Pediatrics 3

Question 1

Epiglottitis (1008)

Answer 1

Caused by H. influenzae. HiB vaccine. Presents with fever, muffled voice, drooling, respiratory distress. Tx with intubation, tracheostomy, and epinephrine (vasoconstriction).

Question 2

Therapy for a newly diagnosed child with CF (1012)

Answer 2

Pulmonary therapy.

CPT (secretion removal), chest wall oscillations, expectorants, mucolytic agents, DNase.

Question 3

How to check output on a dehydrated infant (1017)

Answer 3

Body weight to determine level of dehydration.

Assess output by weighing wet/dry diapers.

Question 4

Foods easy on the bowel for a child trying to rehydrate (1019)

Answer 4

BRAT diet, cereal, crackers, toast, pretzels.

Question 5

Questions to ask a parent about a child with chronic constipation (1020)

Answer 5

About bowel patterns.

High fat, protein. Inadequate fluids. Medications. Iron Supplements. Anti-convulsant therapy all exacerbate things.

Question 6

Pyloric stenosis (1021)

Answer 6

Obstruction at the end of the gastric outlet.

Hypertrophied pyloric muscle.

Presents with projectile vomiting.

Question 7

Symptoms of intussuception (1023)

Answer 7

Currant jelly stools.

Feces mixed with blood and mucus from the intestinal mucosa rubbing together.

Question 8

Diagnostic tests to confirm TB in a child (1011)

Answer 8

Positive bacterial sputum culture.

Skin test (TST) is not diagnostic.

Question 9

SS of dehydration in an infant (1018)

Answer 9

Dry mucous membranes, sunken eyes, sunken fontanelles, lethargy, rapid weak pulse, low BP.

Question 10

Regurgitation after every feeding is a sign of what condition (1020, 1021)

Answer 10

Gastroesophageal reflux (GER)

Incompetent cardiac sphincter causes regurgitation of gastric contents into the esophagus or oropharynx.

Question 11

SS of croup (1008)

Answer 11

Barking cough.

Also difficulty breathing and laryngeal spasms.

Question 12

SS of bronchitis (1010)

Answer 12

Retractions, tachypnea, nasal flaring, paroxysmal nonproductive coughing, and wheezing.

Question 13

SS of serious complications of intussuception (1023)

Answer 13

Peritonitis, intestinal ischemia, infarction, perforation, and shock.

Question 14

Care for a child with Wilm’s tumor (1029)

Answer 14

Prepare child and parents for surgery. Monitor bowel sounds and kidney function.

Question 15

Medical management for an infant with a persistent umbilical hernia (1026)

Answer 15

Surgical closure if persists after 5yo or larger than 2cm.

Question 16

Medical management for a hypertrophic pyloric stenosis (1022)

Answer 16

Surgical correction by Fredet-Ramstedt procedure (pyloromyotomy).

Cut pylorus muscle down to create a larger lumen.

Question 17

Intussuception (1023)

Answer 17

Telescoping intestine (at the ileocecal valve) causing the mucosal walls to rub together. Presents with abdominal pain, vomiting, and currant jelly stools.

Question 18

Definition of a hernia (1025)

Answer 18

Protrusion of (portion) an organ through a structural defect or weakened muscle.

Question 19

Best treatment to rehydrate a breastfed infant (1019)

Answer 19

Continue breast feeding in addition to oral rehydration solutions (Pedilyte, Infalyte).

In severe cases, IV therapy of D5saline.

Question 20

Percent of dehydration in a child (1017)

Answer 20

Mild - 5%

Moderate - 10%

Severe - 15%

Question 21

Abnormality of urine with nephrosis (1027)

Answer 21

Proteinuria (protein in the urine).

Question 22

SS of decreased O2 with CF (1011)

Answer 22

Hypoxia, clubbing of fingers and toes, cyanosis, barrel chest.

Presents with chronic cough, wheezing, sputum production, and dyspnea.

Question 23

Nephrotic syndrome, fluid loss and sodium retention (1027)

Answer 23

Glomerular damage -> glomerulus permeable to protein -> proteinuria -> hypoprteinemia -> lowered osmotic pressure in capillaries -> hyper-permeabiliy of the capillaries -> edema -> hypovolemia -> kidneys retain Na and water -> hypernatremia

Question 24

Wilm’s tumor (1028, 1029)

Answer 24

Tumor most commonly effects the left kidney. Metastasizes to the lungs, lymph nodes, liver, brain, and bone.

Presents as a firm abdominal mass.

Dx definitive with surgical biopsy. Do not palpate more than necessary.

Tx with surgical resection.

Question 25

Common transmission methods for MMR (1059, 1061)

Answer 25

Rubeola (measles) - Respiratory secretions.

Rubella (german measles) - Respiratory secretions and transplacental transmission.

Mumps - Respiratory secretions.

Question 26

How long is a chid with Varicella contagious for (1060, 1061)

Answer 26

Varicella is communicable from [1 day before eruption] until all lesions are crusted over [1 week after onset].

Question 27

Best treatment for all the itching with Varicella (1059)

Answer 27

Apply pressure rather than scratching and use mittens.

Loose clothing, daily baths without soap, keep nails short.

Question 28

Risk factors for SIDS (1006)

Answer 28

Sleeping prone, using soft pillows, adult bedding, and lower socioeconomic classes.

Respiratory dysfunction, smoking, and drug use. Premature with low birth weight and low APGAR scores, multiple births, and CNS dysfunction.

Question 29

How to obtain a sputum sample from a 3 year old (1011)

Answer 29

Gastric aspirations.

Toddlers and children tend to swallow their respiratory mucus rather than spitting them up.

Question 30

Hirschsprung’s disease (1024)

Answer 30

Megacolon. Intestinal obstruction by absence of ganglion cells in a portion of the colon. More typical for those with Trisomy 21. Presents with bowel distention and diagnosed with barium enema.

Question 31

What are undescended testicles and how can they be treated (1030)

Answer 31

Administration of human chorionic gonadotropin.

Orchiopexy - surgical fixation of a testes with care to prevent testicular damage.

Question 32

What nursing findings would be consistent with a diagnosis of bacterial pneumonia (1005)

Answer 32

Streptococcal, staphylococcal, pneumococal, and H. influenzae.

Elevation in WBC count. C/S of respiratory secretions and blood.

Coughing, wheezing, respiratory distress, anorexia, lethargy, headache, fever, abdominal pain, and nasal discharge.

Question 33

Best time to administer pancreatic enzymes for CF patient (1012)

Answer 33

Before meals and snacks.

Question 34

Most important aspect to treatment for a child with CF (1012)

Answer 34

Pulmonary therapy.

Chest physiotherapy (CPT).

High frequency chest wall oscillations.

Question 35

Primary medical management for an infant with pyloric stenosis (1022, 1023)

Answer 35

Fredet-ramstedt procedure (pyloromyotomy) to create a larger lumen.

Question 36

Characteristics of currant jelly (1023)

Answer 36

Mucosa of intestinal cells rub against each other. Blood and mucus from the mucosa leak into the intestinal lumen.

Presents as feces mixed with blood and mucus.

Question 37

Term for undescended testicles (1030)

Answer 37

Cryptorchidism.

Failure of the testes to descend into the scrotum.

Question 38

Medications for a child with gastroesophageal reflux (1021)

Answer 38

H2-Histamine receptor agonists to reduce the amount of acid.
(Zantac, Pepcid, Tagamet)

Acceleration of gastric emptying (Reglan).

Question 39

Dramatic decrease in the incidence of SIDS during the 1990’s (1006)

Answer 39

“Back to Sleep” campaign encouraging parents to put their infants to sleep on their backs.

Question 40

Recommended age to receive first measles’ vaccine (CDC)

Answer 40

12-15 months

Question 41

What is the highest concern post-op for spina bifida (1047)

Answer 41

Bleeding and infection.

Question 42

SS of meningitis in a toddler (1041)

Answer 42

Kernig’s Sign - resistance to knee extension.
Brudzinski Sign - Neck flex, hip flex.

Nuchal rigidity, opisthotonos, lowered LOC, and seizures.