PAEDIATRIC Flashcards
A nurse is counselling the family of a child with AIDS. What is the most important concern the nurse should discuss with the parents?
A/ Risk for injury
B/ Susceptibility of infection
C/ Inadequate nutritional intake
D/ Altered growth and development
B/ Infection
Rationale:
Children with AIDS have a dysfunction of the immune system and are susceptible to opportunistic infections. Although adequate nutrition can be a problem for kids with AIDS, infection poses a greater threat. Altered growth is not as significant as infection.
An 8 year old child who is experiencing a sickle cell pain episode is admitted to the child health unit. What is the appropriate nursing care during this acute period?
A/ Limiting Fluids until the crisis ends
B/ Administering Prescribed Analgesics
C/ Applying cold compresses to painful joints
D/ Performing range-of-motion exercises of affected joints to stimulate blood flow.
B/ Pain meds
Rationale:
Severe pain is associated with sickle cell crisis and should be controlled through analgesics. Hydration is important to promote hemodilution, improve circulation and prevent more sickling. Cold will constrict vessels and make the situation worse. Warmth is preferred. ROM exercises would increase swelling and pain. Bad call… Pain tx is number one with sickle.
What teaching must the nurse emphasize to the family when preparing a school-aged child with persistent asthma for discharge?
A/ A cold, dry environment is desirable
B/ Limits should not be placed on their behaviour
C/ The health problem is gone when symptoms subside
D/ Medications should be used even when the child is asymptomatic
D/
Rationale:
Children with asthma must continue to take their meds to keep them asymptomatic. Some environmental moisture is needed for asthmatics, and limits should always be placed of any adolescent behaviour regardless of illness or not.
tx includes: Inhaled corticosteroids, Long-acting Beta2-agonists, and leukotriene modifiers.
A school nurse is teaching a group of teachers’ aides about the cause of lead poisoning in children. What should be considered in terms of prevention?
A/ Lead poisoning is known to be caused by ingestion of foods high in fat
B/ Lead poisoning is known to be caused by passive or inattentive parenting
C/ Environmental factors are involved because lead is available for ingestion and inhalation
D/ Increasing milk intake will counteract the adverse affects of lead ingestion
C/ Environmental factors through inhalation and ingestion
Rationale:
Caused by lead in the environment. Unless fat has been exposed to lead, it is not a factor. Parenting roles are neither a factor too.Milk does not counteract the effects of lead.
A 5 year-old child is admitted to the paediatric unit complaining of colicky abdominal pain with guarding, nausea, anorexia, and a low-grade fever. Palpation of the right lower quadrant of the abdomen elicits pain. What is the likely diagnosis for this patient?
A/ Ulcerative Colitis
B/ Acute Appendicitis
C/ Hirschsprung Disease
D/ Hookworm Infestation
B/ Acute Appendicitis
Rationale:
Classic signs of appendicitis. Kid would have diarrhea if ulcerative colitis. Hirschsprung disease is manifested by constipation, and manifestations of hookworm infestations are: anemia, malnutrition, and popular eruptions.
What is the most important thing for a nurse to teach parents of a child with Duchenne Muscular Dystrophy to do for their school-aged-child?
A/ Maintain high caloric diet
B/ Institute seizure precautions
C/ Restrict the use of larger muscles
D/ Perform range of motion exercises
D/ ROM exercises
Rationale:
ROMs are essential to help achieve primary objectives of maintaining optimal muscle function for as long as possible and preventing the development of contractures. High caloric diet would make them fat, which would push them to a wheel-chair faster than you can say “fat guy in a little coat”. Seizures have nothing to do with duchenne, and restricting large muscles could result is disuse atrophy and contractures.
A school nurse informs the mother of an 11-year old girl that her daughter has been giving her lunch to her friends and buying cookies and cola a lunch. The mother asks the nurse how to best solve the problem, and the nurse responds BEST by saying:
A/ “Give her enough money to buy a proper lunch”
B/ “Withhold her allowance until she promises to eat her lunch”
C/ “Explain to her child how important a nutritious lunch is for her health”
D/ “Have her help you plan nutritious meals that include her favourite foods”
E/ “Lace all your cookies at home with fish oil, and your cola with bacon grease; thus, rendering her love of sweets obsolete and ensuring she will never eat poorly again”
D/ Develop meal plan together.
Rationale:
Involving the kid will give the child a sense of achievement and encourage her to eat the foods that are enjoyed and nutritious for her. Other options do not promote adherence or healthy behaviour. Punishment will cause rebellion. Lacing foods would work, but it is frowned upon by many paediatric institutions.
What is the priority nursing intervention for a young infant who has an IV in place after undergoing abdominal surgery?
A/ Administering oral Fluids
B/ Limiting Handling by parents
C/ Weighing diapers after each void to ensure proper In and out
D/ Maintaining patency of IV infusion
D/ Patency of IV
Rationale:
It is imperative to monitor IV site and tubing for patency to avoid obstruction or infiltration. Oral fluids are not administered after abdominal surgery until peristalsis has returned. The is no reason to limit parent handling under these circumstances. Although it is important to measure in and out, IV maintenance is priority.
An infant with the diagnosis of heart failure is being given Furosemide BID. Which lab values should the nurse report to the primary care physician?
A/ Na+ 140 mmol/L
B/ Ca+ 1.2mmol/L
C/ Cl 102 mmol/L
D/ K+ 3.0mmol/L
D/ Potassium
Rationale:
Furosemide is a potassium-sparing loop diuretic, making K+ something that should be checked often. Normal K+ concentration of infants if 3.5-5.0mmol/L in infants. Other values are in normal ranges.
A 2-week old infant is admitted with a tentative diagnosis of a VSD (ventricular septal defect). The parents report that their baby has had a hard time feeding since coming home after birth. What should the nurse consider before responding?
A/ Feeding problems often occur in neonates
B/ Inadequate suckling is not significant in the absence of cyanosis
C/ Ineffective suckling and swallowing may be indications of a heart defect
D/ Many neonates retain mucus, and this can interfere with feeding for several weeks.
C/ Indication of heart defect
Rationale:
Compromised heart function causes decreased cardiac output; which often results in cyanosis and fatigue from ineffective suckling and swallowing. When feeding issues persist in a neonate, it generally is an indication of some pathology. Inadequate suckling is NEVER insignificant! Newborns become free from mucus around 24-48 hours post birth.
A 5-month-old infant is brought to the paediatric clinic for a routine monthly exam. What assessment finding alerts the nurse to notify the primary HCP?
A/ HR of 100bpm
B/ BP of 75/48 mm Hg
C/ Respiratory rate of 70/min
D/ Temp 37.5C
C/ Resp of 70/min
Rationale:
Average resp rate of infants is 35/min. Tachypnea requires further investigation. All other vitals are in normal range.
If the child was anxious or scared, their HR would infants and so would their BP
The neonate has a protruding tongue and a crease that traverses the entire width of each palm. The nurse recognizes that these findings are characteristic of what congenital condition? A/ Hypothyroidism B/ Down Syndrome C/ Turner Syndrome D/ Fetal Alcohol Syndrome
B/ Down Syndrome
Dysmorphic features that are characteristic of Down Syndrome include:
Protruding tongue
Simian creases across the palms
Turner Syndrome is characterized by a webbed neck and peripheral edema, children with FAS have dysmorphic features, but are different from downs.
An infant with a congenital Heart defect is being given gavage feedings. The parents ask the nurse why this is necessary. What is the best response from the nurse?
A/ It limits the chance of vomiting
B/ It allows the feeding to be administered rapidly
C/ The energy that would have been expended on sucking is preserved
D/ The quantity of nutritional liquid can be better regulated than with a bottle.
C/ Energy conservation
Gavage feeding is preferred for weak infants, those with respiratory distress or ineffective sucking-swallowing coordination. It conserves energy and reduces the workload of the heart.
Feeding an infant is NOT desirable as it could lead to aspiration. Gavage may reduce emesis, but it is not typically indicated if baby is vomiting. Amount given CAN be regulated through bottle feeding.
While teaching a parents' group about acute otitis media, the nurse includes the fact that among infants and children, acute otitis media is an infection commonly caused by: A/ A virus B/ Bacteria C/ A fungus D/ Rickettsia
B/ Bacteria
What is the priority nursing intervention for a 6-month-old infant with bronchiolitis?
A/ Discouraging parental visits to conserve energy
B/ Monitoring skin colour, anterior fontanel, and vitals
C/ Wearing gown, cap, mask, and gloves while rendering care
D/ Promoting stimulating activities to meet developmental needs
B/ Monitor!
Constant assessments are VITAL in determining the infant’s oxygenation and hydration status and responses to the disease process.
The parents of an infant recently diagnosed with cystic fibrosis ask a nurse what causes the foul-smelling, frothy shit. What is the best response by the nurse? A/ Undigested Fats B/ Sodium and Chloride C/ Partially digested Carbohydrates D/ Lipase, Trypsin, and amylase release
A/ Undigested fats
Due to lack of pancreatic enzyme lipase, fats remain unabsorbed and are excreted in excessive amounts in the stool.
A 4-month-old is on nothing-by-mouth status prior to surgery. What should the nurse do when the baby starts crying? A/ Offer a pacifier B/ Provide baby rattle C/ Hang mobile over crib D/ Wrap a soft blanket around baby
A/ Pacifier
Sucking a pacifier provides comfort to infants through oral gratification. Rattles would stimulate the infant further, along with a mobile. Blankets would provide tactile stimulation but would not stimulate their mouth.
During the assessment of a hospitalized infant, the nurse notes dry mucous membranes, the absence of tears when the infant cries, and poor skin turgor. Which parameter should help the nurse further evaluate these findings?
A/ Daily serum electrolytes
B/ Respiratory rate and rhythm
C/ Intake and output over past 24 hours
D/ Alterations in heart sounds since admission
C/ In and outs
Infant is showing signs of severe dehydration. In and out determines how much fluid the baby is getting and expelling. Checking the others would be the result of severe dehydration.
A nurse in the clinic is taking the health history of a 16 year old girl. When the nurse asks questions regarding her sexual activity, she begins to perspire and hyperventilate. As her anxiety increases, she indicates that she feels dizzy, SOB, and that her heart is racing. What condition can the nurse identify? A/ Metabolic acidosis B/ Respiratory Acidosis C/ Pulmonary Hypertension D/ Hyperventilation syndrome
D/ Hyperventilation syndrome
Hyperventilation syndrome is respiratory alkalosis that happens with deep and rapid breathing. Clinical findings are related to increased pH and lowered bicarb and O2 levels.
A nurse is completing the discharge protocol for a 14 year old patient with osteomyelitis. The nurse teaches the parents how and when to administer the IV antibiotics at home. The schedule for admission is QID. When should they administer the meds? A/ 8am, 12, pm, 4pm, 8pm B/ 8am, 4pm, 12am, 4am C/ 10am, 2pm, 10pm, 2am D/ 6am, 12pm, 6pm, 12am
D/
Iv antibiotics should be administered 6 hours apart from one another when QID. This ensures the constant blood level of the drug is maintained.
A 15 year old with Type I diabetes has a history of non-compliance with therapy. What must the nurse consider about the teen's developmental stage before starting a counselling program? A/ They usually deny their illness B/ They have a need for attention C/ The struggle for identity is typical D/ Regression is associated with illness
C/ identity struggle
Striving to attain identity and independence are tasks of the adolescent, and rebellion against established norms may be exhibited.
What is the most appropriate nursing intervention for a child with sickle cell anemia?
A/ Teaching the family who to limit sickling crisis
B/ Preparing the child for occasional blood transfusions
C/ Educating the family about prophylactic medications
D/ Expelling to the child how excess oxygen causes sickling.
A/ Most important goal of sickle cell is learning how to prevent crisis’. This is done by hydration, promoting oxygenation, and avoiding strenuous exercise.
Transfusion are more of a common occurrence, and there are Ø prophylactic meds for sickle cell crisis. Excess oxygen does NOT cause sickling, but a depletion.
An adolescent boy comes to the school nurse complaining of a 2 day hx of low grade fever, exhaustion, and lack of energy and a lack of appetite. He has missed two days of school in the previous week. Which assessment should the nurse use to identify the possible origin of the problem?
A/ Eliciting the Kernig sign
B/ Eliciting the Brudzinski sign
C/ Checking for lymphadenopathy
D/ Checking the pupillary response to light and accommodation.
C/ Lymphadenopathy
Infectious mononucleosis is viral and common in people between 15-30 years. Signs and symptoms include fever, fatigue, swollen glands, enlargement of the liver and spleen.
Pupillary response to light and accommodation is checked as part of a neuro assessment and is not indicated. The Kernig Sign (asking the child to Straighten a leg bent at a 90 degree angle) and the Brudzinski Sign (asking child who is supine to bend his head and try to put his chin on his chest) are parts of exams to identify meningitis.
A nurse in a paediatric clinic is testing a 4 year old with recurrent otitis media for signs of hearing loss. The mother asks what can be done is there is a hearing loss. The nurse responds that the most common tx is: A/ Myringotomy B/ Adenoidectomy C/ Neomycin ear drops D/ Systemic steroid therapy
A/ Myringotomy
Myringotomy is a surgical incision to permit drainage of infected middle ear fluid and thus improve hearing.
Removal of adenoids with not releave pressure from inflamed ear. Antibiotics are administered systemically, not locally if needed. Steroids are not prescribed.
A child with acute lymphoid leukemia is started on chemotherapy protocol that includes prednisone. What side effects of this medication does the nurse anticipate? A/ Alopecia B/ Anorexia C/ Weight loss D/ Mood changes
D/ Mood changes
Euphoria and mood swings may result from steroidal therapy. Alopecia and anorexia are not symptoms of steroids. The patient can experience an increase in appetite which can lead to weight gain, NOT weight loss.
A nurse is caring for a 4 year old child who was just diagnosed with cystic fibrosis. The child has been passing loose, bulky, foul-smelling stools and is in the third percentile for weight, What is the best explanation of the growth failure?
A/ Impaired digestion and absorption because of the lack of pancreatic enzymes
B/ Dyspnea and SOB, which cause anorexia and disinterest in food
C/ Increased bowel motility and diarrhea which leads to inadequate absorption of nutrients
D/ Pulmonary obstruction, which causes an oxygen deficit and inadequate tissue nourishment
A/ Lack of enzymes
Lack of trypsin, amylase, and lipase that typically aids in fat digestion and absorption. This leads to the wasting of tissues and the failure to thrive. Kids with CF are recommended to eat 150%-200% of the regular caloric intake for their age.
A child undergoes tonsillectomy and adenoidectomy for numerous recurrent respiratory tract infections. After the surgery, the nurse should teach the parents to:
A/ Offer ice chips
B/ Encourage the intake of ice cream
C/ Keep the child in supine position
D/ Gargle with diluted mouthwash solution
E/ Do a Darth Vader impression with their raspy voice.
A/ Offer ice chips
Ice soothes and promotes vasoconstriction. Milk products like ice cream will coat the mouth, making the child feel the urge to clean their throat and could precipitate bleeding. Supine promotes edema and does not allow the oral secretions to drain from the mouth. Mouthwash is not indicated.
A nurse is obtaining the health hx from the mother os a preschooler with Reye Syndrome. The nurse should ask the mother if the child has recently had: A/ Rubella B/ Chickenpox C/ Rheumatic Fever D/ Bacterial Meningitis
B/ Chickenpox
Children with Reye’s syndrome (which is viral) are among those recently recovering from Chicken pox. Reye Syndrome Does not occur post-rubella, and Rheumatic fever is a streptococcal infection.
After Several days of bedrest, a preschool-aged boy with the diagnosis of liver laceration becomes demanding and will not listen to nurses. The child was found in the playroom twice on the previous shift. How can the nurse best meet the needs of this child?
A/ tell the child why remaining in bed will enhance recovery
B/ Have a television set moved into the kid’s room ASAP
C/ Place soft restraints on the child when family cannot be present.
D/ Move the child into a room with another preschooler with whom he can play with.
D/ Make friends.
Preschoolers are social individuals who enjoy the company of others and become bored when isolated. They will not understand complex explanations of cause and effect (A). Although TV provides a distraction, encouragement of peer contact is preferred.
A pre-school aged child admitted with Reye syndrome will most likely be placed... A/ In an isolation room B/ On a presurgical Unit C/ On a paediatric Floor D/ In the ICU
D/ ICU
A child with Reye Syndrome is critically ill and needs the constant supervision that is available in an ICU. Reye Syndrome is not contagious, Surgery is needed. A general paediatric unit does not offer the continued assessment and intensive interventions that are needed for a child with Reye syndrome.
A nurse is caring for a preschooler who is being prepared for surgery. What does the nurse expect to have the most influence on the Child's response to hospitalization? A/ Fear of separation B/ Fear of Bodily harm C/ Belief in death's finality D/ Belief in the supernatural
B/ Fear of bodily harm
Fear of mutilation is typical at this age because they have vague views of body boundaries. Toddlers are more likely to fear separation than preschoolers, and preschoolers do not see death as final, nor do they have developed supernatural beliefs.
A 4 year old child who barely survived a near-drowning incident is in critical condition in the paediatric ICU. Suddenly the child opens her eyes and smiles, prompting the parents to say “Look! I think she is getting better now!” What is the best response from the nurse?
A/ “You’re right, that’s a very good sign”
B/ “Try to have your child hold your hand”
C/ “We’re doing everything we can to provide recovery”
D/ “Sometimes they smile right before they die”
C/
The nurse needs to emphasize that they are doing everything they can to promote recovery without providing false hope.
While examining a newborn, the nurse brushes his finger upward on the infant's sole. The newborn responds by fanning their toes outward. Which reflex is the nurse using? A/ Rooting B/ Moro C/ Plantar Grasp D/ Babinski
D/ Babinski
An 18 month old toddler stepped on a rusty nail and is brought to the ER a week later. The nurse determines the family lives in a rural area and that the child has never received healthcare. The child shows signs of generalized tetanus, including neck and jaw stiffness and facial muscle spasms. What does the nurse conclude with these clinical findings?
A/ Bacterial infection of the upper respiratory tissues progressing to sepsis and death
B/ Neuropathy caused by allergic reaction to the presence of the invading organism
C/ Localized edema of the upper trunk and neck tissues resulting in the obstruction of their airway
D/ Painful muscle rigidity caused by exposure of the nervous system to the exotoxin of the causative organism
D/ Exotoxin
Tetanus is characterized by trismus (difficulty opening mouth). Stiffness of the facial and neck muscles progressing to larygospasm, generalized rigidity, opisthotonos, and respiratory arrest. Tetanus is NOT bacterial, but is an exotoxin that affects the CNS.
After a 4 year old child undergoes craniotomy the nurse performs a neurological assessment that includes level of consciousness, pupillary activity, and reflex activity. What should the nurse include in this assessment? A/ B/P B/ Motor Function C/ Rectal Temp D/ Head Circumference
D/ Head size
Motor function is part of a neurological assessment and provides insight into cerebral function. Blood pressure and temp are not a direct measure of neurological status. A change in head circumference is the result of increased cranial pressure and is NOT expected in a 4 year old whose cranial bones are fused.
A nurse is Teaching dietary management to the parents of a toddler who is undergoing chelation therapy to treat lead poisoning. What should be included in the dietary care plan?
A/ Maintaining a low sodium diet
B/ Ensuring adequate fluid intake
C/ Avoiding refined sugar and flour
D/ Offering high-calorie, low protein diet
B/ Fluid intake
Hydration is needed because the lead complexes released during chelation therapy are excreted by the kidneys. There is no basis for restricting salt, or refined sugar and flour.
A nurse is teaching the mother of a toddler with celiac disease the specific foods allowed on the Gluten-free diet. What information is important for the nurse to help the mother understand.
A/ Corn flour is NOT included in the diet
B/ Labels of prepared foods must be read carefully
C/ Caloric intake is increased to compensate for deficiency of proteins
D/ The gluten-free diet is discontinued when the affected child starts kindergarten
B/ Labels of prepared foods must be read carefully.
Foods can always have hidden gluten and labels should be read carefully. Rice and corn are virtually gluten free. The diet may remain for the rest of the child’s life.
A 3-year-old ingests a substance that may be poisonous. The parent calls a neighbour who is a nurse and asks what they should do. What is the best response from the nurse?
A/ Administer syrup of ipecac
B/ Call Poison control
C/ Take the child to the emergency department
D/ Give the child bread dipped in milk to absorb the poison.
B/ Call poison control
They have the most up-to-date information and how to treat the poisoning. They will advise whether to go to the Emerge or what to do. administration of ipecac is no longer recommended by the American Academy of Paediatrics.
A nurse is planning for the discharge of a child with sickle-cell vaso-occulsive crisis. What is the most important information for the nurse to emphasize? A/ High Calorie Diet B/ Rigorious Exercise regimen C/ An increased intake of fluids D/ Increase of hours spent sleeping
C/ Intake of fluids
Dehydration promotes sickling of cells. Increasing fluids reduces sickling crisis’. Exercise decreases oxygenation and may cause sickling. Increase in time spent sleeping is not needed.
The parents of a 2 year-old boy are watching the nurse administer the Denver II developmental Screening test to their son. They ask, “Why did you make him draw on paper? We don’t let him draw much at home.” What is the best response?
A/ “I should have asked you about drawing first”
B/ “These drawings help us determine his intelligence”
C/ “It lets us test his ability to perform tasks requiring his hands”
D/ “Why in the hell would you not allow your bastard son to draw? Like seriously, you guys are straight up negligent”.
C/ hand testing
The test is used to determine the presence of a child’s development who appears to be behind the norm.
While reviewing the admission of a child, the nurses determines that the 2 year old has not received their MMR vaccine. At what age should the child receive their vaccine? A/ 2 months B/ 4 months C/ 6 months D/ 12 months
D/ 12 months
A nurse is teahcing the parents of a toddler whose been recently diagnosed with hemophilia. What area of the body should the nurse inform the parents about the increased risk of bleeding? A/ Brain B/ Joints C/ Kidneys D/ Abdomen
B/ Joints
Their constant movement and weight-bearing makes them susceptible. Bleeding may occur in the other areas, but are less likely.
A 2-year-old is brought to the ER with fever, drooling, and agitation. The child is not coughing and is sitting upright and leaning forward. Which nursing intervention is a priority?
A/ IV fluids and antibiotics
B/ Immediate removal of the parents from the room to keep the child calm
C/ Maintenance of the child in a prone position during transportation to radiology
D/ Procurement of a crash cart and Emergency airway management tools to be kept on hand during examination of the throat.
D/
Because the possibility of airway obstruction by the epiglottis, a crash cart and emergency airway management tools should be close at hand during examination. IV fluids and antibiotics should be started, but it is not 1st priority. The child must stay seated to help promote comfort of breathing.
