Final Exam Cards

Question 1

S&S of Sickle Cell

Answer 1

pressure, clotting, sickled cells, classic signs of anemia

Question 2

Why doesn’t sickle cell present in infants

Answer 2

they still have fetal hemoglobin in circulation

Question 3

Hirschprung’s Disease

Answer 3

autosomal dominant genetic mutation in which the infant fails to pass meconium in the first 48hrs- abdominal distention, diarrhea, constipation

Question 4

How is hypospadias fixed?

Answer 4

surgery then circumcision at 12-18 months of age

Question 5

Nursing care of post op scoliosis repair

Answer 5

LOGROLL when necessary, maintain skin integrity, control pain, anticipate OOB by POD 2-3, monitor neurovascular status

Question 6

Munchausen by Proxy signs

Answer 6

*Child with multiple medical problems that do not respond to treatment or do not follow an expected pattern
*Physical or lab findings inconsistent with medical history, or are clinically impossible
*Caregiver is not reassured by “good news” or results
*Caregivers who are unusually calm in the face of child’s health crisis.
*Symptoms that only occur when caregiver is present, or symptoms that are alleviated when caregiver is absent
*Caregivers that are fascinated by medical details
*Caregivers who are very upset with medical team and demand more procedures or tests or transfers to another facility.

Question 7

Developmental hip dysplasia S&S

Answer 7

Hip joint laxity, asymmetrical gluteal and thigh folds, limb length discrepancy, trendelenburg’s sign, ortolani’s and barlow’s, Allis’ sign

Question 8

Torticollis management

Answer 8

PROM exercises, move the crib in a different direction from the door so the baby will look at the side opposite the preferred gaze, if the condition does not resolve, and 90% do, surgical release is performed

Question 9

Cerebral Palsy Progression

Answer 9

Presents with Opisthotonos (exaggerated arching of the back, abnormal motor functioning, feeding difficulties, stiff or rigid limbs, altered muscle tone, delayed milestones (esp. gross motor development) hand preference before 6mos of age, diapering difficulty due to hip spasticity

Question 10

How do we treat MRSA

Answer 10

Vanco, Clindamycin

Question 11

Short term side effects of radiation therapy

Answer 11

Nutrition, Nausea/vomiting, Mouth sores, Fatigue, Reddened or itchy skin, Hair loss, Pancytopenia, Changes in taste and smell, Sleepiness (somnolence syndrome), Swollen parotid glands, Decreased saliva

Question 12

Long term side effects of radiation therapy

Answer 12

Cognitive function, Radiation-site specific problems, Delayed/absent puberty, Fertility, Secondary tumors

Question 13

Pressures on the left side of the heart are (what) than the right side

Answer 13

greater

Question 14

Right sided heart failure signs

Answer 14

RV function is reduced causing increased CVP and systemic venous hypertension, hepatomegaly, edema in extremities

Question 15

Left sided heart failure signs

Answer 15

LV dysfunction, increased pressure in the LA and pulmonary veins, lungs become congested with blood=pulmonary edema

Question 16

How do we provide culturally sensitive care?

Answer 16

Talk to the parents and ask what they do to take care of a sick child
If the practice is safe for the child, try to incorporate it into the care
Always listen!

Question 17

How do we treat lice?

Answer 17

*Treat with OTC lice products in children OVER 2 years old
*After treatment, comb out the nits with a fine-tooth comb
*repeat treatment in 7 to 10 days to kill any newly hatched nits

Question 18

How long does bone healing take in children?

Answer 18

2-12 weeks

Question 19

Nursing care of kids who are victims of sexual abuse

Answer 19

*Bring in the SANE nurse
*Never promise not to tell
*Preserve evidence- no showering until evidence is collected
*Reassurance

Question 20

Cleft Palate- Parental Education

Answer 20

*Prone position ok
*Speech therapy
*Soft foods only until advanced by MD or NP
*NO pacifiers, NO straws, NO utensils, NO popsicles- child must use cup for feeds
*Educate parents on s/s otitis (altered Eustachian tube positioning)

Question 21

Pre cardiac catheterization care

Answer 21

Height/Weight, Cardiac assessment (include pulses), Explain procedure to child and parent, Assess for any s/s infection, NPO (watch hydration), Monitor glucose level in babes

Question 22

Post cardiac cath care

Answer 22

Monitor pulses (esp. those distally to cath site), Neurovascular assessment of extremities, VS, Monitor s/s bleeding, I&O, Bed rest 6-8 hours post procedure with affected leg straight and flat, Glucose levels in babes, Manage bleeding by direct pressure 1 inch above cath site

Question 23

Teaching Parents about Cardiac Caths

Answer 23

Pressure dsg stays on for 24hrs then band aid, Keep dressing dry, no baths until ok’d by NP or MD, Call with any redness, swelling, excessive pain, warmth to cath site, School ok, heavy lifting or rigorous exercise not ok until NP/MD gives permission

Question 24

Symptoms of decreased pulmonary blood flow

Answer 24

Tachypnea, dyspnea, cough, wheezes

Question 25

S&S of Autism

Answer 25

*Failure to maintain eye contact *Failure to respond to social cues *Ritualistic behavior, need to follow strict routine. Deviation from routine can cause extreme anxiety *Self-stimulatory behaviors-rocking, hand flapping, spinning. Some behaviors can cause injury to self *Preoccupation with insignificant details *Perseverance on words or objects

Question 26

Autism Treatment

Answer 26

*Individualized therapy has been shown to work best *Social behavior training, anxiety reduction, behavior modification *Antidepressants and antipsychotics have been used *Inclusion or mainstreaming...pros and cons...

Question 27

Treatment of AML

Answer 27

BMT after remission, chemo, more intense

Question 28

Treatment of ALL

Answer 28

Chemo, steroids, serial LP's, frequent labs

Question 29

Nursing care/ support of children with disabilities

Answer 29

*Developmental approach *Consistency *Emphasize abilities *Plan care involving child and family *Encourage independence *Assist with coping *Facilitate hope *Help to establish future goals

Question 30

Leukemia pt education

Answer 30

Pts are encouraged to return to as normal a life as possible, mitigating infection risk

Question 31

Kids and Diets

Answer 31

Introducing foods slowly, 1 new food per week, limit sugar, toddlers can't have anything they can choke on

Question 32

Diets and CF

Answer 32

high protein, high calorie

Question 33

Bacterial Meningitis Nursing care

Answer 33

*Place patient on Isolation(respiratory/droplet) *Start antibiotics STAT *IV hydration *Monitor for increased ICP and institute nursing care for pts with increased ICP *Control temperature *Close contacts with patient need prophylactic treatment (Cipro, Rifampin)

Question 34

Management of bleeding with hemophilia

Answer 34

*Prevent bleeding *Replace missing factor *Mouth lacerations: watch ABCs, may need to be NPO until bleeding managed *Dental work/Teeth Extractions: pre and post administration of antifibirinolytic agent *Planning/ coordination for dental/ surgical procedures

Question 35

Hemarthrosis S&S

Answer 35

joint stiffness, tingling and pain with increasing inability to move joint. Warmth, redness, swelling and pain are also common

Question 36

How to treat hemarthrosis

Answer 36

ICE pack, NWB, elevate affected limb above heart, immobilization-NO PROM exercises until acute injury phase is done

Question 37

Teaching and Health promotion for Hemophilia

Answer 37

*Teaching re: disease awareness *Teaching/ Support for home infusion *Health promotion/Prevention- Sport choices (non contact), Healthy weight and good fitness, Normalization – Chronic Illness, Use of prophylactic infusions

Question 38

Osteogenesis Imperfecta- Parental education

Answer 38

*Teach parents to carry documentation of OI *Never push or pull *Lift from the buttocks *When changing diaper, do not grab both legs together at ankles, lift from buttocks *Bathe in a padded infant tub *When dressing, “roll” clothes on, do not pull arms and legs through openings *Touch is important to people, so not be afraid to cuddle and touch...just do it carefully!!!

Question 39

Nursing care of Myelomeningocele

Answer 39

*Avoid rectal temps! *Prevent infection, esp when sac is visible. *Cover sac in sterile, moist, non-adherent dressing. *Surgical closure of sac within first 24 hours *VP shunt if necessary *Orthopedic care *GU care-continence

Question 40

Glomerulonephritis S&S

Answer 40

*Edema (periorbital then progresses to body [pulmonary]) *Hematuria, Cola colored urine, protein in urine, ↑USG, Oliguria, Hypertension *Know that the disease is usually self limiting, with 98% of kids achieving full recovery

Question 41

Glomerulonephritis nursing care

Answer 41

oCare of the child with edema Loop diuretics Skin care, repositioning Diet should be low salt or no added salt Strict I&O, daily weights, if necessary, fluid restriction oMonitor for infection oHypertension Monitor Q4-6 hrs Antihypertensives USE THE CORRECT CUFF and BE CONSISTENT!

Question 42

Nursing care for pertussis

Answer 42

*Erythromycin or Bactrim for 14 days or *Azithromycin-5-7 days *If someone in the house has pertussis, Pertussis Prophylaxis is recommended for family members if there’s an infant in the house < 6 months *Prevent coughing episodes: encourage restful activities *Monitor hydration, nutrition *If child is treated at home, notify public health department

Question 43

Leukemia labs

Answer 43

oWBCs: Increased oHemoglobin: Decreased oPlatelets: Decreased oNeutrophils: Decreased oBlast Cells Present

Question 44

AML symptoms

Answer 44

Lymphadenopathy, Fatigue, Fever, Recurrent Infections, Petechiae, bleeding (nose and gums)

Question 45

ALL symptoms

Answer 45

fatigue, fever, pallor, petechiae, bleeding, bruising, bone pain, lymphadenopathy, HSM

Question 46

Mild intermittent Asthma

Answer 46

brief exacerbations with daytime and nighttime symptoms 2xweek or less

Question 47

Mild persistent asthma

Answer 47

exacerbations more than twice a week but less than once a day. Nighttime symptoms more than twice a month

Question 48

Moderate persistent asthma

Answer 48

daily symptoms and nighttime symptoms more than once a week

Question 49

Severe persistent asthma

Answer 49

continuous daytime symptoms with limited physical activity and frequent nighttime symptoms

Question 50

Prevention of TLS

Answer 50

Allopurinol, lysis labs, hydration, diuretics, electrolytes

Question 51

ADD/ADHD Diagnosis

Answer 51

*Inattention, Impulsiveness, Hyperactivity *Symptoms need to occur in at least 2 settings, ages 4-18yrs

Question 52

Epiglottitis

Answer 52

oCharacterized by muffled voice, drooling, agitation, lack of spontaneous cough, tripod position oDO NOT ATTEMPT TO VISUALIZE THE AIRWAY! X-ray will confirm oKeep child calm and sitting up; abx and steroids stat. oWe give Hib vaccine-so this condition is rare.

Question 53

LTB

Answer 53

"classic croup” most common type of croup, preceded by a URI, gradual onset, low grade fever, symptoms worse at night, cough is brassy, barky “seal like”, inspiratory stridor, cough, vocal hoarseness, X-rays not helpful in dx

Question 54

Acute spasmodic laryngitis

Answer 54

“midnight croup” paroxysmal attacks that occur at night, not preceded by an illness. Kids go to bed fine, then wake up with the barky cough, child is anxious, there is no fever

Question 55

Croup nursing care

Answer 55

*Have emergency equipment available *Remain calm and reassuring *Accompany the child to all tests (nurse) *Cool mist/humidified air *Clear liquids-but hold all po liquids in periods of respiratory distress or acute illness

Question 56

Red flags for child abuse

Answer 56

*Spiral fractures, bruising in unusual places (torso), parent/ relative answering for child/ assertive, child is in fear of this relative *Injury is inconsistent with explanation and developmental level

Question 57

Compartment syndrome

Answer 57

*Unrelieved or increased pain *Pale, dusky, edematous tissue distal to injury *Pain on PROM *Pulselessness and loss of sensation (so pain suddenly subsides) *This is an EMERGENCY. Immediately notify physician. Prep patient for cast adjustment and possible fasciotomy.

Question 58

Tonsilectomy post op

Answer 58

*Prone or side lying *NO suction! *Check for bleeding frequently (frequent swallowing is a clue) *Emesis with old blood is common, bright red blood is not *Pain management *Ice collar *Clear, cool liquids-nothing red!

Question 59

Local reactions and vaccines

Answer 59

Shot sites can have swelling, redness and pain. Most often, these symptoms start within 24 hours of the shot. They most often last 3 to 5 days. With the DTaP vaccine, they can last up to 7 days.

Question 60

Fever and vaccines

Answer 60

Fever with most vaccines begins within 24 hours and lasts 1 to 2 days.

Question 61

Delayed reactions and vaccines

Answer 61

With the MMR and chickenpox shots, fever and rash can occur. These symptoms start later. They usually begin between 1 and 4 weeks.

Question 62

Anaphylaxis

Answer 62

Severe allergic reactions are very rare but can occur with any vaccine. They start within 2 hours

Question 63

Polio vaccine allergies

Answer 63

allergic to streptomycin, neomycin, polymyxin

Question 64

Varicella/ MMR vaccine allergies

Answer 64

allergic to neomycin and gelatin

Question 65

Flu vaccine allergy

Answer 65

allergic to eggs or latex

Question 66

Hep B vaccine allergy

Answer 66

allergic to baker's yeast

Question 67

Meningitis vaccine allergy

Answer 67

allergic to latex

Question 68

Pt ed for antibiotics

Answer 68

*Always take the entire prescription *Possibility of diarrhea *Store them properly *Have a back up contraception- decreases effectiveness of OC *Know when to take with food or an empty stomach *Watch hearing with aminoglycosides

Question 69

Vesicant nursing care

Answer 69

*Give in the PICC line *Watch for extravasion *Give good skin care *Blood return pre, during and post

Question 70

Central Apnea

Answer 70

CNS does not transmit signal to breathe

Question 71

Obstructive Apnea

Answer 71

Upper airway obstruction, chest wall movement present

Question 72

Mixed Apnea

Answer 72

combo of central and obstructive

Question 73

UN millenium goals

Answer 73

*Eradicate extreme poverty and hunger *Achieve universal primary education *Promote gender equality and empower women *Reduce child mortality *Improve maternal health *Combat HIV/AIDS, malaria and other diseases *Ensure environmental sustainability *A global partnership for development

Question 74

Parental ed for tantrums

Answer 74

Don’t feed into it, if you give them the energy, you “approve” of the behavior

Question 75

Explaining CT scan to kids

Answer 75

*Developmentally appropriate *“So this machine is going to take pictures of the inside of your body, it’ll take x episodes of Cocomelon to be done, and you have to stay still so the pictures can come out clear”

Question 76

Peak flow meter

Answer 76

*Peak Flow Meter: measures peak expiratory flow (max flow of air that’s expelled in 1 second). Individual result. Establish personal best value by doing Peak Flow twice a day for 2-3 weeks when child is stable (afternoon is best)- measures lung disease, 80-100%

Question 77

Pavlick harness

Answer 77

*Observe for any asymmetry on assessment, observe walking when appropriate *For Babes in Pavlick Harness: oWear Onsie-straps shouldn’t touch skin oDiaper should be under straps oSkin integrity-how should you educate parents?

Question 78

RBC transfusions

Answer 78

*Increases CBC, increases fluid volume *Less lethargic, more alert, feeling better, less risk for hypoxia

Question 79

Celiac disease education

Answer 79

*NO wheat, barley, oats and rye *OK to eat corn, rice and millet *If celiac is severe, you may also be lactose intolerant *So overall, we want a diet that is high in calories, high in proteins, contains simple carbs and is low in fats. We avoid high fiber foods until bowel inflammation is resolved. *Lots of education...if there is a nutritionist on the team, make sure they meet the patient *Developmentally approach the problem and anticipate compliance issues *Work to get a “buy in” from the parents *Community education- schools, coaches

Question 80

Car seat safety

Answer 80

*Rear facing- birth-2 years *Forward facing- 2-4 years *Booster- 4-8 years *Seatbelt- 8 years+ *Sitting in the front- start at age 12

Question 81

Stuttering

Answer 81

*Encourage the child to speak slowly *Do not rush or finish the word or sentence for them

Question 82

Iron deficiency anemia- pt ed

Answer 82

*Give iron supplements with fruit juice, not milk *Administer liquid iron through straw or perform oral care after administration *Monitor for constipation, pallor, weakness, fatigue

Question 83

Thrombocytopenia

Answer 83

reduced platelets, expect bleeding disorders

Question 84

Anemia

Answer 84

reduced RBCs, expect anemia

Question 85

Pancytopenia

Answer 85

reduction of all blood cells, expect anemias and bleeding disorders

Question 86

Care of the hospitalized child

Answer 86

include the family and recognize their diversity, respect coping mechanisms, expect regression, promote normalcy

Question 87

Atraumatic care

Answer 87

prevent or minimize child separation from the family and bodily injury/ pain, promote a sense of self control