Preschool Flashcards

Question

autonomy versus shame

Answer 1

The stage of autonomy versus shame and doubt occurs between 18 months and 3 years.

Answer 2

Industry versus inferiority occurs between 5 to 12 years.

Answer 3

Intimacy versus isolation occurs in adulthood between the ages of 19 to 40 years.

Answer 4

A sense of identity is developed by “trying on” roles and discussing values and goals with others.

Answer 5

A sense of trust develops when an adolescent is able to find out whom (and what ideas) to have faith in. The adolescent period is also a time where past stages of development are revisited.

Answer 6

The sense of autonomy is where the adolescent seeks ways to express individuality. The stage of initiative is where the adolescent develops vision of what he or she might become. Talking with another adolescent who also uses a wheelchair to ambulate will help the adolescent see possibilities and reassurances

Answer 7

The earliest sign of puberty in most girls is the development of breast "buds," nickel-sized bumps under the nipple. Menarche usually follows within 2 years of the first signs of breast development.

Answer 8

a rounded knotty depression in the center of a person's belly caused by the detachment of the umbilical cord after birth

Answer 9

an overweight, sedentary 15-year-old girl

Answer 10

Euphoria, increased energy and alertness, agitation, weight loss, insomnia, tachycardia, and hypertension

Answer 11

Stimulants have similar effects as alcohol but the high only lasts a few minutes and includes slurred speech, lack of coordination, euphoria, and dizziness.

Answer 12

Opiates produce feelings of relaxation and euphoria.

Answer 13

CNS depressants cause euphoria followed by depression or hostility, impaired judgment, decreased inhibitions, slurred speech, and incoordination.

Answer 14

When identity has been established, generally between the ages of 16 and 18 years, adolescents seek intimate relationships, usually with members of the opposite sex. Intimacy, which is mutual sharing of one's deepest feelings with another person, is impossible unless both persons have established a sense of trust and a sense of identity. Intimate relationships are a preparation for long-term relationships, and people who fail to achieve intimacy may develop feelings of isolation and experience chronic difficulty in communicating with others.

Answer 15

According to Erikson, the central task of adolescence is to develop unique personality and identity. The developmental task for the school-age child is to develop a sense of industry, and completing activities builds that feeling of confidence. Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) and do things on their own.

Answer 16

By allowing the adolescent to follow trends and fads in clothing choices, hairstyles, and music, the caregiver decreases the stress for the child. a trend is defined as “a general development or change in a situation or in the way that people are behaving.” On the other hand, a fad is “a style, activity, or interest that is very popular for a short period of time.”

Answer 17

In each stage of development, a significant person or group exerts a lasting influence on the ongoing development of the child. An adolescent striving for self-identity and increased independence spends more time with peers than with family. It is important for the hospitalized adolescent to still be able to visit with peers.

Answer 18

the first occurrence of menstruation

Answer 19

a substance which removes or conceals unpleasant smells, especially bodily odors.

Answer 20

pubertal changes are more likely to experience nocturnal emissions. informally known as a · wet dream, · sex dream, · nightfall or · sleep orgasm, is a spontaneous orgasm during sleep that includes ejaculation

Answer 21

Piaget’s developmental theories focus on the cognitive maturation of the child. The ability to critically think is a sign of successful cognitive maturation. A sense of internal identity is consistent with Erikson’s theories of development. Kohlberg’s theories development focus on morals and values.

Answer 22

the appearance of nocturnal emissions ("wet dreams") is often used as the indication that the preadolescent period has ended and that the adolescent is maturing into an adult

Answer 23

Atraumatic care is defined in Wong's Nursing Care of Infants and Children as “care that minimizes the psychologic and physical stress

Answer 24

Clarifying consists of repeating statements others have made so both people can be certain that the message is understood. This is an example of clarifying.

Answer 25

Reflecting is restating the last word or phrase. Open-ended questions invite a variety of responses and allow the client to give all the pertinent information needed to answer the question.

Answer 26

Perception checking documents a feeling or emotion that is reported. It is a way of understanding others accurately instead of jumping to conclusions.

Answer 27

Infants primarily communicate through touch, sight, and hearing

Answer 28

The extended family is an immediate family with other family members in the same house.

Answer 29

The immediate family is composed of an individual's smallest family unit (commonly parents and their children), all of whom share a common household.

Answer 30

Members of a communal family share responsibility for homemaking and child-rearing; all children are the collective responsibility of adult members. - child-rearing: the process of bringing up a child or children - communal family: A communal family is a combination of two or more families living together

Answer 31

In a blended family, both partners in the marriage bring children from a previous marriage into the household.

Answer 32

The least effective technique is ignoring the adolescent's tirade about his therapy. tirade:a long, angry speech of criticism or accusation

Answer 33

take blame for their parents quarreling and try to behave better. quarreling: have a heated argument or disagreement

Answer 34

to give a lot of love or attention to (someone or something)

Answer 35

milestones

Answer 36

Artificially acquired active immunity develops through vaccine administration of an antigen that stimulates the child’s body to produce antibodies against that antigen (pathogen) and to remember the antigen should it reappear. Natural immunity is produced through natural invasion of an antigen (pathogen). Natural and artificial passive immunity involves providing antibodies to fight a pathogen rather than expecting the child’s body to produce them. This type of immunity has a short life.

Answer 37

Rotavirus is a very common cause of gastroenteritis among young children that spreads readily via the fecal-oral route.

Answer 38

A positive Kernig and Brudzinski sign are indicative a meningeal irritation --Three layers of membranes known as meninges protect the brain and spinal cord. The delicate inner layer is the pia mater. The middle layer is the arachnoid, a web-like structure filled with fluid that cushions the brain. The tough outer layer is called the dura mater.

Answer 39

Toddlers are egocentric | ---egocentric: thinking only of oneself, without regard for the feelings or desires of others

Answer 40

allows a parent to elaborate, which is what the nurse desires in this case

Answer 41

a child's toy consisting of a stick with colored vanes that twirl in the wind

Answer 42

Therapeutic play is nondirected and focuses on helping the child cope with feelings and fears. It helps the child deal with the challenges of illness and hospitalization. Therapeutic play is a technique to help children better understand what will be happening to them in a specific situation. For instance, the child who will have an IV line started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. - ----Emotional play or play therapy is play that allows the child to act out stressors or dramatize real-life stressors. For example, to relieve anger a child may be given something to pound. - -- Interactive play is where children play together cooperatively. - ---Parallel play is where toddlers play side by side but not together.

Answer 43

Allow the child to put on surgical attire and “operate” on a doll to teach what will be ---attire: clothes, especially fine or formal ones

Answer 44

An infant in pain will display physical cues

Answer 45

crying that is not easily consolable, acting active and fussy, stiffened posture, and elevated vital signs ---consolable: to alleviate or lessen the grief, sorrow, or disappointment of; give solace or comfort: Only his children could console him when his wife died.

Answer 46

This is regression caused by the stress of hospitalization. The child feels threatened and moves back to a more secure stage of development.

Answer 47

child’s corrected age: count on premature age

Answer 48

Parents "see" the child as more fragile and dependent than he actually is.

Answer 49

chronological age: old from the day first born

Answer 50

occlusion: the blockage or closing of a blood vessel or hollow organ.

Answer 51

right side

Answer 52

- ---Drug absorption (transfer of the drug from its point of entry in the body into the bloodstream) is influenced by the route of administration as well as by the concentration and acidity of the drug. Vomiting and diarrhea, frequent symptoms of childhood illnesses, interfere with absorption because a drug does not remain in the gastrointestinal tract long enough to be absorbed. - ---Distribution refers to the movement of the drug through the bloodstream to a specific site of action. ----------Metabolism involves conversion of the drug into an active form (biotransformation) or an inactive form (inactivation). - ----Excretion is the elimination of raw drug or drug metabolites, a process that largely prevents properly administered drugs from becoming toxic.

Answer 53

A tube placed through your baby's nose (called a. Nasogastric or NG tube) carries breast milk/formula to the stomach

Answer 54

Tinea is the name of a group of diseases caused by a fungus.

Answer 55

offer to play a game with the child if the child takes the medicine --bride: persuade (someone) to act in one's favor,

Answer 56

"hold the child down." This makes the parents the villain in the situation

Answer 57

squirt: cause (a liquid) to be ejected from a small opening in a thin, fast stream or jet - --she squirted soda into a glass

Answer 58

Heart rate, respiratory rate, and blood pressure increases are seen more with acute pain.

Answer 59

These effects may include sleep disturbances, exhaustion, irritability, mood disturbances, and depression.

Answer 60

Conscious sedation refers to a state of depressed consciousness, usually obtained through IV analgesia therapy.

Answer 61

- --Thought stopping is a technique in which children learn to stop anxious thoughts by substituting a positive or relaxing thought in its place. - -- Hypnosis involves the child entering a trance-like state to effectively avoid sensing pain. Hypnosis is "a trance state characterized by extreme suggestibility, relaxation and heightened imagination". trance-like: a half-conscious state - --Biofeedback is based on the theory people can regulate internal events such as heart rate and pain response in response to a stimulus. A biofeedback apparatus is used to measure muscle tone or the child's ability to relax.

Answer 62

divert the child's attention away from the pain through controlled, purposeful behaviors.

Answer 63

- --The poker chip tool uses four red poker chips placed in a horizontal line in front of the child. Each chip represents a different level of pain. The technique can be used with children as young as 4 years of age, provided the child has some concept of "more or less." ----The Pain Experience Inventory is designed to elicit the terms a child uses to denote pain and what actions a child thinks will best alleviate pain. If possible, it should be used before the child has pain. - ---The CRIES inventory is a 10-point scale named for five physiological and behavioral variables commonly associated with neonatal pain (Crying, Requires increased oxygen administration, Increased vital signs, Expression, Sleeplessness) and thus is not age-appropriate in this case. - ---The FLACC (Faces, Legs, Activity, Cry Consolability) pain assessment tool is a scale by which health care providers can rate a young child's pain when a child cannot give input, such as during circumcision.

Answer 64

In infants under the 3 months of age the most causative agents are group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen, a full septic work-up is done. Neonates have the poorest outcomes from sepsis. - --Neisseria meningitidis is one cause of sepsis in older children. - --The Epstein-Barr virus is a herpes virus that causes mononucleosis. - ---The cytomegalovirus is a common herpes virus. It is spread through bodily fluids and is not necessarily a concern unless the person is immunocompromised or is pregnant.

Answer 65

The hallmark symptom of measles is the appearance of Koplik spots.

Answer 66

A virus that enters the body through the gastrointestinal tract and thrives there, often moving on to attack the nervous system. The polioviruses are enteroviruses.

Answer 67

For the child with an enterovirus infection, contact precautions are used during the illness. Standard precautions are followed at all times and are appropriate for any child. - --Droplet precautions would be used for a child infected with pertussis. - --Airborne precautions would be indicated for the child with varicella.

Answer 68

The most common tick-borne diseases are Ehrlichiosis, Anaplasmosis, Rocky Mountain spotted fever, Hepatozoonosis, Babesiosis, and Lyme disease.

Answer 69

Chickenpox lesions are infectious until they crust

Answer 70

scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.

Answer 71

Infectious diseases caused by tick bites include Lyme disease and Rocky Mountain spotted fever. - -Psittacosis is transmitted to children by birds. Ascariasis is a roundworm infection. - -Scabies is a parasitic infection caused by a female mite.

Answer 72

Rocky Mountain spotted fever is a potentially fatal disease that's usually caused by the bite of a tick infected with rickettsia group bacteria. Symptoms include fever, headache, and muscle aches. A rash may be present, frequently with blackened or crusted skin at the site of a tick bite. Spotted fever responds well to prompt treatment with antibiotics.

Answer 73

Deer ticks can carry the bacteria that causes Lyme disease. Lyme disease causes a rash, often in a bull's-eye pattern, and flu-like symptoms. Joint pain and weakness in the limbs also can occur. Most people with Lyme disease recover completely with appropriate antibiotic treatment. For those who develop syndromes after their infection is treated, pain medications may provide symptomatic relief.

Answer 74

Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. - ---- Pertussis is a respiratory disorder that causes severe paroxysmal coughing, which produces a whooping sound. - ----Measles is recognized by Koplik spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. - ----Scabies is a skin condition where lice lay eggs under the skin. The rash is very pruritic and is seen on the hands, feet, and folds of the skin.

Answer 75

---Paroxysmal coughing involves frequent and violent coughing that can make it hard for a person to breathe. ----Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it's marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like "whoop."

Answer 76

- ---Roseola begins with a high fever; after 3 or 4 days, the fever falls abruptly and a distinctive rash of discrete, rose-pink macules approximately 2 to 3 mm in size and flat with the skin surface appears. - ---With rubella, after the 1 to 5 days of prodromal signs, a discrete pink-red maculopapular rash begins on the face, then spreads downward to the trunk and extremities. On the third day, the rash disappears. - ---Measles feature Koplik spots (small, irregular, bright-red spots with a blue-white center point), which appear on the buccal membrane. - ---- Chickenpox is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a distinctive rash. - ---- Varicella lesions first begin as a macula, then progress rapidly within 6 to 8 hours to a papule, then a vesicle that becomes umbilicated and then forms a crust.---umbilicated: having a small depression that resembles a navel umbilicated vesicles

Answer 77

An unprovoked attack is much more suggestive that the animal is rabid rabies: A deadly virus spread to people from the saliva of infected animals. ---Rabies is usually spread through an animal bite. Animals most likely to spread rabies include dogs, bats, coyotes, foxes, skunks, and raccoons. Symptoms include fever, headache, excess salivation, muscle spasms, paralysis, and mental confusion

Answer 78

petechiae can indicate serious infection in an infant. --- If you have tiny red, purple, or brown spots on your skin The bruising is known as purpura caused by internal bleeding from small blood vessels

Answer 79

Varicella zoster results in a lifelong latent infection. It can reactivate later in life resulting in shingles.

Answer 80

Lyme disease should be treated with cefuroxime when the child is younger than 8 years old and allergic to penicillin. Doxycycline is the drug of choice for children older than 8 years. Children younger than 8 who take a tetracycline like doxycycline risk permanent teeth discoloration and should be given amoxicillin unless they are allergic to it

Answer 81

Cool compresses or cool baths will help to relieve the itching associated with the rash.

Answer 82

- -The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection. - - The prodromal period is the time from the onset of nonspecific symptoms to specific symptoms, for example, cold/flu-like symptoms before Koplik spots occur in measles. - - The illness is the time during which symptoms of the specific illness occur. - -The convalescent stage is the time when the acute symptoms disappear.

Answer 83

Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities. - -Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen, or back that is followed by a pattern of small lesions. It is self-limiting and can be treated with steroid creams. - -- Rosacea is a chronic inflammatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious.

Answer 84

Eosinophils are the first line of defense against parasitic infections and allergic reactions and will be elevated. - --Monocytes are a second line of defense and will be elevated in response to leukemias, lymphomas, and chronic inflammation. - --Basophils respond to allergic disorders and hypersensitivity reactions. - --Neutrophils are the first line of defense upon invasion of bacteria, fungus, cell debris, and other foreign substances.

Answer 85

Two common medications containing salicylates are bismuth subsalicylate and effervescent heartburn relief antiacid.

Answer 86

Status epilepticus is a common neurological emergency in children. The most common cause of status epilepticus in children is febrile seizures. Status epilepticus occurs when seizures last longer than 30 minutes or recur without return of consciousness between seizures.

Answer 87

- --An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. - -- A tonic seizure consists of a brief onset of increased tone or muscle. - ---A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. - ---An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

Answer 88

With the focal onset impaired awareness seizure, formerly called complex partial seizure, the child is confused or their awareness is affected during the seizure. The seizure begins in a small area of the brain and changes or alters consciousness. These seizures can have motor and non-motor symptoms. They cause memory loss and staring and nonpurposeful movements, such as hand rubbing, lip smacking (slap, hit, strike), arm dropping, and swallowing. - -- In the tonic phase of tonic–clonic seizures, the child's muscles contract, the child may fall, and the child's extremities may stiffen. - --- During the prodromal period of the tonic–clonic seizure, the child might have a lack of coordination. - ---Focal onset aware seizures (formerly called simple partial seizures) can either have motor or sensory symptoms. A focal onset motor seizure causes a localized motor activity such as shaking of an arm, leg, or other body part.

Answer 89

A positive Kernig sign can indicate irritation of the meninges. - -A positive Brudzinski sign also is indicative of the condition. - -A positive Chadwick sign is a bluish discoloration of the cervix indicating pregnancy.

Answer 90

Nuchal rigidity simply refers to neck stiffness

Answer 91

A seizure disorder is caused by a disruption in the electrical impulses in the brain. Tonic-clonic seizures are the most dramatic seizure disorder. It is characterized by a loss of consciousness, along with the entire body experiencing tonic contractions followed by rhythmic clonic contractions alternating with relaxation of all muscle groups.

Answer 92

Lumbar punctures are performed to analyze cerebrospinal fluid (CSF) to rule out meningitis or encephalitis as a cause of seizures.

Answer 93

Positional plagiocephaly refers to asymmetry in head shape without fused sutures. It results from gravitational force exertion on the developing cranium and has increased in incidence since the inception of the "back to sleep" programs to prevent sudden infant death syndrome.

Answer 94

Ketogenic diets (high in fat, low in carbohydrates, and adequate in protein) cause the child to have high levels of ketones, which help to reduce seizure activity.

Answer 95

Two signs of basilar skull fracture include Battle sign (bruising or ecchymosis behind the ear) and “raccoon eyes” (blood leaking into the frontal sinuses causing an edematous and bruised periorbital area). Rhinorrhea is CSF leakage from the nose. Otorrhea is CSF leaking from the ear.

Answer 96

Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes, or a series of seizures in which the child does not return to his or her previous normal level of consciousness.

Answer 97

Increased intracranial pressure (ICP) may be caused by several factors: head trauma, birth trauma, hydrocephalus, infection, and/or tumors. Whatever the reason, the brain swells and becomes inflamed. Dexamethasone is a steroid. A steroid may be prescribed to reduce inflammation and pressure on vital centers of the brain.

Answer 98

Caput succedaneum results from pressure from the uterus or vaginal wall during a head-first delivery. The use of forceps is associated with a cephalohematoma. Caput succedaneum is not due to the baby's head becoming blocked inside the vagina.

Answer 99

acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity.

Answer 100

Cranial nerve IX (glossopharyngeal) would be assessed to test the swallowing and gag reflex.

Answer 101

External otitis (acute otitis externa or swimmer's ear) is an infection and inflammation of the skin of the external ear canal. The classic sign of external otitis is pain on movement of the pinna or pain on pressure over the tragus (a prominence on the inner side of the external ear).

Answer 102

Conjunctivitis may be classified as allergic, infectious or chemical. Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen as might be found when cleaning unused spaces.

Answer 103

Myopia is nearsightedness, which means that the child can see objects clearly at close range but not at a distance. It occurs because the light entering the eye focuses in front of the retina. - --Hyperopia is farsightedness. - --Esotropia is better known as "cross-eyed." It is a form of strabismus in which one or both eyes focus inward. - --Exotropia is a form of strabismus where the eyes are deviated outward.

Answer 104

Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. Refraction is the way light rays bend as they pass through the lens to the retina.

Answer 105

Myringotomy (incision of the eardrum) may be performed to establish drainage and to insert tiny tubes into the tympanic membrane to facilitate drainage. The procedure is done for children with chronic otitis media, not as soon as the child is diagnosed.

Answer 106

the upper eye lid until it is everted; turn (a structure or organ) outward or inside out

Answer 107

a speck of dirt or a fragment of glass, often clings to the inside of the upper lid and can be readily removed by touching it with a moistened, sterile, cotton-tipped applicator while the lid is everted

Answer 108

A scleral hemorrhage is caused by blunt trauma or increased pressure such as with coughing

Answer 109

acute otitis media there is fluid and/or infection in the middle ear causing pain. The child may be very fussy, cry inconsolably, bat the head, tug at the ear or roll the head from side to side to help reduce the pain. - - Severe vomiting and confusion would be more related to gastroenteritis and dehydration. - -High-pitched cry and nuchal rigidity are associated with meningitis. - -Body stiffening and loss of consciousness are associated with seizures.

Answer 110

Glaucoma is increased intraocular pressure caused by inadequate or blocked drainage of aqueous humor. The cornea, which appears enlarged, may be edematous and hazy. In addition there may be tearing, pain, and photophobia. - -Conjunctivitis (pink eye) is a contagious infection of the conjunctiva. - --A stye (hordeolum) is a localized infection of the sebaceous gland of the eyelid. - -- A cataract is a cloudiness or opacity of the lens of the eye. It can be congenital in children.

Answer 111

Amblyopia is when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called "lazy eye." The student can still see and, in some cases, has limited impairment due to brain compensation. It is associated with other conditions such as poor refraction, ptosis, cataracts, or stra·bis·muss.

Answer 112

A foreign body can be either solid or liquid and it can lodge in the upper or lower airways. If a child has symptoms of cough, wheezing and/or stridor, it is an indication the foreign body is obstructing the upper airway. The child with a foreign body obstruction is anxious, has difficulty talking, and may be drooling. Edema of the airways may have occurred but generalized edema is not present.

Answer 113

Cystic fibrosis (CF) is a genetic disorder causing thickened tenacious secretions of the sweat glands, gastrointestinal tract, pancreas, respiratory tract and exocrine tissues. The treatment is aimed at minimizing pulmonary complications, maximizing lung function, preventing infection, and facilitating growth. A pneumothorax is a complication of CF. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age.

Answer 114

Pancreatic enzymes should be administered at all meals and snacks to promote adequate digestion and absorption of nutrients. They are supplied in capsule form. For the infant and young child, they can be opened and sprinkled on foods such cereal, pudding, or applesauce. They also can be swallowed whole.

Answer 115

epiglottitis may have had a mild upper respiratory infection before the development of a sore throat, and then became anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. - -The child with tonsillitis may have a fever, sore throat, difficulty swallowing, hypertrophied tonsils, and erythema of the soft palate. Exudate may be visible on the tonsils. - -The child with acute laryngotracheobronchitis develops hoarseness and a barking cough with a fever, cyanosis, heart failure; acute respiratory embarrassment can also result.

Answer 116

Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. - -- Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. - --Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

Answer 117

cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.

Answer 118

A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. - -- A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; - ---fluoroscopy is used to identify masses or abscesses as with pneumonia; - --- and the sweat chloride test is indicated for cystic fibrosis.

Answer 119

epiglottitis is acute inflammation of the epiglottis that most often affects children ages 2 to 7 years. The child may have been well or may have had a mild upper respiratory infection before the development of a sore throat (difficulty swallowing) and a high fever of 102.2℉ to 104℉ (39℃ to 40℃). The child is very anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. This is called the “tripod” position. Immediate emergency attention is necessary.

Answer 120

Wheezing occurs from obstruction in the lower trachea and bronchioles. It is an expiratory sound from difficulty pushing air through a narrowed airway. When there is obstruction of the bronchioles—as with such disease processes as asthma and cystic fibrosis—wheezing will not clear with coughing.

Answer 121

Pneumonia may be caused by many reasons: bacteria, viruses, fungus, and aspiration. If the child has mild symptoms (no respiratory distress) he or she may be treated at home. Hospitalization is required if the child has oxygen requirements, shows signs of respiratory distress, has poor oral intake, and has lethargy. Oxygen supplementation, IV fluids, and antibiotics will be necessary. It is very frightening for the parents to see their child so ill, and it is very frightening for the child to be so sick and be in a strange environment. The parents should be allowed to remain with their child at all times and their concerns should be addressed.

Answer 122

Oxygen administration is indicated for the treatment of hypoxemia. Suctioning removes excess secretions from the airway caused by colds or flu. Saline lavage loosens mucus that may be blocking the airway so that it may be suctioned out. Saline gargles are indicated for relieving throat pain as with pharyngitis or tonsillitis.

Answer 123

Heart failure occurs when the heart has the inability to pump effectively to provide adequate blood, oxygen, and nutrients to the body's organs and tissues. Symptoms occur because of three factors. The neurohormonal influences cause symptoms of tachycardia, pallor, decreased urine output, sweating, hypertension, weight gain and edema. The symptoms seen from systolic dysfunction are dyspnea on exertion, increased work of breathing, and feeding difficulties. Diastolic influences produce hepatomegaly, jugular vein distention and periorbital edema.

Answer 124

With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased systemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot.

Answer 125

Polycythemia can occur in clients with a cyanotic heart defect. The body tries to compensate for having low oxygen levels and produces more red blood cells (RBCs). This would cause an increased result on the lab tests.

Answer 126

Placing the infant in the knee–chest position is the first priority when caring for an infant with tetralogy of Fallot.

Answer 127

Cardiac tamponade is a medical emergency and should be addressed.

Answer 128

If a child is experiencing heart failure, the infant will need oxygen. One of the medications the infant would be on is a diuretic. An infant with heart failure will need smaller, more frequent feedings to conserve energy for feeding.

Answer 129

infant's patent ductus arteriosus (PDA). caused by an opening called the ductus arteriosus. A PDA usually closes by 1 week of age. If it does not close, the defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

Answer 130

Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle.

Answer 131

The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset, nausea, and abdominal distress are common with oral antibiotics and do not need to be reported immediately.

Answer 132

heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication of cardiac catheterization

Answer 133

A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. - -Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. - --A narrow or thread pulse is associated with heart failure or severe aortic stenosis. - -- Hepatomegaly is a sign of right-sided heart failure.

Answer 134

Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. ---Coarctation of aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.

Answer 135

Balloon angioplasty by way of cardiac catheterization is the procedure of choice for pulmonary stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed valve. As the balloon is inflated, it breaks valve adhesions and relieves the stenosis.

Answer 136

Softening of nail beds is the first sign of clubbing due to chronic hypoxia. Rounding of the fingernails is followed by shininess and thickness of nail ends.

Answer 137

Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, , then the presacral region, and the extremities.

Answer 138

A bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation.

Answer 139

Kawasaki disease is an acute systemic vasculitis. Symptoms begin with very high fevers. One of the signs of Kawasaki disease is the peeling hands and feet and in perineal region. The child is usually tachycardic and laboratory values would indicate increased platelets and decreased hemoglobin. Another classic sign of Kawasaki is the strawberry tongue.

Answer 140

Palliative pulmonary artery banding should help the infant grow enough so that the atrioventricular canal defect can be repaired. The pulmonary artery banding will help, but the defect will still need to be fixed. Most infants will need surgery for a large, symptomatic VSD.

Answer 141

Echocardiography, or ultrasound cardiography, has become the primary diagnostic test for congenital heart disease. An echocardiogram involves high-frequency sound waves, directed toward the heart, being used to locate and study the movement and dimensions of cardiac structures, such as the size of chambers; thickness of walls; relationship of major vessels to chambers; and the thickness, motion, and pressure gradients of valves.

Answer 142

An accentuated third heart sound is suggestive of sudden ventricular distention. Decreased blood pressure; cool, clammy, and pale extremities; and a heart murmur are all associated with cardiovascular disorders.

Answer 143

For children with congenital defects with increased pulmonary blood flow, oxygen supplementation is not helpful. Oxygen acts as a pulmonary vasodilator. If pulmonary dilation occurs, pulmonary blood flow is even greater, causing tachypnea, increasing lung fluid retention, and eventually causing a much greater problem with oxygenation; therefore, preventing the development of pulmonary disease via early surgical correction is essential. Although oxygen must be ordered by the physician and it isn't the best treatment, the nurse stating, "While it seems that oxygen would help, it actually makes the condition worse. Treating the cause of the disease will help" best answers the question while also showing empathy.

Answer 144

- --A gastrostomy provides an opening between the stomach and the abdominal wall - - an esophagostomy communicates between the esophagus and an external site on the neck. - --Ostomies may be created at various sites in the small intestine (e.g., jejunostomy, ileostomy) or in the large intestine (e.g., colostomy).

Answer 145

Manual reduction of an incarcerated hernia

Answer 146

Celiac disease is an immunologic response to gluten, which causes damage to the small intestine. Steatorrhea (fatty stools) is a classic symptom of celiac disease. Symptoms also include abdominal distention or bloating, constipation, and nutritional deficiencies. - --Currant jelly stools are a sign of intussusception. the inversion of one portion of the intestine within another. - --Projectile vomiting is a sign of pyloric stenosis. - --Severe diarrhea could be caused by a bacteria or virus. Projectile stools represent severe diarrhea.

Answer 147

the infant with pyloric stenosis often eats well and gains weight and then starts vomiting occasionally after meals. Within a few days the vomiting increases in frequency and force, becoming projectile. ---With pyloric stenosis the circular muscle pylorus is hypertrophied. This thickness causes gastric outlet obstruction. The condition is seen in younger infants starting at 3 to 6 weeks of age. The infant has projectile nonbilious vomiting. It occurs directly after eating and is not related to the feeding position. The infant is hungry shortly after eating. There is weight loss and/or dehydration. The treatment is a pyloromyotomy to reduce the increased size and increase the opening.

Answer 148

Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel. Resection: the process of cutting out tissue or part of an organ.

Answer 149

Hepatitis A is transmitted via the oral-fecal route; it is water borne and often occurs in areas of poor sanitation. The adolescent with hepatitis A will exhibit flu-like symptoms, a headache, anorexia and fatigue.

Answer 150

Hepatitis B is spread through IV drug use, sex, contaminated blood and perinatally. The treatment is rest, hydration, and nutrition. Hospitalization is required if there is vomiting, dehydration, elevated bleeding times and mental status changes. The adolescent should be taught about good hygiene, safe sex practices, careful handwashing and blood/bodily fluid contact precautions.

Answer 151

Celiac disease is an immunological disorder in which gluten causes damage to the small intestines. Gluten is commonly found in grains. Children with celiac disease cannot digest the protein in common grains, such as wheat, rye, and oats.

Answer 152

Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp.

Answer 153

Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. - --Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Polyhydramnios: refers to an excessive volume of amniotic fluid - --Omphalocele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm. Omphalocele: (hernia", "bulging", or a "dilation) protrusion of abdominal contents through an opening at the navel occurring especially as a congenital defect.

Answer 154

Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus. - ---Congenital aganglionic megacolon is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin. - --Colic consists of recurrent paroxysmal bouts of abdominal pain. - --Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, which leads to an obstruction at the distal end of the stomach.

Answer 155

Signs of hemolytic uremic syndrome include oliguria, irritability, jaundice, bloody diarrhea, purpura, ecchymosis, and pallor 5 to 10 days after a prodromal illness. The child also usually experiences anorexia, slight fevers, and can become lethargic.

Answer 156

Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection.

Answer 157

acute glomerulonephritis is grossly bloody urine

Answer 158

Mittelschmerz is a dull, aching abdominal pain at the time of ovulation (hence the name, which means "midcycle").

Answer 159

A bruit is an audible vascular sound associated with turbulent blood flow A thrill is a vibratory sensation felt on the skin overlying an area of turbulence and indicates a loud heart murmur usually caused by an incompetent heart valve.

Answer 160

is the swelling of a kidney due to a build-up of urine. It happens when urine cannot drain out from the kidney to the bladder from a blockage or obstruction. ---Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure.

Answer 161

An intravenous pyelogram is an X-ray study of the upper urinary tract in which a radio opaque dye is injected into a peripheral vein, requiring intravenous access.

Answer 162

Enuresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment.

Answer 163

premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings

Answer 164

Dysmenorrhea is pain associated with menstruation. A prostaglandin release is responsible for the smooth muscle contraction of the uterus during menstruation.

Answer 165

Precocious puberty is the early sexual development or maturation of a girl or boy. It occurs most often in girls, not boys, and does not relate to a heavy menses.

Answer 166

Fever, severe muscle pain, and a sunburn-like rash on the palms and soles of the hands and feet are consistent with the diagnosis of toxic shock syndrome.

Answer 167

Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through (i.e., looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse). A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.

Answer 168

A simple, or closed, fracture is a single break in the bone without penetration of the skin.

Answer 169

If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete.

Answer 170

Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. ----Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck extension traction, and Russell traction.

Answer 171

a protrusion of the meninges through a gap in the spine due to a congenital defect

Answer 172

is a neural tube defect in which the bones of the spine do not completely form

Answer 173

is a condition where the "ball and socket" joint of the hip does not properly form in babies and young children

Answer 174

a severe form of muscular dystrophy caused by a genetic defect and usually affecting boys

Answer 175

abnormal lateral curvature of the spine.

Answer 176

The cast maintains the legs in a frog-like position.

Answer 177

Gowers’ sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken. The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and “walk” hands up his legs to stand.

Answer 178

pectus excavatum, the sternum goes inward to form a depression in the chest. This gives the chest a concave (caved-in) appearance, which is why the condition is also called funnel chest or sunken chest.

Answer 179

Crusting and white or yellow scales on a baby's scalp.

Answer 180

Tinea capitis is a fungal infection of the scalp that causes circular patches of hair loss. - --- Tinea faciei is a fungal infection of the face - --tinea cruris is a fungal infection of the inner thighs and inguinal creases - --and tinea corporis is a fungal infection located on the entire body.

Answer 181

Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units ---Irritation and irritating substances, such as vigorous scrubbing and cosmetics with a greasy base, Increased hormone levels, hereditary factors, and anaerobic bacteria can cause acne vulgaris as well.

Answer 182

- ----A burn that encompasses the epidermis and the underlying dermis is a second-degree burn. - --A first-degree burn would only involve the epidermis, and - --a third-degree burn would involve nerve endings as well as destruction of the epidermis and dermis. A fourth-degree burn would extend even deeper into the fat layer.

Answer 183

frostbite: the skin develops clear blisters early on, and the skin's surface hardens. - -- the skin develops clear blisters early on, and the skin's surface hardens. - --Second-degree frostbite demonstrates blistering with erythema and edema. - ---First-degree frostbite results in superficial white plaques with surrounding erythema. - ---In third-degree frostbite, the nurse would note hemorrhagic blisters that would progress to tissue necrosis and sloughing when the fourth degree is reached.

Answer 184

community-acquired MRSA (CA-MRSA) are turf burns, towel sharing, participation in team sports, or attendance at day care or outdoor camps. The condition usually presents with a moderate to severe skin infection or with an infection that is not responding as expected to therapy. - --Impetigo is a readily recognizable skin rash infection. - ---Staphylococcal scalded skin syndrome results from infection with S. aureus that produces a toxin, which then causes exfoliation, and it has abrupt onset. - ---Folliculitis is an infection of a hair follicle.

Answer 185

Urticaria is a type I hypersensitivity reaction. Therefore, the priority nursing assessment is to carefully assess airway and breathing, as hypersensitivity reactions may affect respiratory status.

Answer 186

Erythema toxicum neonatorum (ETN), or neonatal erythema, is one of the more well-known benign, self-limiting skin eruptions in the newborn period. Incidence estimates range from 50% to 70% of all healthy newborns. The rash usually remits within 1 week with no treatme

Answer 187

Erythema multiforme typically manifests in lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk. - -- Thick or flaky/greasy yellow scales are signs of seborrhea. - --Silvery or yellow-white scale plaques and sharply demarcated borders define psoriasis. - --Superficial tan or hypopigmented oval-shaped scaly lesions, especially on the upper back and chest and proximal arms, are indicative of tinea versicolor.

Answer 188

DIC is a complex condition that is secondary to other problems such as sepsis. It is life-threatening. Symptoms of DIC include uncontrolled bleeding, petechiae, ecchymosis, purpuric rash, prolonged prothrombin time and partial thromboplastin time, an increased D-dimer assay, decreased antithrombin III levels, below-normal fibrinogen levels, and increased fibrin-degradation products. The platelet count is decreased in DIC. In moderate to severe cases it is less than 50,000/mm3 (50 ×109/L). The symptom the nurse would see first is uncontrolled bleeding.

Answer 189

Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. The child will exhibit symptoms of excessive petechiae, purpura, and bruising. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron-deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.

Answer 190

Sickle cells clump together and prevent normal blood flow. This leads to tissue hypoxia. With a vaso-occlusive crisis, the cells are clumped together and prevent blood flow to the joint or organ. The blood with the clumped sickled cells is very viscous. Adequate hydration is crucial in relieving the problems of a vaso-occlusive crisis. The hydration dilutes the blood and decreases the viscosity. During a crisis the recommended fluid intake (IV and PO) is 150 ml/kg/day. ----Vaso-occlusive crisis is manifested by bone pain (most commonly in the lumbosacral spine), fever, leukocytosis, distended abdomen, and acute abdominal pain.

Answer 191

Osteosarcoma is the most malignant form of bone cancer. It is caused by the embryonic mesenchymal tissue that forms in the bones. A football injury may predispose more scrutiny of a lesion but it will not be the cause of the cancer, nor will the dislike of milk.

Answer 192

As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white.

Answer 193

Bone marrow aspiration and biopsy are diagnostic.

Answer 194

The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system.

Answer 195

The component of red blood cells (RBCs) that allows them to carry out the transport of oxygen is hemoglobin, composed of the protein globin and heme, an iron-containing pigment. Fetal hemoglobin differs from adult hemoglobin; for this reason, diseases such as sickle cell anemia or the Thalassemias, which are disorders of the beta chains, do not become clinically apparent until this hemoglobin change has occurred (at approximately 6 months of age).

Answer 196

When the MCV is elevated, the RBCs are larger and referred to as macrocytic.

Answer 197

sickle cell anemia develop mild scleral yellowing from excess bilirubin from the breakdown of damaged cells.

Answer 198

After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft.

Answer 199

The child with thalassemia major may have both an enlarged spleen and liver due to excessive iron deposits, fibrotic scarring in the liver, and the spleen's increased attempts to destroy defective RBCs.

Answer 200

Complement activation results in increased vascular permeability, smooth muscle contraction, chemotaxis, phagocytosis, and lysis of the foreign antigen.

Answer 201

A goal of therapy during pregnancy is to maintain the CD4 cell count at greater than 500 cells/mm3 by administering oral zidovudine, which helps halt maternal/fetal transmission dramatically along with one or more protease inhibitors, such as ritonavir or indinavir, in conjunction with a nucleoside reverse transcriptase inhibitor (NRTI).

Answer 202

Normal immune function is a complex process involving phagocytosis (process by which phagocytes swallow up and break down microorganisms), humoral immunity (immunity mediated by antibodies secreted by B cells), cellular immunity (cell-mediated immunity controlled by T cells), and activation of the complement system. Cellular immunity is generally functional at birth, and as the infant is exposed to various substances over time, humoral immunity develops.

Answer 203

A thyroid scan visualizes nodes through the use of a contrast medium and fluoroscopy. The child cannot be administered the contrast medium if allergic to shellfish or iodine. It can cause a reaction.

Answer 204

Central diabetes insipidus (DI) is a disorder of the posterior pituitary that results from deficient secretion of ADH. ADH is responsible for the concentration of urine in the renal tubules. Without ADH there is a massive amount of water loss and an increase in serum sodium. - --Nephrogenic DI occurs as a genetic problem or from end-stage renal disease. It is the result of the inability of the kidney to respond to ADH and not from a pituitary gland problem. - ---LH is produced from the anterior pituitary. In females, it stimulates ovulation and the development of the corpus luteum. - ---TSH is secreted by the thyroid gland. ACTH is secreted by the anterior pituitary.

Answer 205

Hyperthyroidism is manifested by heat intolerance, nervousness or anxiety, diarrhea, weight loss, and smooth velvety skin. ---Constipation, weight gain, and facial edema are associated with hypothyroidism.

Answer 206

Congenital adrenal hyperplasia is a syndrome that is inherited as an autosomal recessive trait, which causes the adrenal glands to not be able to synthesize cortisol. Because the adrenal gland is unable to produce cortisol, the level of adrenocorticotropic hormone (ACTH) secreted by the pituitary in an attempt to stimulate the gland to increase function is increased. Although the adrenals enlarge under the effect of ACTH, they still cannot produce cortisol but rather overproduce androgen. Excessive androgen production during intrauterine life masculinizes the genital organs in a female fetus so that the clitoris is so enlarged it appears to be a penis. This disorder does not cause divergent vision. The child will not be born small for gestational age. This disorder does not cause abnormal facial features.

Answer 207

Hypoparathyroidism results in low production of PTH, which in turn leads to hypocalcemia and hyperphosphatemia.

Answer 208

Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, Excess fluid volume from edema is the highest priority.

Answer 209

Symptoms of Graves disease include an increased rate of growth; weight loss despite an excellent appetite; hyperactivity; warm, moist skin; tachycardia; fine tremors; an enlarged thyroid gland or goiter; and ophthalmic changes including exophthalmos. These are not symptoms of Cushing disease, diabetes, or SIADH.

Answer 210

The anterior pituitary, or adenohypophysis, is made up of endocrine glandular tissue and secretes growth hormone (GH), adrenocorticotropic hormone (ACTH), TSH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. The posterior lobe is called the neurohypophysis because it is formed of neural tissue. It secretes antidiuretic hormone (ADH; vasopressin) and oxytocin.

Answer 211

Insulin deficiency, in association with increased levels of counter-regulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glucosuria is glucose that is spilled into the urine.

Answer 212

Infants with thyrotoxicosis may display hyperphagia but fail to gain weight. A combination of lethargy and irritability suggests congenital hypothyroidism. Cool, dry skin that is scaly to the touch suggests congenital hypothyroidism. Hypoactivity and hypotonicity are findings that suggest congenital hypothyroidism.

Answer 213

Graves disease is the most common cause of hyperthyroidism in children. Hyperthyroidism occurs more often in females, and the peak incidence occurs during adolescence. - -- Addison disease refers to chronic adrenocortical insufficiency. - ---Cushing syndrome results from excessive levels of circulating cortisol. - --- Plummer disease is a less common cause of hyperthyroidism

Answer 214

Tiredness, fatigue, constipation, cold intolerance and weight gain are all symptoms of hypothyroidism. ---Nervousness, anxiety, heat intolerance, weight loss and smooth velvety skin are all symptoms of hyperthyroidism.

Answer 215

A gene is the basic unit of heredity of all traits. - ---A chromosome is a long, continuous strand of DNA that carries genetic information. - --An allele refers to one of two or more alternative versions of a gene at a given position on a chromosome that imparts the same characteristic of that gene. - --An autosome is a non-sex chromosome.

Answer 216

Phenylketonuria is part of normal newborn screening: Children with phenylketonuria will have a musty or mousy odor to their urine, as well as an eczema-like rash, irritability, and vomiting. Increased reflex action and seizures are typical of maple sugar urine disease. Signs of jaundice, diarrhea, and vomiting are typical of galactosemia. Seizures are a sign of biotinidase deficiency or maple sugar urine disease. - --Prenatal screening includes Down syndrome. - --Preconception screening includes sickle cell anemia and cystic fibrosis.

Answer 217

- --Small and nonfunctional ovaries are characteristic of Turner syndrome. - --Klinefelter syndrome affects males, causing only testosterone deficiency. Males may develop female-like characteristics such as gynecomastia (enlargement of a man's breasts) and may experience hypogonadism (Production of a man's testosterone and a woman's estrogen are inhibited). Decreased pubic and facial hair, along with tall stature, are characteristic of the disorder. Most males with Klinefelter syndrome have one extra X chromosome (47, XXY), and in rare cases there may be one additional extra X chromosome (48, XXXY). - --Hypogonadism, NOT enlarged testes, is a sign consistent with CHARGE syndrome. Visual and hearing deficiencies. narrowing of the throat passage, the child may experience coughing when drinking fluids - --Marfan syndrome is a disorder that affects connective tissue. The aorta is susceptible to weakening because of the connective tissue disorder, leading to sudden death from aortic dissection.

Answer 218

This is an irreversible progressive disorder that affects the functioning of muscles and the neurologic system.

Answer 219

Nondisjunction simply means failure to separate. Nondisjunction can happen at any chromosome and is attributed to 95% of Down syndrome cases.

Answer 220

Congenital heart defects are associated with Down syndrome.

Answer 221

The most distinctive feature present in 90% of prepubertal males with fragile X syndrome is macro-orchidism, or large testes. Someone with fragile X syndrome typically has a long face with a large mandible and large, everted ears.

Answer 222

Cri-du-chat syndrome is the result of a missing portion of chromosome 5. In addition to an abnormal cry, which sounds much more like the sound of a cat than a human infant's cry, children with cri-du-chat syndrome tend to have a small head, wide-set eyes, a downward slant to the palpebral fissure of the eye, and a recessed mandible. They are severely intellectually disabled. - --Rounded soles of the feet are characteristic of trisomy 18 syndrome. - --Cleft lip and palate are characteristic of trisomy 13 syndrome. - ---Small and nonfunctional ovaries are characteristic of Turner syndrome.

Answer 223

Principles of inheritance of single-gene disorders are the same that govern the inheritance of other traits, such as eye and hair color. These patterns occur because a single gene is defective and the disorders that result are referred to as monogenic disorders (sometimes referred to as Mendelian disorders).

Answer 224

The child is exhibiting signs and symptoms of increased intracranial pressure related to premature fusing of the skull joints.

Answer 225

Therefore, assessment of body areas such as the space between the eyes, the shape of the ears, and the number of digits may provide findings that indicate a genetic defect such as low-set ears in trisomy 18 or 13.

Answer 226

Angelman syndrome is characterized by jerky ataxic movements, similar to a puppet’s gait.

Answer 227

A stands for imperforate (lacking the normal opening) anus or anal atresia (absence or abnormal narrowing of an opening or passage in the body), or an anus that does not open to the outside of the body.

Answer 228

Children with Sturge-Weber syndrome will have a facial nevus (birthmark), or port-wine stain (a kind of large, deep red birthmark), most often seen on the forehead and one eye.

Answer 229

can frequently demonstrate active defiance, has frequent anger and is noncompliant with adult requests or limits. In this situation the nurse's goal is to clearly but empathetically explain the rules and firmly adhere to them.

Answer 230

The child with enuresis or encopresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment.

Answer 231

Rumination is the rechewing of undigested food. It occurs primarily in infants and is a little-understood process. Pica is the eating of non-food substances such as clay, paint, or sand. It occurs in preschool to school-age children.

Answer 232

Tourette syndrome, children have uncontrolled vocal tics.

Answer 233

Adolescents with conduct disorder are often unmanageable at home and disruptive in the community. They have little empathy or concern for others. They may be callous and lack appropriate feelings of guilt, although they may express remorse superficially to avoid punishment. They often blame others for their actions. Risk-taking behaviors such as drinking,

Answer 234

Asperger syndrome is on the autism spectrum, where the child is extremely high in intelligence. - --Bipolar symptoms consist of wide swings between depression and mania. - --Tourette syndrome is a condition where motor and vocal tics occur.

Answer 235

Social phobia is a disorder characterized by the child or teen demonstrating a persistent fear of speaking or eating in front of others, using public restrooms, or speaking to authorities. - --Generalized anxiety disorder (GAD) is characterized by unrealistic concerns over past behavior, future events, and personal competence. - -- Selective mutism refers to a persistent failure to speak. - -- With separation anxiety, the child may need to remain close to the parents, and the child’s worries focus on separation themes.

Answer 236

Anabolic steroid use can cause periods of euphoria and decreased fatigue, not more fatigue. Gynecomastia is a common side effect of prolonged steroid use, as well as liver damage, hypertension, psychotic episodes, and aggression.

Answer 237

Children with ASD often display hyperactivity, aggression, temper tantrums, or self-injury behaviors like head banging or hand-biting. They may resist cuddling, lack eye contact, be indifferent to touch or affection, and have little change in facial expression. They do not develop a smiling response to others nor an interest in being touched or cuddled. In fact, they can react violently to attempts to hold them. They do not show the normal fear of separation from parents that most toddlers exhibit. Often they seem not to notice when family caregivers are present.

Answer 238

Repeated hospitalizations that fail to produce a medical diagnosis, transfers to other hospitals, and discharges against medical advice are warning signs of caregiver-fabricated illness

Answer 239

An IQ of 35-50 is classified as moderate. - --An IQ of 50-70 is classified as mild. - --An IQ of 20-35 is classified as severe. - --An IQ that is less than 20 is considered profound.

Answer 240

Reinforcing behaviors with rewards reflects a basic principle of behavioral therapy. This process reinforces the desired behaviors by replacing inappropriate behaviors with positive behaviors. - --Psychodynamic theory involves in-depth talk theory based on psychoanalysis. Systems theory is looking at all systems to see how they work together to produce a result. This work involves the study of the mind, body and spirit. - --A token economy allows for tokens to be accumulated for good behavior and then exchanged for a meaningful object or privilege.

Answer 241

The child appears to have a learning disorder based on challenges with reading, spelling, and writing as well as being organized and managing time. Other findings consistent with a learning disorder include delayed language development and difficulty discriminating among sounds.

Answer 242

It is important to continue the usual routine of the hospitalized child, particularly of children with intellectual challenge.

Answer 243

A needle thoracotomy is indicated for tension pneumothorax to relieve the air collected in the space - --Defibrillation is used to stimulate or alter the heart's electrical rhythm - --Intubation is indicated for apnea and in situations in which the airway cannot be maintained. - -- Suctioning would be indicated for excessive airway secretions that influence airway patency. - --Providing sedation is an intervention for pain that will be assessed after effective breathing is established.

Answer 244

Fever increases the basal metabolic rate, resulting in tachycardia, tachypnea, and increased oxygen demand.

Answer 245

Exhaled CO2 monitoring is recommended when a child has been intubated. It provides quick, visual assurance that the tracheal tube remains in place and that the child is being adequately ventilated.

Answer 246

Most pediatric arrests are related primarily to airway and breathing, and usually only secondarily to the heart issues.

Answer 247

Infants less than 2 months (or premature) may display periodic breathing. The infant who is experiencing period breathing looks pink and has a normal heart rate and the nurse would not need to intervene further.

Answer 248

Indications the tube is accidentally inserted into the esophagus include auscultation of breath sounds over the abdominal region.

Answer 249

The nurse would first evaluate the airway, assessing its patency. Position the airway in a manner that promotes good air flow. Since cervical spine injury is a possibility, do not use the head tilt–chin lift maneuver; use only the jaw-thrust technique for opening the airway. The description of the injury would be suspicious for cervical injury. The nurse would evaluate the child’s airway before evaluating pain scale and managing cervical concerns, although the nurse is managing cervical concerns by not performing a head tilt-child lift maneuver. A pulse oximeter measurement would not be the priority.

Answer 250

The experience of an emergency situation and an unexpected death is very frightening to parents. The nurse plays a key role in providing empathy and support. Using open-ended questions elicits the parents' thoughts and fears and helps the nurse assess the issues at hand. Questions that can be answered with "yes" or "no" are less effective. The nurse should provide honest answers in a reassuring manner and never give false reassurances such as "It's going to be all right." That is something that cannot be promised. Parents should be encouraged to stay with the child until they are ready to leave. Moving them to the lounge may cause more emotional distress. Calling the chaplain is a good support for the family but only if the family wishes chaplaincy services. Eating would be the least thought for parents shortly after their child has died. The nurse offering this to the parents may be very uncomfortable in the situation and can only offer a tangible solution for an emotional problem.

Answer 251

The nurse would perform a primary assessment. When assessing a child with a traumatic injury, airway (A), breathing (B), and circulation (C) are assessed first: assess the patency of the airway and establish the effectiveness of breathing, examining the child's respiratory effort, breath sounds, and color; evaluate the circulation, noting pulse rate and quality and observing the color, skin temperature, and perfusion. Once this is accomplished, the nurse would notify the health care provider and apply monitors as needed. The nurse should ensure a code cart is available before the start of the shift.

Answer 252

Unintentional injuries are the leading cause of death among children. In the younger age child, falls are the highest cause. For the older adolescent, automobile wrecks are the highest cause. Drowning is the second leading cause of death in children and adolescents worldwide. Cancer follows injuries in the number of deaths, especially in children under 14 years of age. Congenital defects produce the second leading cause of death in infants. It is second only to prematurity. Immunosuppressive disease has a lower mortality rate. One reason is the availability of HIV drugs and treating the mother during pregnancy.

Answer 253

If head or spine injuries are suspected, then after the airway is opened, the cervical spine must be stabilized to prevent damage. Checking the mouth for debris is part of securing an airway. Administering oxygen and establishing IV access would be done after the C-spine is stabilized.

Answer 254

Certain emergency drugs for children may be given via a tracheal tube (a tube inserted into the trachea that serves to maintain the airway and facilitate artificial respiration). Use the mnemonic LEAN (lidocaine, epinephrine, atropine, and naloxone) to remember which drugs may be given via the tracheal route. Sodium bicarbonate and glucose may not be given via the tracheal tube.