Pediatric Nursing: Exam VI Flashcards


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Pediatric Nursing
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Peds Nursing program 2014 Fall CAC
updated 9 years ago by jenkarmata
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1

When caring for an infant w/an upper respiratory tract infection & elevated temperature, an appropriate nursing intervention is to:

Give small amounts of fluid frequently to prevent dehydration

2

A parent whose 2 school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend

Swimming

3

When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should be based on which principle?

The child may think the equipment is alive

4

A parent asks the nurse about negativism in toddlers. The most appropriate recommendation is to

Reduce the opportunities for a 'no' answer

5

Imaginary playmates are beneficial to the preschool child because they

become friends in times of loneliness

6

Which strategy would be the least appropriate for a child to use to cope

having parents solve problems

7

What information could be given to the parent of a 12-month old child regarding appropriate play activities for this age?

Give large push-pull toys for kinetic stimulation

8

The nurse is caring for a neonate w/suspected tracheoesophageal fistula. Nursing care should include

elevating the head but not giving nothing by mouth

9

An infants parent asked the nurse about preventing otitis media (OM). What should the nurse recommend?

Avoid tobacco smoke

10

A school-age child w/diarrhea has been rehydrated. The nurse is discussing the child's diet w/the family. Which statement by the parent would indicate a correct understanding of the teaching?

I should have my child eat a normal diet w/easily digested foods for the next 48hrs

11

Which statement best describes fear in school-age children?

Most of the new fears that trouble them are related to school & family

12

In terms of gross motor development, what would the nurse expect a 6-month old infant to have accomplished? CHOOSE ALL THAT APPLY:

A. Sit while propped
B. Roll from back to abdomen
C. Roll from abdomen to back

13

Matthew, age 18 months, has just been admitted w/croup. His parent is tearful & tells the nurse, 'This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here.' What is appropriate in the care plan for this parent who is experiencing guilt?

Clarify the misconception about the illness

14

Kimberly's parents have been using a rearward-facing convertible car seat since she was born. Most car seats can be safely switched to the forward facing position when the child weighs

20 lbs

15

What is most characteristic of the physical punishment of children, such as spanking?

Misbehavior is likely to occur when parents are not present.

16

A child weighs 38.5 lbs & is 3'8" tall. Calculate the child's BSA. Do not round until finished w/all calculations.
**Round to the nearest hundredth place. Remember the rule of leading and trailing zeros.

0.74

17

The parents of a 2 year old tell the nurse that they are concerned because the toddler has started to use 'baby talk' since the arrival of their new baby. The nurse should recommend that the parents

ignore the 'baby talk.'

18

What is probably the single most important influence on growth at all stages of development?

Nutrition

19

A 10-year old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, 'wait a minute, 'and, I'm not ready.' The nurse should recognize that

This is normal behavior for school-age child

20

When teaching injury prevention during the school-age years, the nurse should include

teach basic rules of water safety

21

Caring for the newborn w/a cleft lip & palate before surgical repair includes

providing satisfaction of sucking needs

22

A child comes to the clinic and needs a prescription of an antibiotic. There is no pediatric dosage for this antibiotic. The child has a BSA of 0.68 & the adult dose is 1500mg. What is the pediatric dose
* DO NOT ROUN UNTIL ALL CALCULATIONS ARE COMPLETE. ANSWER W/A WHOLE NUMBER

600

23

When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. The best explanation for this is

Infection or inflammation proximal to the site

24

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include

Cleansing suture line, supine & side-lying positions, arm restraints.

25

An objective of care for the child w/nephrosis is to

reduce excretion of urinary protein

26

A child weighs 5kg & 59cm long. The adult dose is 250mg. Determine the pediatric dose. Do not round until all calculations are complete. Round to a whole number

42

27

The nurse encourages the mother of a toddler w/acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that

The mother's presence will reduce anxiety and ease child's respiratory efforts

28

Which is characteristic of physical development of a 30-month old child? *CHOOSE ALL THAT APPLY

b. Primary dentition is complete
e. Sphincter control is usually achieved

29

Which statement best describes the infant's physical development?

Birth weight doubles by age 6 months & triples by 1 year

30

A 3 month old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as

normal development

31

The nurse is assessing a 6 month old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately

15 pounds

32

In providing nourishment for a child w/cystic fibrosis (CF), which factor should the nurse keep in mind?

Diet should be high in carbohydrates and protein

33

The nurse discussing w/a parent group the importance of fluoride for healthy teeth. The nurse should recommend that the parents

determine whether their water supply is fluoridated

34

What behavior indicates that an infant has developed object permanence?

Actively searches for a hidden object

35

The nurse has just started assessing a young child who is febrile & appears very ill. There is hyperextension of the child's head (opisthotonos)w/no pain on flexion. The most appropriate action is to

refer for immediate medical evaluation

36

The nurse is caring for a 5yr old child who is scheduled for a tonsillectomy in 2hrs. Which actions should the nurse include in the child's postoperative care plan? (Choose all that apply)

a. Notify the surgeon if the child swallows frequently

b. Place the child on the abdomen until fully awake

d. Allow the child to have diluted juice after the procedure

37

Determine a child's BSA based on the following measurements: Height, 66 cm & weight 6.8kg
* Do not round until finished w/all calculations. Round to the nearest hundredth place. Do not forget the rule of leading and trailing zeroes.

0.35

38

Which factor is most important in predisposing toddlers to frequent infections such as otitis media, tonsillitis, and upper respiratory tract infections?

Short, straight internal ear/throat structures & large tonsillar tissue

39

The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety?

I hope my friends don't forget about visiting me

40

A young child is brought to the emergency department who has lost 7lbs in the last week secondary to acute diarrhea & vomiting. The child has sunken eyes & dry mucous membranes. Therapeutic management of this child will begin with

Intravenous fluids

41

The nurse is caring for an infant w/suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis?

Visible peristalsis and weight loss

42

An appropriate nursing intervention when caring for a child w/pneumonia is to

encourage rest

43

The nurse is caring for a 10 month old infant w/respiratory syncytial virus (RSV)bronchiolitis. Which intervention should be included in the child's care? (Choose all that apply)

a. Cluster care to encourage adequate rest

c. Encourage infant to drink 8oz of formula q 4hrs

e. Place on noninvasive oxygen monitoring

44

Therapeutic management of nephrosis includes

Corticosteroids

45

A mother tells the nurse that she doesn't want her infant immunized because of the discomfort associated w/injections. The nurse should explain that

A topical anesthetic (like EMLA)can be applied before injections are given

46

The nurse is doing a routine assessment on a 14 month old infant and notes that the anterior fontanel is closed. This should be interpreted as

a normal finding

47

The best play activity for a 6 month old infant to provide tactile stimulation is to

allow to splash in bath

48

A 3YO child comes to the clinical w/complaints of coughing and purulent drainage from the nose. Medication dosage is determined based upon the child's body surface area. The child weighs 25 lbs & is 30in tall. Calculate the child's BSA.
*Do not round until you finish all calculations. Round to the nearest on hundredth place. Remember the rule of leading and trailing zeroes.

0.49

49

The nurse closely monitors the temperature of a child w/nephrosis. The purpose of this is to detect an early sign of

infection

50

The nurse observes some children in the playroom. Which play situation exhibits is the characteristics of parallel play?

Brian playing w/his truck next to Kristina playing w/her truck

51

Kawasaki Disease: Implementation

* Temp ↑104°

1. Monitor I&Os

2. Provide Passive ROM

3. ****Administer ASA****

4. ***Administer IV immune globulin***

5. Educate parent/patient

52

Growth & development: Weight

A: From 1-2 yrs

B: From 2-3 yrs

C: By 2 1/2 yrs

A: 1/2lb a month
B: 3-5lbs per year

C: 4x birth weight

53

Growth & development: Height

A: From 1-2 yrs

B: 2yrs

C: From 2-3 yrs

A: 3-5" yr

B: 50% of adult height

C: 2-2.5" yr

54

Growth & development: 15 mos

- Walks w/out help

- Uses cup well

- Builds tower of 2 blocks

- Binocular vision

55

Growth & development: 18 mos

-Jumps in place

- Identifies geometric forms (18-24mos)

- Uses short sentences (18-24mos)

56

Tonsillitis: Implementation

* Larger than adults

Manifestations:

- Inflammation (obstruction)

- Self limiting

Mgmt:

-Minimize discomfort

-Tonsillectomy (malignant or obstructive)

Post-op:

Side lying & watch for excessive swallowing

57

Bacterial Endocarditis: Assessment

* Infections of valves & inner lining of heart

~Clinical manifestation~

  • Unexplained fever
  • anorexia
  • Malaise
  • Weight loss
  • Extracardiac emboli (Splinter hemorrhages, Osler nodes, Janeway lesions, Petechia)

58

Hospitalized Child/School age

* Major fears

  • Pain & bodily injury
  • Loss & bodily injury
  • Loss of control
  • New fears r/t school, peers & family***

59

Hospitalized Child/School age: Nursing interventions

* More realistic understanding of disease

* Wants to know why

* Become distressed over separation

  • Be honest
  • Clarify misconceptions
  • Encourage child's participation
  • Allowing visiting of peers
  • Therapeutic play
  • Art therapy
  • Provide explanations
  • Praise child

60

Discipline/ Analysis/ Evaluation

  1. Consistency
  2. Timing (don't wait for dad to come home)
  3. Commitment/follow through
  4. Unity (with grandparents on same page)
  5. Flexibility
  6. Planning
  7. Behavior orientation
  8. Privacy
  9. Termination

POSITIVE / NEGATIVE REINFORCEMENT

61

Child assessment/ Television

American Academy of Pediatrics

  • Limit TV to no more than 2hrs/day

- Sedentary

- Interferes w/play

- Cannot tell difference between ads & shows

- Substance use, violence, sex

62

Bronchitis

4 or less

Usually viral

Persistent dry hacking cough (worse @ night)

Nonproductive, becomes productive in 2-3 days

63

Treatment for bronchitis

  • Cough suppressants
  • Monitor for respiratory distress
  • Cool humidified air
  • Monitor for dehydration- increase fluids
  • Tylenol if febrile

64

Bronchiolitis

< 2 yrs

* Virus (RSV usually)

- Symptoms-

  • Labored respirations
  • Tachynea
  • Retractions
  • Rhinorrhea
  • Wheezing
  • Fever

65

Bronchiolitis Treatment

Supplement O2

Bronchodilators

Suction

Adequate fluid intake ** If not contraindicated (tachypnea- they can aspirate)**

66

Tonsillitis

* Larger than adults ( protective mechanism)

- Manifestations-

1. Inflammation (obstruction)

2. Self limiting

67

Tonsillitis treatment

- Minimize discomfort

- Tonsillectomy (malignant or obstructive)

~Post-op~

- Side lying

68

Bacterial endocarditis

Definition: Infections of valves & inner lining of heart

Clinical manifestations:

  • Unexplained fever
  • Anorexia
  • Malaise
  • Weight loss
  • Extracardiac emboli

-Splinter hemorrhages, Osler nodes, Janeway lesions, Petechia

69

Hospitalized child- School-age

Major fears

* New fears r/t school, peers, & family

* Pain & bodily injury

* Loss of control

70

Hospitalized child- School-age

  • More realistic understanding of disease
  • Wants to know why
  • Become distress over separation

71

Hospitalized child- School-age: Nursing Intervention

  1. Be honest
  2. Clarify misconceptions
  3. Encourage child's participation
  4. Allow visiting of peers
  5. Therapeutic play
  6. Art therapy
  7. Provide explanations
  8. Praise child

72

Pertussis

* Acute respiratory infection: Bordetella pertussis

  • Normally in non-immunized children <4
  • Highly contagious

- Clinical manifestations-

  • Catarrhal stage: 1-2 weeks, regular cold
  • Paroxysmal stage: Cough at worst, not communicable
  • Convalescent stage: Cough is less severe

73

Pertussis treatment/management

  1. Pertussis immunoglobulin
  2. Reduce environmental factors causing cough
  3. Encourage fluids
  4. Humidity

PREVENTION:

Vaccination

74

CHF Assessment:

Early signs

  • Tachycardia
  • Tachypnea
  • Respiratory distress
  • Profuse scalp sweating
  • Fatigue
  • Irritability
  • Sudden weight gain (edema)

75

CHF Assessment:

Right side

Increased pressure in right atrium & the systemic venous system

76

CHF Assessment:

Left side

Increased lung congestion

77

CHF assessment & treatment

Assessment:

  1. Edema
  2. Cardiac enlargement
  3. Gallop
  4. Tachypnea
  5. SOB
  6. Fatigue
  7. Poor appetite
  8. Sweating w/poor activity

78

CHF treatment

Maintain oxygenation

↓ fatigue

Monitor I&Os

Monitor lung sounds & supplement O2

79

Hypercyanotic spells: Implementation

1st: Knee to chest position

2nd: Give O2

3rd: Give morphine

4th: Give IV fluids

80

CHD: Hypoxia

Severe- worse than hypoxemia

Low O2 to tissue

Poor perfusion

* You will see child squat (tripod position) trying to relieve hypoxia

81

CHD: Hypoxemia

Arterial O2 ↓

severe condition

poor feeding, leading to poor weight

tachypnea

dyspnea

polycythemia

Clubbing of fingers (should return to normal when fixed)

tissue hypoxia

82

Cardiac cath manifestations/implementation: School age

  1. Accurate height & weight
  2. Hx of allergies
  3. S/S of infection
  4. Assess & mark distal pulses before procedure (which pulse depends on entry site)
  5. Baseline oxygen saturation
  6. Prepare child / family

83

Cardiac cath manifestations/implementation: School age & adolescents

  • Description of the catheterization lab (tour, pics)
  • Explain procedure
  • Emphasize what they will see, feel, and hear (can wear headphones)
  • Let pt. know they will be NPO @ midnight
  • Let pt. know there may be a tube down their throat to help them breath & their throat may be sore afterwards

84

Rheumatic fever: Clinical manifestations (Assessment) pg 242

Inflammatory autoimmune disease

Affects: Connective tissue of the ♥, joints, subcutaneous tissue, blood vessels of the CNS.

Complications: Cardiac valve disease (mitral valve stenosis)

2-6 weeks post GABHS infection

85

Cystic fibrosis: Implementation pg 203-205

Maintain airway

Provide Pulmonary hygiene

Chest physiotherapy

Postural drainage (allow gravity to work/move the bronchi and be coughed out)

Chest percussion

Vibration

Coughing & deep breathing (incentive spirometer)

Help to mobilize and eliminate secretions

86

Cystic fibrosis:Medications

Aerosolized meds, low flow humidified air, beware of giving too much oxygen as it can depress respiratory drive to chronically hypoxic children.

Monitor for infections

  • Give pulmozine= this out mucous
  • Goal= prevent respiratory infections
  • GI= can't poop meconium
  • Malnutrition due to inability to process nutrients, supplement w/vitamins A,D,E,K
  • Give pancreatic enzymes before they take food= kind of like a powder
  • ↑ protein ↑calorie diet, fat soluble nutrients
  • Infertile secondary to mucous in cervix

NEVER GIVE ANTIHISTAMINES TO CF pt.'s AS THEY HAVE A DRYING EFFECT, MAKING EXPECTROATION OF MUCOUS MORE DIFFICULT.

87

General aspects of care for child w/respiratory issues: Implementation

  1. Promote rest
  2. Promote comfort
  3. Prevent spread by washing hands
  4. ↓ temp which can cause dehydration or seizure
  5. Promote hydration
  6. Provide nutrition
  7. Educate on ABX
  8. Support family & give instructions

88

Croup: Epiglottis

Acute epiglottis (2-8 YO): inflammation of larynx & epiglottis. Can be life threatening, usually bacterial. *Rapid onset*

S/S:

  • Dysphagia (difficulty swallowing)
  • Stridor
  • Drooling
  • ↑ Fever
  • ↑ Pulse
  • ↑ Respirations

* Sitting up, leaning forward, lower jaw thrust forward in tripod position.

89

Croup: Epiglottis- Implementation

If you suspect epiglottis, never inspect by hand or intubation kit in hand as it can cause bronchospasm & airway occlusion.

Always use gloves.

Monitor respiratory status

Avoid letting them cry

Hydrate them

Palivizumab prophylactically & Abx

***GIVE HIB VACCINE= H. influenza ***

90

Acute LTB (<5YO):

Viral

S/S: Stridor, brassy cough, hoarseness, dyspnea, restlessness, irritability, low grade fever, seal call.

Tx:

Give racemic, epinephrine, corticosteroids & fluids

91

Asthma: Triggers

  1. Smoking
  2. Cold air, food/drinks
  3. Viral infections
  4. Stress
  5. Pet dander
  6. Exercise

92

Asthma: manifestations

  • Wheezing
  • Broncospasms
  • Hyperinflation
  • Dry cough
  • Tachypnea & retractions

93

Asthma: Exercise

Exercise is still necessary- baseball, gym, sprints & SWIMMING

94

Asthma: Tx

  • Chest PT after edema is gone to rid mucous & open airway
  • Put in high fowlers position
  • xray
  • parenteral fluids to thin mucous
  • O2 therapy
  • Avoid cold
  • Swimming helps
  • Albuterol

95

Pneumonia: Implementation- Viral

Wheezing, tachypnea, pt. looks very ill, lasts about 5-7 days.

Give: O2, mist, suction, ↑ fluids, antipyretics, chest PT & postural drainage

S/S: Wheezing is more common w/RSV. Consolidation on xray, HA, fatigue & malaise

96

Pneumonia: Implementation-Bacterial

S/S: ↑Fever, productive cough, ill looking, retractions, grunting, chest pain, significant RDS, consolidation on xray.

* Recent upper respiratory infection

* Cough may linger for a few weeks

Implementation:

Monitor oxygenation, hydrate, monitor resp. status, Abx for bacterial pneumonia. Elevate HOB, avoid over feeding, burp frequently if bottle feeding.