidal)
Dyskinetic (NON-spastic, Extrapyramidal)
Ataxic (NON-spastic, Extrapyramidal)
Mixed Type
389
Characterized by persistent primitive reflexes, positive Babinski reflex, ankle clonus, exaggerated stretch reflexes, eventual development of contractures; **70 to 80% of all cases of CP**?
Spastic (Pyramidal)
390
Characteristics of spastic (Pyramidal) CP?
MOST COMMON CLASSIFICATION
**Diplegia** -all extremities affected; lower more than upper (NOT COMMON)
**Tetraplegia**-all 4 extremities affected (not common)
**Triplegia**
**Monoplegia**
**Hemiplegia**
**Hypertonicity** with poor control of posture, balance, and coordinated motion impairment of fine and gross motor skills
391
Involuntary, irregular, jerking mvmts characterized by slow, wormlike, writhing mvmts that usually involve extremities, trunk, neck, facial muscles, and tongue
Athetoid-chorea (Dyskinetic CP)
392
The etiology of CP is most commonly r/t:
A. existing prenatal brain abnormalities
B. maternal asphyxia
C. childhood meningitis
D. preeclampsia
A
393
Pure cerebral paraplegia of lower extremities?
Paraplegia
394
Exaggerated arching of the back
Opisthotonic posture
395
Most common form of spastic CO; motor deficit \> in upper extremity; one side of body affected?
Hemiparesis
396
When does hand dominance normally develop &what does it indicate when a child develops hand dominence at about 6 mo of age?
NORMAL = Preschool years
CP
397
Physical signs indicative of CP?
Poor head control after 3 mo of age
Stiff or rigid arms or legs
Pushing away/arching back
Floppy/limp posture
Can't sit up w/o support by 8 mo
Using only 1 side of body, or only arms to crawl
Clenched hands after 3 mo
Persistence of primitive reflexes such as Moro and atonic neck past 6 mo
Hand preference demonstrated before 18 mo
Leg scissoring
Seizures
hearing/vision imp
Persistent tongue thrusting after 6 mo
399
Most common soft tissue sarcoma in children, especially children under 5 y/o?
Rhabdomyosarcoma
400
Where does rhabdomyosarcoma occur?
Striated skeletal muscle
401
Most common subtype of rhabdomyosarcoma, mostly found in head, neck, abd, & GU tract?
Embryonal
402
Second most common subtype of rhabdomyosarcoma, mostly arises in deep tissue of extremities & trunk?
Alveolar
403
Subtype of rhabdomyosarcoma that is RARE in children (ADULT FORM), most often occuring in soft parts of extremities & trunk?
Pleomorphic
404
Clinical manifestations of Rhabdomyosarcoma (RMS)?
Initial s/s are r/t site of tumor and compression of adjacent organs
Commonly mistake s/s for "earache" or "runny nose"
405
DX EVALUATION OF RHABDOMYOSARCOMA?
H&P
CT or MRI
METS eval shold include CT of chest, bone scan, & bilateral BM aspirates & BXs
LP to examine SF
Excisional BX or surgical resection of tumor when possible to confirm DX
406
RHABDOMYOSARCOMA is...?
Malignant solid tumor of the soft tissue
407
With a multimodal approach to TX for nonmetastatic rhabdomyosarcoma, what % of pts are expected to survive?
A. 15%
B. 35%
C. 50%
D. 80%
D
408
C/M of RMS located in the orbit?
Rapidly developing unilateral proptosis
Ecchymosis of conjunctiva
Loss of extraocular mvmts (strabismus
409
C/M of RMS located in the nasopharynx
Stuffy nose (earliest)
Nasal obstruction - dysphagia, nasal voice, serous otitis media
Sore throat and ear
epistaxis
palpable neck nodes
visible mass in oropharynx
410
TX of RMS?
Multimodal therapy
Removal if possible
Chemo, irradiation, or both
Pts with embryonal tumors and group 1 dz can be tx with chemo alone
411
Goup 1 RMS
Localized dz
Tumor completely resected
Regional nodes NOT involved
412
Group 2 RMS
Localized dz with microscopic residual, or regional dz with no residual or with microscopic residual
413
Group 3 RMS
Incomplete resection or BX with gross residual dz
414
Group 4 RMS
METS present at DX
415
C/M of RMS located in the paranasal sinuses?
Nasal obstruction
Local pain
Discharge
Sinusitis
Swelling
416
C/M of RMS located in the middle ear?
S/S of chronic serous OM
Pain
Sanguinopurulent drainage
Facial nerve palsy
417
C/M of RMS located in the retroperitoneal area?
USUALLY A SILENT TUMOR
Abd mass
Pain
S/S of intestinal or GU obs
418
C/M of RMS of the peritoneum?
Visible superficial mass Bowel or bladder dysfxn
