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ABSN HESIs > Pediatric HESI > Flashcards

Pediatric HESI Flashcards

1
Q

What are the primary goals for a child admitted with Eczema (Atopic Dermatitis)?

A

relieve itching and inflammation
lubricate the skin
control secondary infections r/t scratching

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2
Q

Where does Eczema (Atopic Dermatitis) commonly occur in adolescents?

A

antecubital

popliteal

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3
Q

A child with a skin disorder needs to be monitored for S&S of ______.

A

infection

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4
Q

What is Impetigo?

A

a contagious bacterial (strep or staph) infection of the skin

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5
Q

Impetigo lesions progress to a crusting stage, where we can expect to see ______.

A

a honey-colored crust

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6
Q

What is the nursing priority intervention for Impetigo?

A

isolate the child and use contact precautions (very contagious)

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7
Q

When is scabies contagious and how is it transmitted?

A

contagious period - the entire course of infestation

transmission - close contact with an infected person (all those in a household need to be treated simultaneously)

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8
Q

What should be taken into consideration when administering Lindane - an alternative med used to treat scabies?

A

do not give to children under 2 years old - neurotoxicity and seizures

rationale - children under 2 have more permeable skin, a higher systemic absorption may occur and put the child at risk for CNS toxicity and seizures

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9
Q

How should Permethrin (Elimite) - a med used to treat scabies - be applied?

A

to cool dry skin at least 30 minutes after bathing

to the entire skin, not just the scabies part

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10
Q

What patient teaching should be given to the parents of a child with scabies?

A

wash all clothing/bedding once per day for at least a week

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11
Q

What is the nursing priority for a child with a burn injury?

A 
#1 - stop the burning process 
#2 - ABCs 
#3 - remove burned clothing
#4 - keep the child warm
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12
Q

How are burns documented in a pediatric client?

A

TBSA% using age-related charts

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13
Q

What is the MOST accurate way to determine if fluid resuscitation for a burn patient has been adequate?

A

neurological assessment

rationale - the burn itself should not affect the brain, so the child should be AAOX3

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14
Q

A nurse suspects scabies when she sees the child’s skin has _____.

A

fine grayish red lines

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15
Q

Where do impetigo lesions commonly form?

A

the mouth and nose

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16
Q

Do adults or children present with more severe scarring after a burn injury?

A

a child

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17
Q

Burns involving more than __% of TBSA require fluid resuscitation.

A

10%

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18
Q

A (higher/lower) proportion of body fluid to mass in a child increases the risk fo cardiovascular problems.

A

higher fluid

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19
Q

Which pain medication should be avoided in children with sickle cell anemia because it increases the risk of seizures?

A

Meperidine (Demerol)

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20
Q

What patient teaching should be given regarding the administration of liquid iron supplements?

A

it stains teeth - use a straw and brush teeth after

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21
Q

What INCREASES iron absorption and should be given concurrently with iron supplements?

A

vitamin C

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22
Q

What DECREASES iron absorption and should NOT be given with iron supplements?

A

mild or antacids

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23
Q

How is aplastic anemia diagnosed?

A

bone marrow aspiration

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24
Q

What are some expected assessment findings for a child with aplastic anemia?

A 
pancytopenia
petechiae
purpura
pallor
bleeding
weakness
tachycardia
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25
Q

What is the primary treatment for hemophilia?

A

replacement of the missing clotting factor

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26
Q

What are some expected assessment findings for hemophilia (a bleeding disorder caused by lack of a clotting factor)?

A

abnormal bleeding
nosebleeds
pain/tenderness/swelling r/t joint bleeding
easy bruising

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27
Q

What will tests that measure platelets show in a child with hemophilia?

A

they will have NORMAL platelet levels but decreased clotting factors

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28
Q

Von Willebrand’s Disease is characterized by _____.

A

bleeding from mucous membranes

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29
Q

What does a child with a bleeding disorder need to have with them at all times?

A

a Medic-Alert bracelet

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30
Q

Which groups have the highest incidence of B-Thalassemia?

A

Those of Mediterranean descent - Italians, Greeks, Syrians

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31
Q

What is the priority intervention for a child newly admitted with a bleeding disorder?

A

put them on bleeding precautions and assess for bleeding

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32
Q

What is B-Thalassemia?

A

an autosomal recessive disorder that reduces the production of hemoglobin

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33
Q

What are some expected assessment findings for a child with B-Thalassemia?

A

frontal bossing (prominent brow ridge/forehead)
maxillary prominence
wide-set eyes
flattened nose

green/yellow skin tone
hepato/splenomegaly
severe anemia
microcytic RBCs

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34
Q

What drug will be given to prevent organ damage from iron toxicity (chelation therapy)?

A

Deferoxamine (Desferal)

Exjade

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35
Q

What, if not given throughout the therapy for a sickle cell exacerbation, will cause pain that can not be controlled?

A

Hydration - do not deprive fluids

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36
Q

What lab result will a patient with iron deficiency anemia display?

A

microcytic RBCs

rationale - iron aids in the production of hemoglobin for RBCs

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37
Q

What is Von Willebrand’s Disease?

A

a hereditary bleeding disorder that causes platelets to adhere to damaged endothelium (organ lining)

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38
Q

What is the pathology of leukemia?

A

developing WBCs depress the bone marrow, causing anemia, infection, and bleeding

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39
Q

What will the WBC labs show for a child with leukemia?

A

they can be low, normal or elevated depending on the stage of the disease

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40
Q

What are some common S&S of leukemia?

A 
fever
fatigue
pallor
anorexia
hemorrhage
bone and joint pain 
pathologic fractures
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41
Q

A positive bone marrow biopsy for a patient with leukemia will show:

A

leukemic blast (immature phase) cells

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42
Q

What is the number one nursing consideration for a child receiving chemotherapy?

A

monitor for infection.

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43
Q

Hallmark sign of Hodgkin’s Disease:

A

Reed-Sternberg cells

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44
Q

What are some assessment findings for Hodgkin’s Disease?

A

painless enlarged fixed lymph nodes

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45
Q

What is a Nephroblastoma (Wilms’ Tumor)?

A

the most common intraabdominal and kidney tumor of childhood

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46
Q

What is the hallmark sign of a nephroblastoma (Wilms’ Tumor)?

A

a firm non-tender mass within the abdomen

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47
Q

What should you NOT do before surgical removal of a nephroblastoma (Wilms’ Tumor)?

A

DO NOT PALPATE the abdomen - the tumor is often encapsulated, and if the capsule breaks we risk metastasis

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48
Q

What causes the S&S of neuroblastomas?

A

compression of the surrounding tissue

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49
Q

What is the most common bone cancer in children?

A

osteosarcoma

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50
Q

What are some common assessment findings for an osteosarcoma tumor?

A

bone pain relieved by a flexed position

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51
Q

What is the number one nursing assessment for a brain tumor?

A

signs of increased ICP

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52
Q

Thrombocytopenia is defined as a platelet count less than

A

20,000

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53
Q

What is an EARLY sign of increased ICP?

A

vomiting

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54
Q

What should NOT be administered to a child with a fever? Why?

A

Asprin b/c of the risk for Reye’s syndrome

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55
Q

Afre an antipyretic is administered, what should be your next nursing step?

A

recheck the temp 30-60 minutes after

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56
Q

Why are infants and children more susceptible to fluid volume deficit?

A

their body water is in the extracellular space

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57
Q

What % of weight loss will a child with SEVERE dehydration have?

A

10% or more

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58
Q

What will the vitals show for a child with SEVERE dehydration?

A

HR increased
RR increased
BP decreased

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59
Q

What will the capillary bed refill be like in a child with SEVERE dehydration?

A

very delayed (>4sec) with tenting

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60
Q

What is the most accurate measure of dehydration?

A

weight

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61
Q

What is Phenylketonuria (PKU)?

A

an autosomal recessive disorder that leads to CNS damage from too much phenylalanine

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62
Q

How many states require the routine screening of newborns for PKU?

A

all 50

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63
Q

Which foods are high in phenylalanine and should be avoided by a child with PKU?

A

high protein meats
dairy
aspartame

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64
Q

What is Type I Diabetes? Type II?

A

Type I - the destruction of pancreatic beta cells (that produce insulin)

Type II - the body fails to produce and use insulin properly

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65
Q

What is the “normal” blood glucose level?

A

70-110

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66
Q

What are some assessment findings for a child with Diabetes Mellitus?

A

Polyuria
Polyphagia
Polydipsia

HYPERglycemia
fruity breath

Weight LOSS

blurred vision
change is LOC

H/A
fatigue
lethargy

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67
Q

What is a priority nursing action for a child newly diagnosed with Diabetes Mellitus?

A

plan a consult with a diabetic specialist

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68
Q

How many grams of carbohydrates should be consumed for every 30-45 minutes of exercise in a diabetic child?

A

15 grams

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69
Q

When would DILUTED insulin be administered?

A

in infants who need a smaller dose

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70
Q

What is the goal for Hemoglobin A1c levels in a child with Diabetes Mellitus?

A

< 7%

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71
Q

Which is a more accurate measure for blood glucose; a lancet finger prick or a urine test?

A

a lancet finger prick (BG monitoring)

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72
Q

Which voided urine specimen is most accurate when taking a urine cache?

A

the second one (toss the first one)

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73
Q

Urine glucose testing is unreliable, so why/when would we take a urine sample for a diabetic child?

A

when the child is sick or HYPERglycemic, their urine should be tested for ketones

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74
Q

What are some S&S of HYPOglycemia?

A

“cold and clammy, need some candy”

tingling around the mouth

H/A
nausea
sweating
tremors
hunger
confusion / anxiety 
slurred speech
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75
Q

Once a HYPOglycemic child becomes unconscious outside of the hospital, what is the first nursing action?

A

squeeze cake frosting/glucose paste onto their gums and retest the glucose level in 15 minutes

if it’s still low, and the child remains unconscious, prepare to administer glucagon as prescribed

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76
Q

What are some food items to treat HYPOglycemia?

A 
1/2 cup orange juice 
1 box raisins
1 candy bar
1 tsp honey
2-3 glucose tabs
3-4 LifeSavers candies 
3-4 hard candies 
4 sugar cubes (1 tbsp sugar)
8 oz milk
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77
Q

HYPERglycemia is defined t what blood glucose level?

A

200 or more

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78
Q

if a diabetic child is sick, should you withhold insulin?

A

never withhold insulin

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79
Q

What is DKA? How does it occur? What are the defining labs?

A

diabetic ketoacidosis

hyperglycemia turns into a metabolic acidosis

blood glucose > 300
ketones present in the urine

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80
Q

What are the S&S of DKA?

A 
Kussmaul breathing 
acetone (fruity) breath 
lethargy 
decreasing LOC
HYPOtension r/t dehydration

HYPERglycemia symptoms

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81
Q

What lab should be monitored during a DKA crisis?

A

potassium - insulin administration affects potassium levels

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82
Q

If a diabetic child is sick AT HOME and presents with ketones in the urine, what should the nurse recommend the parents do?

A

encourage the child to drink fluids to clear the ketones - it is NOT necessary to bring the child into the clinic immediately at this time

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83
Q

A child is being prescribed potassium chloride, what is the PRIORITY nursing assessment before administering this prescription?

A

chick urine output

rationale - potassium chloride should never be administered in the presence of oliguria or anuria b/c of the risk for HYPERkalemia. If the urine output is less than 1-2mL/kg/hr, potassium chloride should not be administered.

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84
Q

What level of phenylalanine defines PKU?

A

over 20 mg/dL

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85
Q

What is the expected INITIAL prescription for a child presenting with DKA?

A

normal saline - hydration is the first step for HYPERglyemia

rationale - a potassium IV will likely be required, but it is not the INITIAL tx for DKA

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86
Q

After administering an antipyretic, why should COLD water not be sponged onto a child with a fever? What should the nurse do instead?

A

it may cause shivering - increasing metabolic processes and therefore the fever (tepid water is OK)

instead, all excess blankets and clothing should be removed from the child

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87
Q

What is an acceptable urine specific gravity to note when a child has been dehydrated and is improving?

A

1.002 - 1.025

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88
Q

What is the major concern for a vomiting child?

A

dehydration

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89
Q

What is the priority nursing intervention for a child who is vomiting?

A

prevent aspiration

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90
Q

What is a major cause of dehydration, especially for children under the age of 5?

A

acute diarrhea

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91
Q

What are the major concerns for a child having diarrhea?

A

dehydration
loss of electrolytes
metabolic acidosis

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92
Q

What might the nurse have to give to a postoperative cleft lip repair child?

A

a soft elbow/jacket restraints

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93
Q

What must be kept at the bedside for a cleft lip repair?

A

suction

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94
Q

What are the “3 c’s” of esophageal atresia?

A

coughing during feeding
choking during feeding
cyanosis

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95
Q

What patient teaching should be given to the parents of a child with esophageal atresia repair postoperatively?

A

ID the need for suctioning - respiratory distress and constricted esophagus

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96
Q

What are some complications of GERD?

A

esophagitis
esophageal sticture
aspiraton of gastric contents
aspiration pneumonia

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97
Q

How should a GERD infant be placed when sleeping?

A

supine - to prevent SIDS unless otherwise prescribed by the HCP

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98
Q

What are some hallmark signs of hypertrophic pyloric stenosis?

HPS is the enlargement of the muscles surrounding the pyloric sphincter that may lead to complete obstruction

A

mild regurgitation turning into projectile vomiting after feeding

peristaltic waves that are visible from left to right during feeding

there is an olive-shaped mass just to the right of the umbilicus

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99
Q

What is a pyloromyotomy? When is it done?

A

an incision through the mm of the pylorus - used for hypertrophic pyloric stenosis

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100
Q

What is the priority intervention for a child with lactose intolerance?

A

eliminate diary or administer an enzyme tablet replacement

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101
Q

A child with lactose intolerance will need to take 2 supplements because of the risk of _____ and _____ deficiency.

A

calcium

vitamin D

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102
Q

What is Celiac Disease?

A

intolerance to gluten (wheat, barley, rye, and oats)

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103
Q

What are the S&S of a celiac crisis?

A

watery diarrhea

vomiting

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104
Q

What are some dietary interventions for a child with celiac disease?

A

substitute corn and rice for gluten

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105
Q

Where will the most pain be felt for a child with appendicitis?

A

McBurney’s point

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106
Q

What is the hallmark indication of a perforated appendix?

A

sudden relief of pain followed by an increase in pain and guarding of the abdomen

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107
Q

What position should a patient be placed in following an appendectomy?

A

right side-lying or semi Fowler’s

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108
Q

What therapies should be avoided following an appendectomy?

A

heat to the abdomen
laxatives
enemas

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109
Q

What is the most serious complication of Hirschsprung’s Disease (MegaColon)?

A

enterocolitis

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110
Q

What is the first sign of Hirschsprung’s Disease in infancy?

A

failure to pass meconium

failure to suck

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111
Q

What dietary interventions should be carried out for a child with Hirschsprung’s Disease?

A

low-fiber
high-calorie
high-protein

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112
Q

What poop will you see for Intussusception (telescoping)?

A

currant jelly stools (bright red blood and mucus)

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113
Q

What is the sign that Intussusception has resolved?

A

passage of normal brown stool

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114
Q

What is an Omphalocele? What is the priority nursing intervention for it?

A

the intestines herniated through the abdomen - SAC IS INTACT

priority - KEEP THAT SAC INTACT; the sac is covered with sterile gauze to prevent drying out and the patient is kept NPO

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115
Q

What is Gastroschisis? What is the priority nursing intervention for it?

A

the intestines herniated through the abdomen - THE SAC IS NOT INTACT

priority - the exposed bowel is covered in saline-soaked pads but NOT wrapped with plastic b/c if the bowel expands, the wrapping may cause pressure and necrosis

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116
Q

What is an incarcerated hernia?

A

part of the bowel becomes tightly caught in the hernial sac and compromises blood supply - MEDICAL EMERGENCY - may lead to gangrene

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117
Q

What is the priority dietary tx for constipation and encopresis (fecal incontinence with constipation)?

A

high fiber diet and fluids

decrease milk and sugar intake

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118
Q

What are some high fiber foods?

A 
bread and grains
raw veggies
fruits
beans
popcorn/nuts
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119
Q

What are the S&S of IBS in children?

A

alternating constipation and diarrhea with the presence of undigested food and mucus in the stool

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120
Q

What are some preoperative interventions for a child with an imperforate anus?

A

determine the presence of an anal opening

look for stool in urine and vagina (indicates a fistula)

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121
Q

What is the preferred patient positioning following surgery for a child with an imperforate anus?

A

side-lying prone with hips elevated
or
supine with legs hips flexed to 90

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122
Q

How are all of the Hepatitis viruses acquired?

A

HAV & HEV - contaminated food
HBV & HDV - body fluids
HCV - parenterally

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123
Q

What is Hepatitis? What are some assessment findings during the different phases?

A

inflammation of the liver

Prodromal & Anicteric phase:
NO jaundice
Fever
Rash

Icteric phase: 
Jaundice 
Dark urine
Pale stools
Pruritus
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124
Q

Which Hepatitis viruses do we have vaccines for?

A

A & B

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125
Q

How do we prevent the spread of Hepatitis?

A

handwashing and standard precautions

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126
Q

What therapy is administered for a child with lead poisoning?

A

chelation therapy:

Calcium Disodium Edenate
Chemet
BAL - not for allergy to peanuts, not with iron

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127
Q

What defines a toxic dose of Acetaminophen (Tylenol) in children?

A

150 mg/kg

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128
Q

What is the antidote to Acetaminophen (Tylenol) overdose?

A

Mucomyst

  • dilute in juice b/c of odor
  • do not give with activated charcoal lavage (in the event of an unconscious pt)
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129
Q

What level defines a toxic dose of Aspirin?

A

300-500 mg/kg

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130
Q

What is the treatment for Aspirin overdose?

A

activated charcoal

131
Q

What should a parent give to their child if they’ve ingested bleach/paint/detergent after they’ve called the poison control center?

A

milk or water to dilute the corrosive

DO NOT induce vomiting

132
Q

What poop will you expect to see for Hirschprung’s Disease?

A

ribbon-like stools

133
Q

What should you do to feed a GERD child?

A

thicken the feedings with rice cereal

134
Q

Vomiting leads to ______

Diarrhea leads to ______

A

vomiting - metabolic ALKalosis (loss of stomach acid)

diarrhea - metabolic ACIDosis (loss of bicarb)

135
Q

What is strabismus? When is it considered a normal finding?

A

cross-eyed

normal until 4 months of age

136
Q

What interventions are expected for a child with strabismus?

A

patch the good eye

137
Q

What is conjunctivitis?

A

pink eye

138
Q

What should be suspected if chlamydial conjunctivitis is present?

A

sexual abuse if the child is not sexually active

139
Q

How should ear drops be administered in a child younger than 3?

A

pull the pinna DOWN and BACK

for older than 3 - pull it UP and BACK

140
Q

What is a myringotomy? What patient teaching should be given?

A

tubes for ear infections

tell the parents that if the tubes fall out - it’s ok, just let the HCP know

141
Q

What should NOT be done for a child after a tonsillectomy?

A

suction - unless they are aspirating

142
Q

What is a sign of bleeding following a tonsillectomy?

A

frequent swallowing

143
Q

What is a NEVER for epiglottitis (croup)?

A

do not visualize the throat
do not take an oral temperature
do not obtain a throat culture

all risks for spasm and complete airway occlusion

144
Q

What patient teaching should be given to the parents of a child with laryngotracheobronchitis?

A

don’t give cough syrups/cold medicines - they may dry and thicken secretions

145
Q

What must be implemented for a child with an unknown upper respiratory infection?

A

isolation precautions

146
Q

What intervention should be encouraged for a child with bronchitis?

A

increased fluid intake

147
Q

Does a child with RSV need to be isolated?

A

yes - but they can be put in a room with another RSV patient

148
Q

What is cystic fibrosis?

A

thick, tenacious secretions that block small passageways around the organs

149
Q

How does cystic fibrosis affect the respiratory system?

A

emphysema

150
Q

How does cystic fibrosis affect the GI system?

A

intestinal obstruction

malnutrition

151
Q

What test is used to diagnose cystic fibrosis?

A

quantitative sweat chloride test

chloride levels of 40-60 mEq/L

152
Q

How does cystic fibrosis affect the integumentary system?

A

super salty and chloride sweat

153
Q

SIDS most frequently affects infants ______

A

2-3 months old

154
Q

What vaccine may cause a negative TB test?

A

measles

155
Q

What position should a child with pneumonia in the RIGHT lower lobe be placed to increase comfort?

A

place him RIGHT side-lying

this is splinting

156
Q

What is a manifestation of respiratory distress in regards to positioning?

A

tripod positioning

tachycardia

157
Q

What indicates a positive Tuberculin skin test?

A

induration of 10mm or more

158
Q

According to the book, should you wear a mask when in contact with an RSV child?

A

apparently not - only standard precautions are needed

159
Q

What is the most common cause of inadequate cardiac output in infants and children?

A

a congenital heart defect that produces excess pressure/volume on the heart muscle

160
Q

What medication would you expect to be prescribed for a child with early heart failure?

A

Digoxin (Lanoxin)

161
Q

When would you NOT give Digoxin?

A

HR < 90-110

162
Q

What is the expected dose of Digoxin for infants?

A

1mL

163
Q

What is the therapeutic range for Digoxin?

A

0.8-2 ng/dL

164
Q

What electrolyte imbalance makes Digoxin toxicity worse? What medication might cause the electrolyte imbalance?

A

HYPOkalemia

caused by Lasix (Furosemide)

165
Q

What labs need to be checked before administering potassium?

A

creatinine and BUN

166
Q

What are the S&S of INCREASED pulmonary blood flow cardiac defects?

A 
decreased peripheral pulses
HYPOtension
lethargy 
pale cool extremities 
feeding and exercise problems
oliguria

(everything shunts to the core)

tachycardia

167
Q

What is the most common cardiac defect in Down syndrome? What will the infant present with?

A

Atrioventricular canal defect (increased pulmonary blood flow)

present with cyanosis that increases with crying

168
Q

What will an infant with a patent ductus arteriosus present with?

A

widened pulse pressure and bounding pulses

169
Q

Which heart defect will present with higher blood pressure in the upper extremities than in the lower extremities?

A

coarctation of the aorta

170
Q

What is a hallmark sign of pulmonary stenosis?

A

murmur and cyanosis

171
Q

What is included in the Tetralogy of Fallot?

A

VSD
Pulmonary stenosis
Overriding Aorta
Right Ventricular Hypertrophy

172
Q

What indicates that a child is experiencing a “tet” spell or “blue” spell?

A

they will squat to improve their oxygenation

173
Q

What is the hallmark sign of chronic hypoxia?

A

clubbing

174
Q

What is the priority treatment for hypoplastic left heart syndrome?

A

keep the ductus arteriosus open - once it closes, the blood won’t be able to get through the aortic atresia

175
Q

What are the priority nursing actions to take if a tet spell occurs in an infant?

A

1 - knees to chest

2 - 100% oxygen

176
Q

What is the priority, postoperative intervention for a cardiac catheterization?

A

keep the leg straight for 4-6 hours

177
Q

What is the priority nursing intervention if you see bleeding postoperatively after cardiac catheterization?

A

apply continuous direct pressure at the catheter entry site and report it immediately

178
Q

When does Rheumatic fever typically present?

A

2-6 weeks after an untreated/partially treated Strep infection (pt will report a “recent sore throat”

179
Q

Left-sided heart failure backs up into the ______.

A

lungs (LEFT LUNGS)

  • crackles/wheezes
  • cough
  • grunting
180
Q

Right-sided heart failure backs up into the _______.

A

body (RIGHT BODY)

  • ascites
  • JVD
  • edema
  • weight gain
181
Q

What type of rash will children with Rheumatic fever present with?

A

erythema marginatum - red skin lesions that start on the trunk and move peripherally

182
Q

What will a child with acute Kawasaki’s Disease present with?

A

fever
conjunctival hyperemia
red throat

183
Q

What is the most serious complication of Kawasaki’s Disease?

A

cardiac involvement - aneurysms

184
Q

What can we expect to be prescribed for a child with Kawasaki’s Disease?

A

IVIG

185
Q

What are the EARLY signs of heart failure?

A

TACHYcardia
TACHYpnea
sudden weight gain

186
Q

What 3 diagnostic tests can confirm Rheumatic Fever?

A

Anti-Streptolysin O titer
Streptozyme assay
Anti-DNase B assay

187
Q

What may cause glomerulonephritis?

A

a strep infection

188
Q

What are the classic manifestations of nephrotic syndrome?

A 
massive proteinuria
massive lipiduria 
hypoalbuminemia (weight GAIN)
edema
anorexia
pallor
189
Q

What finding would lead a nurse to suspect cryptorchidism?

A

testes are not palpable

190
Q

What is NOT done initially for a child with hypospadias or epispadias?

A

circumcision - the foreskin may be used for the surgical reconstruction of the defect

191
Q

Which side of the penis is an epispadias? hypospadias?

A

epispadias - top side - DORSAL surface (the dorsal fin is on the TOP of a dolphin)

hypospadias - underside - VENTRAL surface

192
Q

What should NOT be applied to a bladder exstrophy?

A

petroleum jelly - although we want to keep the bladder moist and clean, petroleum jelly will adhere to the bladder tissue and damage it

193
Q

What will a nurse most likely expect to find in the urine of a child with epispadias?

A

bacteriuria - the position of the urethral opening facilitates bacterial entry

194
Q

What is the primary goal with Cerebral Palsey?

A

early recognition to maximize the child’s abilities

195
Q

What is the earliest indication of improvement or deterioration of a neurological condition?

A

level of consciousness

196
Q

Which type of head injury is more severe; open or closed?

A

closed - b/c the chance for increased ICP is far greater

197
Q

What are the EARLY signs of increased ICP?

A

bulging fontanel
increased head circumference
Macewen’s sign - widely separated bones of the head
Setting Sun sign

198
Q

What are the LATE signs of increased ICP?

A

bradycardia
pupil alteration
decorticate or decerebrate posturing
Cheyne-Stokes respirations

high shrill cry

199
Q

Why do we need to test drainage from the nose or ears?

A

if the fluid contains glucose, it indicates CSF leakage

contact the HCP immediately

200
Q

What do we expect to see in a child with hydrocephalus?

A

increased head circumference
bulging anterior fontanel
Macewen’s sign - widely separated bones of the head
Setting Sun sign

201
Q

How is bacterial meningitis diagnosed?

A

lumbar puncture

  • cloudy CSF
  • elevated WBC
  • elevated protein
  • decreased glucose
202
Q

What drug reverses the effect of benzodiazepines?

A

Flumazenil - don’t give to a client with status asthmaticus that was treated with benzos b/c it can reverse the issue

203
Q

What position should a child with a neural tube defect be placed in?

A

prone with head turned to the side

204
Q

What is the priority for a child with autism?

A

ensuring a safe environment

205
Q

What is a (+) Kernig’s sign? Brudzinski’s?

A

Kernig’s - inability to extend the leg when the hip is flexed

Brudzinski’s - neck flexion causes adduction and flexion in the lower extremities

both are indicative of meningitis

206
Q

What is contraindicated in a child with a basilar skull fracture?

A

suction - the position of the fracture makes it possible for the suction to touch the brain and cause trauma/infection

207
Q

What is the priority nursing care for Reye’s Syndrome?

A

providing a quiet and dim atmosphere

208
Q

What does a (+) Ortolani’s maneuver and (+) Barlow’s test indicate?

A

hip dysplasia

209
Q

What is congenital clubfoot?

A

forefoot adduction
midfoot supination
hindfoot varus
ankle equinus

210
Q

What syndrome might be caused by mechanical changes in the position of a child’s abdominal contents during surgery that presents with vomiting and abdominal distention?

A

superior mesenteric artery syndrome

211
Q

What is the treatment for juvenile idiopathic arthritis?

A

none- treatment is supportive to preserve joint function, minimize inflammation and deformity

212
Q

What systems does Marfan’s Syndrome effect?

A

the connective tissue of the skeletal, cardiovascular, optic and integumentary systems

213
Q

What is contraindicated for a cast?

A

using lotion or powder around the edges

214
Q

Hip dysplasia will present with:

A

limited ROM on the affected side
a SHORTENED leg on the affected side
asymmetrical ABDuction of the hips
asymmetrical gluteal folds

215
Q

How often will a child with congenital clubfoot need to be recast?

A

once per week

216
Q

What is the priority treatment for a child with HIV?

A

preventing opportunistic infection

217
Q

What is the most common opportunistic infection that occurs in children infected with HIV?

A

pneumocystis jiroveci pneumonia

218
Q

Beore administering an antiretroviral medication you muist ________.

A

ensure it is safe for pediatric administration

219
Q

What is the goal of antiretroviral medications?

A

to suppress viral replication and to slow the deline in CD4 cells

220
Q

What is recommended to parents of a child with HIV?

A

to get them immunized BUT

  • only with inactivated viruses
  • NOT measles
  • NOT rotavirus
  • NOT varicella-zoster (unless they’ve had chickenpox)
221
Q

The detection of HIV antigens in infants is confirmed by _____.

The detection of HIV antiBODIES in infants is confirmed by _____.

A

antigens - a p24 antigen assay

antibodies - Western Blot

222
Q

What are the 3 C’s of Rubeola (Measles)?

A

coryza
cough
conjunctivitis

223
Q

What disease presents with Koplik’s spots (small red spots with a bluish-white center and red base on the buccal mucosa)?

A

Rubeola (Measles)

224
Q

What is Roseola (Exanthema Subitum)? How does it present?

A

Human herpesvirus type 6

sudden high fever followed by a rose-pink rash

225
Q

How is Rubella (German Measles) transmitted? How does it present?

A

airborne

pink-red maculopapular rash that begins on the face and spreads to the entire body within 1-3 days

226
Q

How is Mumps transmitted? How does it present?

A

airborne

jaw or ear pain aggravated by chewing - then parotid gland swelling

227
Q

When can a child with chickenpox leave the house?

A

when the vesicles have dried

228
Q

Do infants receive maternal immunity to Pertussis (Whooping Cough)?

A

nope

229
Q

How is Diphtheria transmitted? What needs to be prescribed?

A

direct contact

expect a diphtheria antitoxin to be prescribed (but be sure to R/O sensitivity to horse serum)

230
Q

Hallmark sign of Scarlet Fever?

A

red strawberry tongue

231
Q

What is a hallmark sign of Erythema Infectiosum (Fifth Disease)?

A

face erythema (slapped cheek appearance)

“five fingers - fifth disease”

232
Q

What organs does Mononucleosis affect?

A

lymphadenopathy
hepatomegaly
splenomegaly

233
Q

What teaching should the nurse give to the parents of a child with Mono?

A

the S&S of splenic rupture - LUQ pain and L shoulder pain

234
Q

An asymptomatic MRSA event is called ______, when it becomes symptomatic, it is called ______.

A

colonization

infection

235
Q

How long do flu symptoms usually last?

A

7 days - if longer, suspect complications

236
Q

Do you need a prescription for a vaccine?

A

yas

237
Q

What do you need before you give a vaccine?

A

parental consent

238
Q

What should you do if you suspect that a parent will not bring in their child for a followup immunization?

A

give the recommended vaccines simultaneously - they are all compatible

239
Q

What dose of vaccination can we expect to be prescribed for a preterm infant?

A

the full dose - at the appropriate age

240
Q

During which stage of the disease is Pertussis contagious?

A

the catarrhal stage

241
Q

What should you suggest to a parent who called the clinic 12 hours after a DTaP vaccination and reports redness and swelling around the site of the injection?

A

a cold pack - it’s normal for the injection site to become inflamed for the first 24 hours, a low-grade fever is also OK

242
Q

What is a contraindication for an IPV (polio vaccine) and MMR vaccine?

A

allergy to neomycin and eggs

243
Q

Where should the MMR vaccine be administered?

A

SQ in the upper arm

244
Q

What are the general contraindications for receiving live virus vaccines?

A
  • previous allergic reaction
  • immunocompromised
  • the common cold is NOT a contraindication
245
Q

Is the metabolism of medications accelerated or decelerated in a child?

A

it is delayed - the kidneys and liver are still immature

246
Q

Pediatric medication doses are always rounded to the ______ and measured using a _______.

A

100th

tuberculin syringe

247
Q

Common sites for SQ injections include:

A

central 1/3 of LATERAL upper arm
abdomen
central 1/3 of the ANTERIOR thigh

248
Q

What mm is used for an IM injection in children? What is not used?

A

recommended: vastus lateralis

NOT recommended: gluteal mm (too close to the sciatic nerve)

249
Q

What must be considered when administering an IV push medication for a child on I&O’s?

A

the flush volume must be included

250
Q

How much medication, in mL, can an infant take in an IM injection?

A

1mL (toddler can take the full 2mL)

251
Q

What does BSA mean? SA?

A

BSA - body surface area

SA - surface area

252
Q

What should the nurse do when a dosage recommendation for a medication is only specified for adults?

A

we use a formula using the BSA of the child

253
Q

What are some pain scales we can use for children who are unable to verbally express their pain?

A

CRIES
FACES
FLACC
Oucher Pain Scale

254
Q

Which communicable disease poses a particular threat to unborn children?

A

German Measles (Rubella)

255
Q

What is a contraindication for the DTaP vaccine?

A

history of seizures

256
Q

What is the children’s dose of Tylenol - Acetaminophen?

A

10-15 mg/kg every 4-6 hours

257
Q

What is a contraindication for the Hepatitis B vaccine?

A

allergy to Baker’s yeast

258
Q

What is the Mantoux test?

A

an intradermal test for TB

259
Q

What invalidates the Mantoux (PPD) test?

A

subcutaneous injection (rather than the expected intradermal injection)

260
Q

Has Pertussis (Whooping Cough) been eradicated from the United States?

A

no, there are still fatalities in non immunized infants in the US.

261
Q

What are NORMAL findings after an immunization?

A

fever

soreness/redness at the injection site (give Tylenol, bicycle the legs and place a warm washcloth over the site)

262
Q

Recommended daily dose of Vitamin D:

A

400 IU

263
Q

What vitamins do kids not get enough of?

A

A, B6, B12, C

264
Q

Where is the best place to check the capillary refill on an infant?

A

the sternum

265
Q

What fluid bolus amount can a child receive?

A

20mL/kg

266
Q

What is the normal urine output for infants and children?

A

1-2mL/kg/hr

267
Q

What should urine specific gravity NOT exceed?

A

1.025

268
Q

What is the primary nursing action for an abused child?

A

establish trust and attend to any physical injury

269
Q

What is the syrup of ipecac?

A

it is used to induce vomiting in the event of a poisoning (no longer recommended)

270
Q

Acetaminophen overdose antidote:

A

N-acetylcysteine (Mucomyst)

271
Q

What are common household products that are poisonous to a child if ingested?

A

perfume
aftershave
mouthwash
aloe vera

272
Q

What body system is most severely impacted by lead poisoning?

A

neuro

273
Q

What are Chelating agents (Dimercaprol, Calcium Disodium) given for? Who shouldn’t have them?

A

lead poisoning

do NOT give if allergic to peanuts
do NOT give iron

274
Q

What two things need to be monitored when giving Chelating Agents (Dimercaprol, Calcium Disodium)?

A

CBC and renal function

275
Q

What increases lead absorption in the body?

A
  • empty stomach

- hot water

276
Q

What foods contain vitamin A?

A

orange foods help the eyes!

sweet potatoes
carrots
peaches
apricots

spinach
liver

277
Q

What disease occurs with vitamin C deficiency?

A

scurvy

278
Q

What three indicators are the best for determining nutritional status?

A

weight
skinfold thickness
arm circumference

279
Q

What labs can be expected in a dehydrated child?

A

alkalosis
HYPOnatremia
HYPOkalemia
Elevated hematocrit/BUN

280
Q

How can burns best be assessed in children?

A

the Lund-Browder chart

281
Q

What is the priority intervention for a child who has swallowed poison?

A

ASSESS - airway, cardiac and neuro

282
Q

What are early vs late signs of hypoxia?

A

early - restless, anxious, TACHYpnea, TACHYcardia

late - extreme anxiousness, BRADYcardia

283
Q

Will a child with asthma present with inspiratory or expiratory wheezing?

A

expiratory wheezing

284
Q

What nutritional support should be provided for a child with cystic fibrosis?

A

pancreatic enzymes

285
Q

What is the most common postoperative complication after a tonsillectomy? How will the child present?

A

bleeding

frequent swallowing
vomiting blood

286
Q

What are the increased pulmonary blood flow defects? Which way does blood shunt in these defects?

A

ASD
VSD
PDA
Coarctation of the aorta

left to right shunt

287
Q

What are the decreased pulmonary blood flow defects? Which way does blood shunt in these defects?

A

“The Three T’s”

Tetralogy of Fallot
Truncus Arteriosus
Transposition of the Great Vessels

right to left shunt

288
Q

What is common in children with cyanotic defects?

A

polycythemia - the body needs to produce more RBCs to make up for the chronic hypoxia

289
Q

Some infants may require tube feeding to conserve energy - what is a developmental consideration for these children?

A

they need to be able to satisfy sucking needs

290
Q

What are the 2 main objectives of treating CHF?

A

reduce the heart’s workload

to improve cardiac output

291
Q

What 2 cardiac defects are associated with rheumatic fever?

A

aortic valve stenosis

mitral valve stenosis

292
Q

What is the priority for an infant with cerebral palsy?

A

prevent aspiration

293
Q

What is spina bifida?

A

a neural tube defect

294
Q

What position should a spina bifida patient be in pre and post operatively?

A

prone

295
Q

What are the signs of increased ICP vs shock?

A

ICP - BRADYcarida and HYPERtension

Shock - TACHYcardia and HYPOtension

(ICP and shock are opposites)

296
Q

What is the best way to detect early changes in ICP?

A

know the child’s baseline

297
Q

What is the most common cause of increased seizure activity?

A

medication non-compliance

298
Q

What blood labs can we expect to see with bacterial meningitis?

A

HYPOglycemia
elevated proteins

bacteria will eat the sugar and poop the protein

299
Q

What should be monitored closely with bacterial meningitis?

A

fluid status - there may be SIADH going on causing cerebral edema

300
Q

What is a common manifestation of a brain tumor in children?

A

headache upon awakening

vomiting without nausea

301
Q

What kind of drug is Mannitol?

A

diuretic

302
Q

What is Grower’s sign?

A

indicator of mm dystrophy

the child has to “walk/grow” the hands up the legs to stand

303
Q

What is the first sign of renal failure?

A

decreased urine output

304
Q

What does acute glomerulonephritis follow?

A

a strep infection

305
Q

Which has worse edema; acute glomerulonephritis or nephrotic syndrome?

A

nephrotic syndrome

306
Q

Which has elevated blood pressure; acute glomerulonephritis or nephrotic syndrome?

A

acute glomerulonephritis

307
Q

Which has dark frothy yellow urine; acute glomerulonephritis or nephrotic syndrome? Which has dark tea-colored urine?

A

nephrotic syndrome - frothy yellow

acute glomerulonephritis - tea-colored

308
Q

Which has MASSIVE proteinuria; acute glomerulonephritis or nephrotic syndrome?

A

nephrotic syndrome

309
Q

Which has a positive ASO titer; acute glomerulonephritis or nephrotic syndrome?

A

acute glomerulonephritis - (+) ASO

nephrotic syndrome - (-) ASO

310
Q

What might be the cause of a recurrent UTI in children?

A

Vesicoureteral Reflex (reflux)

311
Q

What is a Wilms Tumor?

A

an encapsulated renal tumor that began in embryo

312
Q

With each pregnancy, what are the chances that a child will get sickle cell (an autosomal recessive disease)?

A

1/4 chance (although all can get it) AND both parents must be carriers

313
Q

Hemophilia is an X-linked recessive trait. If a mother is a carrier, how likely is it that her child will have hemophilia?

A

a MALE child will have a 50% chance of EXPRESSING

a FEMALE child will have a 50% chance of being a CARRIER

314
Q

What is an important part of treatment for a child in sickle cell crisis?

A

hydration

315
Q

What do these terms mean; HgbAS, HgbSS, HgbS?

A

HgbAS - sickle cell trait (heterozygous)
HgbSS - sicle cell disease (homozygous)
HgbS - disease, AND trait

316
Q

What is given PO to a child with sickle cell anemia to stimulate RBC production?

A

folic acid

317
Q

What do you need to have ready when administering L-asparaginase (a chemotherapeutic agent used to treat acute lymphocytic leukemia)?

A

epinephrine and oxygen - to treat anaphylaxis

318
Q

What drugs are often used in combination with antineoplastic drugs?

A

prednisone - to reduce lymphocyte mitosis

allopurinol - to prevent renal damage r/t uric acid buildup

319
Q

What dietary additive should NOT be given to PKU patients?

A

NutraSweet (aspartame) - it contains phenylalanine

320
Q

What are the expected labs that diagnosis HYPOthyroidism?

A

low T4

high TSH

321
Q

How does a brace affect a child with scoliosis?

A

it slows the progression but does not correct the spine’s curvature

322
Q

What should NOT be used to turn a child with a spica cast?

A

an abductor bar

323
Q

How many hours/day should a child wear a skeletal brace?

A

23 hours/day

324
Q

What care is indicated for a child with juvenile rheumatoid arthritis?

A

splinting of affected joints

prescribed exercise to maintain mobility

ABSN HESIs (3 decks)

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