Peds Problems

Question 1

3 month old extends arms and legs in response to loud sounds. What is this finding consistent with?

Answer 1

Moro & startle reflex.
Usually disappears by age 6 months

Question 2

Best for new RN

1. Sickle cell just weaned from PCA to oral and asking for more meds
2. Needs premedication before reduction of fracture. Crying and resist touch to arm or other procedures
3. Palliative end-of-life care opiods around the clock, progressive decrease in alertness
4. Chronic pain whose medication and nonpharmacologic regimen has been recently changed.

Answer 2

2. Needs premedication before reduction of fracture. Crying and resist touch to arm or other procedures

Least complex. Likely to respond well to medication

Question 3

Children receiving chemotherapy which is the biggest concern

1. N/V, K 3.3
2. Epitaxis platelet 100,000
3. Fever absolute neutrophils count 450
4. Fatigue hemoglobin 8

Answer 3

3. Fever absolute neutrophils count 450. (<500 Risk for Infection)

Low neutrophil count, fever, chemo is a serious risk for infection

Question 4

Most appropriate for experienced LPN

1. 1 yr combined immunodeficiency scheduled for chemotherapy
2. 2 yr with Wiskott-Aldrich has order for platelet transfusion
3. 3 yr chronic graft-versus-host and incontence
4. 6 yr recieved chemotherapy 1 week ago admitted with lethargy & 101°

Answer 4

3. 3 yr chronic graft-versus-host and incontence

Almost always a chronic disease is correct choice for the LPN. Never unstable patients

Question 5

Correct PPE for neutropenic child receiving chemotherapy

Answer 5

Standard precautions

Question 6

Rare X-linked recessive disease characterized by eczema, thrombocytopenia (low platelet count)
Immune deficiency
Bloody diarrhea (secondary to the thrombocytopenia)

Name….
Treatment

Answer 6

Wiskott–Aldrich syndrome (WAS)

Treatment: platelet infusion

Question 7

4 month Vomiting & fussy past 24 hrs. Circular bruises on back. Priority assessment

1. Chest x ray
2. Ultrasound of head
3. Electroencephalography
4. Ophthalmolgic exam

Answer 7

4. Ophthalmolgic exam

Shaken baby syndrome

Ophthalmolgic exam check for retinal hemorrhage

Electroencephalography indicated for evidence of Seizures

MRI of head Not Ultrasound can detect subdural hematomas

Question 8

Most impact on incidences of infectious disease in schools

1. Soap & water available in all classrooms
2. Immunizations according to national recommendations
3. Provide written information about infections control to all parents
4. Teach cough & sneeze hygine

Answer 8

2. Immunizations according to national recommendations

Question 9

Leukemia patient’s little brother has Varicella (chickenpox). What action will the nurse take next.

1. Administer Varicella-zoster immune globulin to patient
2. Teach parent correct use of acyclovir
3. Education to parents on airborne and contact precautions
4. Prepare to admit to private room in hospital.

Answer 9

1. Administer Varicella-zoster immune globulin to patient.

Immine globulin will prevent Varicella infection in immunocompromised.

Acyclovir therapy (Used to treat Herpies infections. Varicella, Genital, Zoster) & hospitalization maybe needed if child dev Zoster infections

Question 10

Child contracts rubeola (measels) & has 2 siblings. Which action by the school nurse is priority

1. Exclude child and siblings from school for 21 days
2. Notify all parents of school
3. Recommend siblings get measles vaccine
4. Recommend siblings get measles immunoglobulin

Answer 10

1. Exclude child and siblings from school for 21 days

Rubeola is highly contagious & severe consequences (Fatal)

Incubation time 7 - 21 days

MMR vaccine administered within 72 hrs of initial exposure & immunoglobulin admin within 6 days may provide some protection

Question 11

School nurse talking with a 4 girl who excitedly tells the nurse about her birthday party. As she relates the details she frequently stutters. Which action is most appropriate

1. Refer to audiologist
2. Obtain detailed birth history from parents
3. Document findings in school record
4. Refer to speech pathologist

Answer 11

3. Document findings in school record

Stuttering when exicted is normal during preschool years.

Documenting for further observation to see if it extends past preschool years

Question 12

Cystic fibrosis with increased shortness of breath & pneumonia

What are the priority nursing interventions

Answer 12

Postural drainage & chest physiotherapy

Question 13

The best room mate for a CF patient is another CF patient

T or F

Answer 13

False

This reduces droplet transmission

Question 14

Most concerning after tonsillectomy

1. Frequent swallowing
2. Hypotonic bowel sounds
3. Reports sore throat
4. HR 122

Answer 14

1. Frequent swallowing

Could indicate bleeding- inspect back of throat

Question 15

Newborn infant RDS respiratory distress syndrome Receiving continuous Positive Airway Pressure. Which assessment is most important

1. Apical HR 156
2. Crackles in both lungs
3. Tracheal deviation to the right
4. OX Sat 93%

Answer 15

3. Tracheal deviation to the right
   Positive Airway Pressure may cause Tracheal deviation

Other findings are to be expected with RDS

Question 16

Premature newborn with RDS respiratory distress syndrome. Which will be first medication

1. Theophylline
2. Surfactant
3. Dexamethasone
4. Albuterol

Answer 16

2. Surfactant

Synthetic surfactant improves RDS & decreases pneumothorax in premature infant

Theophylline (Bronchodilator)

Question 17

3 year old with tetralogy of Fallot. Lips & oral mucosa are dusky in color.

First intervention

Answer 17

Place child in Knee to chest posistion

Then apply oxygen

Question 18

Assess first

1. Coarctation of Aorta (narrowing, congenital) decreased pedal pulses
2. Rheumatic fever ( result of inadequately treated strep throat or scarlet fever. Causes inflammation, especially of the heart, blood vessels, and joints.) reports severe knee pain
3. Endocarditis, crackles in both lungs
4. Kawasaki disease temp 102.2

Answer 18

Endocarditis, crackles in both lungs

Crackles in both lungs indicates severe left ventricular failure, complication of endocarditis. Hypoxia is likely.

Question 19

Condition that causes inflammation in the walls of some blood vessels in the body.

It’s most common in infants and young children.

Early stages include a rash and fever. Symptoms include high fever and peeling skin.

In late stages, there may be inflammation of medium size blood vessels (vasculitis). It also affects lymph nodes, skin, and mucous membranes, such as inside the mouth.

Initial treatments include aspirin and intravenous immunoglobulin therapy

Name disease

Answer 19

Kawasaki

Question 20

Child recovering from kawasaki disease and receiving aspirin therapy. Which information is most concerning

1. Attends day care 5 days a week
2. Fingers have areas of peeling skin
3. Very irritable & cries frequent
4. Not immunized

Answer 20

4. Not immunized

Risk of Reyes syndrome with Asprin & Varicella or Flu

Question 21

Sickle cell with severe ab, hip, and knee pain caused by sickle cell crisis. Which action taken requires immediate intervention

1. Admin oral pain med as needed
2. Positioning cold packs on knees
3. Encouraging fluid intake
4. Monitoring VS

Answer 21

2. Positioning cold packs on knees

Sickle cell may include (Vaso-occlusive crisis, Splenic Sequestration- Sickle cells get stuck Trapping Blood in the Spleen, Aplastic Crisis- Stops production of RBC)

Placing cold packs on knees = vasoconstriction- Placing child at risk for Thrombosis formation

Question 22

First to assess

1. 1 yr hemophilia B who was admitted due to decreased responsiveness
2. 3 yr Wilebrand disease (bleeding disorder lack of clotting factor) who has dose of desmopressin (Antidiuretic & Clot promoter) scheduled.
3. 7 yr acute lymphocytic leukemia has chemotherapy-induced thrombocytopenia
4. 16 yr Sickle cell reports acute right lower quadrant pain.

Answer 22

1. 1 yr hemophilia B who was admitted due to decreased responsiveness

Decreased responsiveness with a blood clotting disease may mean intracranial bleeding

Question 23

Idiopathic thrombocytopenia purpura ( Autoimmune disease which attacks the platelets) which should the nurse report immediately

1. PT 12 seconds
2. Hemoglobin 6.1
3. Platelets 40,000
4. Leukocytes 5600

Answer 23

2. Hemoglobin 6.1

May indicate blood loss

Low platelets <20,000 expected findin

Normal PT time between 11 and 13.5 seconds, when

Leukocytes = WBC (Normal 5,000 - 10,000)

Question 24

Which will you double check with another RN

1. Prednisone 1 mg PO
2. Amoxicillan 250 mg PO
3. Methotrexate 10 mg PO
4. Filgrastim 5 mcg SQ

Answer 24

3. Methotrexate 10 mg

Disease-modifying anti-rheumatic drug (DMARD).

Uses: Immune disorders & Cancer

Reduce activity of the immune system for people who have certain conditions

Filgrastim

Bone marrow stimulant

Make white blood cells after receiving cancer medications. It can also improve survival in people who have been exposed to radiation

Question 25

Child with active seizures which is the priority for nurse to obtain 1. HR 2. BMI 3. BP 4. Weight

Answer 25

4. Weight Seizure medication is based on weight in Kg

Question 26

Newborn with myelomeningocele (severe type of spina bifida) which assessment Findings is most concerning 1. Bulging sacs when infant cries 2. Oozing stool from anus 3. Flaccid paralysis of legs 4. Temp 101.8

Answer 26

4. Temp 101.8 Possibe Infection Other findings are to be expected with myelomeningocele

Question 27

Myelomeningocele (MMC) is the most severe type of spina bifida Spinal cord's protective covering and nerves protrude from the baby's back at birth, forming a sac that can contain cerebrospinal fluid. Defects: Muscle weakness or paralysis Bowel and bladder problems Hydrocephalus, or excessive fluid on the brain Chiari malformation, or a change in brain positioning Seizures Orthopedic conditions, such as scoliosis, hip problems, and foot deformities Treatment:

Answer 27

Fetal spina bifida repair, is a surgery to close the spinal defect during pregnancy. Performed between 19 and 26 weeks gestation

Question 28

6 yr fell off jungle Jim and hit her head. Which questions are appropriate to evaluate her neurological status 1. What is your home address 2. What time does your family eat dinner 3. What grade are you in 4. What is your teachers name 5. What time did you fall 6. What is the name of your school

Answer 28

1. What is your home address 3. What grade are you in 4. What is your teachers name 6. What is the name of your school Child is in Piagets stage of concrete operations. Can organize experiences & some complex information. Have a difficulty conceptualize time Not 5. What time did you fall 2.. What time does your family eat dinner

Question 29

2 yr diagnosed with intussusception. Hydrostatic reduction (filling the colon with saline through a catheter inserted into the rectum. A sonologist monitors the reduction on ultrasound) has been performed. Which finding should be reported immediately before surgery proceeds. 1. Palpable sausage shapped mass 2. Passage of normal brown stool 3. Passage of currant jelly like stools 4. Frequent N/V

Answer 29

2. Passage of normal brown stool Signifies that resolution of intussusception Intestine telescopes into itself Often in children. Fatal Symptoms include Sudden, loud crying that comes and goes every 15 to 20 minutes, vomiting, and stool mixed with blood and mucus. It may be possible to push the intestine back into place using an enema. If this fails, surgery may be needed.

Question 30

Teaching a group of daycare workers how to avoid transmission of Hep A in daycare setting. Single most infective measure to emphasize. 1. Hand hygine 2. Children diagnosed with Hep a should not share toys with others 3. Children with episodes of fecal incontence isolate from others 4. Immunizations are recommended before

Answer 30

Hand Hygine most important aspect to emphasize. Fecal incontence & sharing recommended when disease is in infectious stage. Immunizations is advice for parents not Daycare workers

Question 31

9 yr deep partial & full thickness which medication is most important to double check with another nurse. 1. Silver sulfasalazine ointment 2. Famotidine 20 mg IV 3. Lorazepam 0.5 mg PO 4. Multivitamin 1 tab PO

Answer 31

3. Lorazepam 0.5 mg PO High alert drug when given to children. Famotidine Antihistamine and Antacid Treats: Ulcers (GERD), Excess stomach acid. Heartburn caused by acid indigestion.

Question 32

13 yr female Parents are concerned bc she is spending alot of time in her room alone in front of the mirror. Weight & Height are in the 50th percentile. Girl is quite but answers questions appropriately. What advice should nurse provide her parents 1. Further evaluation is needed by psychologist because your daughter is spending a lot of time alone. 2. Limit the amount of time your daughter spends alone. 3. This behavior is normal. Your daughter is adjusting to the physical changes she is experiencing 4. This behavior is associated with depression and further evaluation is needed by a counselor.

Answer 32

3. This behavior is normal. Your daughter is adjusting to the physical changes she is experiencing Considering that height & weight are normal and answers questions normally. This is just normal behavior

Question 33

16 female has been sex active for 6 months with boyfriend. Immunizations are upto date. Screening for which STD is most important 1. Syphilis 2. Genital Herpes 3. HPV 4. Chlamydia

Answer 33

4. Chlamydia CDC recommends annual screening for Chlamydia & Gonorrhea for all sexual activity women <25 Chlamydia is most prevalent STD Syphilis or Herpes is recommended if other factors or evidence is found. Fully immunized = HPV vaccine

Question 34

What is the concern about a child eating an entire jar of gummi multivitamins? What is the Intervention

Answer 34

Iron. Massive hemorrhage, coma, shock, hepatic failure. Deferoxamine

Question 35

Newborn with tracheoesophageal fistula. Which nursing interventions should be implemented in the preop 1. Provide small frequent feeding 2. Elevated HOB 3. Prepare tracheostomy tray 4. Set up suctioning 5. Administer IV fluids

Answer 35

2. Elevated HOB 4. Set up suctioning (Prevents ASPIRATION of stomach contents / acid) 5. Administer IV fluids (Patient is NPO) Tracheoesophageal fistula is exactly what it sounds like. A Fistula (Hole) between Trachea (Windpipe) & Esophagus (Food Tube) Not 1. Provide small frequent feeding (NPO) 3. Prepare tracheostomy tray (There is no trach tube)

Question 36

2 yr Lead level <10mcg/dL Hemoglobin 8 g/dL Hematocrit 24% Mean corpuscular volume 65 What questions will obtain a more thorough history 1. Does child eat nonfood substances 2. More prone to infection 3. Experienced hair loss 4. Frequent nosebleeds 5. How much milk do they drink

Answer 36

Iron deficiency anemia is a microxytic anemia. RBCs not made due to lack of iron. Lab values associated with microcytic anemia include: Low hemoglobin, hemocrit, MCV ( (mean corpuscular volume) measures the average size of your red blood cells) & Thrombosis increases platelets. Anemics experience Pica Excessive cows milk can cause irritation and microscopic blood loss from intestine - causing Anemia 1. Does child eat nonfood substances 5. How much milk do they drink

Question 37

Liquid Iron prescribed to 10 month old with deficiency anemia. Parents tell Dr. That child hates the taste of medication. Which is / are appropriate SATA 1. Give Iron orally with syringe 2. Mix with a bit of chocolate syrup 3. Give with food or milk. 4. Let child drink through straw 5. Give with OJ

Answer 37

1. Give Iron orally with syringe 5. Give with OJ Iron may stain teeth so squirting into back of mouth with syringe good idea OJ contains vitamin C Which helps with absorption Not 2. Mix with a bit of chocolate syrup Contains caffeine Contradicted 3. Give with food or milk. Take on empty stomach 4. Let child drink through straw 6 months can drink through straw but otherwise good idea

Question 38

6 month old girl BS 94 Temp 101 HR 198 RR 40 BP 60/38 Priority 1. Antiemetic rectal 2. Bolus D10W 3. Bolus NS 4. Antipyretic rectal

Answer 38

3. Bolus NS Hypovolemic shock. Need fluid that will go to/ bring other fluid into intravascular space..

Question 39

16 male complains of left hip pain that began during a basketball game. 85th percentile height & weight. Increased pain with weight bearing. Out-toeing (duck feet) of left leg with ambulation. Priority 1. Ibuprofen & rest 2. Heat & elevate left leg. 3. Refer to ED 4. Apply ice & immobilize with splint

Answer 39

3. Refer to ED Classic symptoms Slipped Capital femoral epiphysis Delayed treatment can cause necrosis & death of femoral head

Question 40

Toddler temp 102, sore throat. Child had tonic clonic seizure. What is the priority 1. Assess LOC 2. Obtain Ox Sat 3. Loosen clothing 4. Posistion in side-laying Posistion

Answer 40

4. Posistion in side-laying Posistion It's always side laying first for seizure. It opens airway