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Peds Exam 2 Clinical manifestations of increased ICP in children include all of the following except: Headache Vomiting, w/ or w/o nausea Seizures Setting-sun sign FYI: late signs of inc’d ICP Dec’d LOC Dec’d motor response to command Dec’d sensory response to painful stimuli

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clinical manifestations of increased icp in children include all of the following except
Clinical manifestations of increased ICP in children include all of the following except:
  • Headache
  • Vomiting, w/ or w/o nausea
  • Seizures
  • Setting-sun sign
fyi late signs of inc d icp
FYI: late signs of inc’d ICP
  • Dec’d LOC
  • Dec’d motor response to command
  • Dec’d sensory response to painful stimuli
  • Alterations in pupil size & reactivity
  • Papilledema (optic nerve swelling)
  • Cheyne-Stokes repsirations
  • Decerebrate or decorticate posturing
nurse caring for 8yo w dx of basilar skull fracture which order would nurse question
Nurse caring for 8yo w/ dx of basilar skull fracture. Which order would nurse question?
  • Clear liquid intake
  • Maintain patent IV line
  • Daily weight
  • Suction as needed
slide5

Nurse monitoring child for bleeding post brain tumor resection. Checks head dressing & notes colorless drainage on back of dressing. Which would be most appropriate intervention?

  • Circle area of drainage & continue to monitor
  • Reinforce dressing
  • Notify physician
  • Document findings & continue to monitor
slide6

Post op removal of brain tumor, physician order to maintain child in flat position. Nurse monitoring notes child is restless, pulse rate is elevated & BP has dropped significantly from baseline. Suspects shock. Which would be most appropriate nursing action?

  • Place child in Trendelenburg’s position
  • Elevate head of bed
  • Increase IV fluids
  • Notify physician
slide7
Lumbar puncture performed on child w/ suspected bacterial meningitis. Which of the following CSF results would verify dx?
  • Cloudy CSF, dec’d protein, dec’d glucose
  • Cloudy CSF, inc’d protein, dec’d glucose
  • Clear CSF, inc’d protein, dec’d glucose
  • Clear CSF, dec’d pressure, elevated protein
which statement regarding meningitis is true
Which statement regarding meningitis is true?
  • Both viral & bacterial meningitis may have an associated fever
  • Stiff neck is the most common symptom in infants w/ bacterial meningitis
  • Headaches only occur w/ bacterial meningitis
  • Viral meningitis is more easily detected than bacterial meningitis is children
slide9
Which of the following vaccine(s) protects infants from bacterial meningitis (there may be more than one)?
  • IPV (polio)
  • PCV (pneumococcal)
  • DTaP (diptheria, tetanus, pertussis)
  • Hib (haemophilus influenzae type b)
which of the following positions is the most effective in preventing a further increase in icp
Which of the following positions is the most effective in preventing a further increase in ICP?
  • Left side lying, head flexed, knees drawn up
  • Trendelenburg position
  • Fowlers position
  • Supine w/ 30o head elevation
slide11

Adolescent discharged w/ prescription for phenytoin (Dilantin). Which of the following by father indicates discharge teaching has been effective?

  • I need to admin her medicine in the morning & evening
  • I will keep the annual appt for f/u on her med
  • I will be sure to encourage good oral care & regular dental visits
  • I can allow her to stop taking the med after 6wks, as long as there are no seizures
slide12
Parent of 9yo w/ GH deficiency asks nurse how long son will need to take injections for his growth problem. Which is most appropriate?
  • Injections are usually cont’d until age 10 for girls & 12 for boys
  • Injections need to continue until child reaches the 5th percentile on the growth chart
  • Injections should be cont’d until bone maturation is complete, usually between 14-16yrs
  • The injections will need to be administered throughout the child’s entire life.
slide13

During which of the following periods of growth & dev’t should a nurse anticipate behavioral problems form a child w/ untreated GH deficiency?

  • Infant
  • Preschooler
  • School-age
  • Adolescent
slide14

When providing health teaching to group of adolescents w/ type 1 d.m., a nurse instructs them that a hypoglycemic reaction can occur b/c of:

  • Too much glucose in the body
  • Eating too much junk food
  • Exercising strenuously
  • Not enough insulin in the body
slide15

Nurse caring for child w/ type 1 d.m. who has been taking insulin for 3 mos. Which diagnostic study will provider likely order to determine how well child’s diabetes is being managed?

  • Morning faster blood glucose
  • 2hr oral glucose tolerance test
  • Hb1Ac
  • Diary of child’s daily blood glucoses
place the following steps in order when treating hypoglycemia
Place the following steps in order when treating hypoglycemia:
  • Recheck blood glucose
  • Treat w/ 15g carbs
  • If still low, give 15g more carbs
  • Stop activity & sit down
  • Recheck blood glucose
slide17
Child brought by parents to ER w/ 1st degree burns to shoulders from sun exposure. Which interventions are indicated?
  • Start IV of NS
  • Apply cool, wet compresses
  • Scrub area w/ soft-bristle brush
  • Admin morphine sulfate for pain relief
slide18

Child experiences 3rd degree burns to both legs after they were immersed in boiling water. Which nursing diagnoses will receive priority during the first 24 hours?

  • Deficient fluid volume
  • Imbalanced nutrition: less than body requirements
  • Impaired breathing pattern
  • Disturbed body image
slide19

Mother of 3yo arrives at clinic & tells nurse that child has been scratching the skin continuously & has developed a rash. Nurse assess & suspects scabies. Nurse bases this suspicion on which finding:

  • Clusters of fluid filled vesicles
  • Fine, threadlike lines
  • Purple-colored lesions
  • Thick, honey colored crusts
which of the following orders should a nurse implement first for a child w a uti
Which of the following orders should a nurse implement first for a child w/ a UTI?
  • Ampicillin 250mg IV q 12hr
  • Blood & urine cultures
  • Sitz bath prn for pain
  • Voiding cystourethrogram (VCUG)
3yo being admitted w nephrotic syndrome best roommate is
3yo being admitted w/ nephrotic syndrome. Best roommate is:
  • 16yo recovering post-op from ruptured appendix
  • 8yo w/ leukemia
  • Another toddler w/ rheumatic fever
  • No roommate because isolation is required
slide22
Admission assessment on 2yo who has been dx’d w/ nephrotic syndrome. Nurse knows that most common characteristic assoc’d w/ it is?
  • Generalized edema
  • Frank bright red blood in urine
  • Inc’d urinary output
  • hypertension
slide23

Parents of child w/ glomerulonephritis concerned about activity restrictions after discharge. Nurse bases response on the fact that urinary findings are near normal.

  • Activity must be limited for 1 mo
  • Child must not play active games
  • Child must remain in bed for 2 wks
  • Activity does not affect course of disease
which nursing intervention has highest priority when caring for child w acute glomerulonephritis
Which nursing intervention has highest priority when caring for child w/ acute glomerulonephritis?
  • Assess for dysuria
  • Monitor BP
  • Monitor temp
  • Assess for jaundice
slide25

A child is admitted w/ glomerulonephritis. Nurse should expect to see a recent _______ infection in the history given by the mother.

to prevent swelling of casted extremity elevate the extremity above heart level apply ice to cast
To prevent swelling of casted extremity, elevate the extremity above heart level & apply ice to cast.
  • True
  • False
which of the following is an early sign of impaired neurovascular function in a child w an arm cast
Which of the following is an early sign of impaired neurovascular function in a child w/ an arm cast?
  • Cool, cold fingers
  • Pain
  • Inability to detect a pulse distal to cast
  • Inability to move distal extremity
choose the most appropriate roommate for a 16yo in a full body cast
Choose the most appropriate roommate for a 16yo in a full body cast.
  • 12 yo w/ inguinal hernia repair
  • 9 yo w/ gastroenteritis
  • 6 yo w/ fractured femur
  • 15 yo w/ pneumonia
when caring for child in bryant s traction nurse should be aware that this traction is
When caring for child in Bryant’s traction, nurse should be aware that this traction is:
  • Skin traction to the affected leg
  • Attached to a pin placed in the affected femur
  • Used to allow child to turn from side to side
  • Skin traction & elevates hips slightly from bed
nurse detects a positive ortolani sign in a newborn what is the nurse assessing
Nurse detects a positive Ortolani sign in a newborn. What is the nurse assessing?
  • Broadening of perineum
  • Shortening of one leg
  • Audible click on hip manipulation
  • Unilateral droop of hip
slide32

13mo old dx’d w/ L hip dysplasia & scheduled for surgery & spica cast. Child’s mother questions why a pavlik harness is not being used. Appropriate response is:

  • Pavlik harness is used for children w/ scoliosis, not hip dysplasia
  • Pavlik harness is used for school-age children
  • Your child’s condition is too severe for a pavlik harness
  • Pavlik harness is only used for infants <6mos
slide33

Mother brings 2wk old to clinic for tx following dx of clubfoot made at time of birth. Which statements, indicates need for further teaching?

  • I need to bring my infant back to clinic in 1 mo for a new cast
  • Tx needs to be started as soon as possible
  • I need to come to clinic every week w/ my infant for casting
  • I realize my infant will require follow-up care until full grown
slide34

Nurse providing instructions to parents of child w/ scoliosis regarding use of a brace. Which statement indicated need for further instructions?

  • I should apply lotion under the brace to prevent skin breakdown
  • I should avoid the use of powder b/c it will cake under the brace
  • I will have my child wear soft fabric clothing under the brace
  • I will encourage my child to perform prescribed exercises
to prevent loss of joint fxn in a child w jra nurse should teach parents to avoid letting child
To prevent loss of joint fxn in a child w/ JRA, nurse should teach parents to avoid letting child:
  • Ride a bike
  • Walk to school
  • Do frequent isometric exercises
  • Watch TV for prolonged periods
child scheduled for debridement of leg wounds in what order should nurse perform procedures
Child scheduled for debridement of leg wounds. In what order should nurse perform procedures?
  • Remove dressing
  • Medicate for pain
  • Pour water on dressing to loosen it
  • Assess need for dressing supplies
which of the following are manifestations of scabies all that apply
Which of the following are manifestations of scabies? (all that apply)
  • Nits present
  • Threadlike rash between fingers & other moist areas
  • Circular rash on extremities
  • Pruritus
  • Eczematous eruption in infants
match skin disorder w cause
Match skin disorder w/ cause
  • Impetigo contagiosa
  • Scabies
  • Lyme disease
  • Cold sore, fever blister
  • ringworm
  • Fungal infection
  • Bacterial infection
  • Viral infection
  • Caused by spirochete
  • Caused by burrowing mite
match type of dermatitis w it s description
Match type of dermatitis w/ it’s description
  • Diaper dermatitis
  • Infantile eczema
  • Acne
  • Seborrheic dermatitis
  • Weeping, red vesicles & papules
  • Comedones & pustules
  • Red, inflamed skin
  • Thick, yellow scaly areas
which of the following meds can be used for children w eczema all that apply
Which of the following meds can be used for children w/ eczema? (all that apply)
  • Corticosteroids
  • Accutane
  • Peroxide
  • Antihistamines
  • Calamine lotion
slide41
Diaper dermatitis can be largely prevented by changing an infant’s diapers frequently & keeping the diaper area clean & dry.
  • True
  • False
slide44

Nurse reviewing sick day mangement w/ parent of a child w/ type 1 diabetes. Which of following should be included in teaching? (all that apply)

  • Monitor blood glucose every 4 hr
  • Discontinue taking insulin until feeling better
  • Drink 8 oz fruit juice every hour
  • Test urine for ketones
  • Call PCP if blood glucose is >250mg/dL
slide45

Providing health teaching to group of adolescents w/ D.M., nurse teaches them to observe for s/s of hypoglycemia. Which of following should be included? (all that apply)

  • Frequent urination
  • Inc’d energy level
  • Nausea
  • Nervousness & irritability
  • Sweating & pallor
  • Deep, rapid & labored respirations
hypoglycemic rx can occurs b c of
Hypoglycemic rx can occurs b/c of:
  • Too much glucose in body
  • Eating too much junk food
  • Exercising strenuously
  • Not enough insulin in body
slide47

Child w/ type 1 D.M. on insulin for 3 months. Which of the following diagnostic studies will provider order to how well child’s D.M. is being managed?

  • Morning fasting blood glucose
  • 2hr oral glucose tolerance test
  • Hb1Ac
  • Diary of child’s daily blood glucoses
when teaching child w newly dx d type 1 d m priority should be placed on
When teaching child w/ newly dx’d type 1 D.M., priority should be placed on:
  • Wt loss measures
  • Self-monitoring of blood glucose
  • Need to reduce physical activity
  • Elimination of sugar from diet
slide49
During scheduled exam, child’s HbA1c level is 9%. Child has had type 1 D.M. for 1 yr. Which of the following actions should nurse take?
  • Assess signs of infection & child’s intake for past 24hr
  • Explore child’s general dietary patterns for past 3 mos
  • Review parents’ understanding of diabetic foot care
  • Immediately admin child’s rapid acting insulin dose.
slide50

Nurse asks 12yo w/ GH deficiency to draw a pic off herself playing w/ children on a playground. List potential characteristics that might represent positive & negative self-esteem.

nurse asks 12yo w gh deficiency to draw a pic off herself playing w children on a playground
Nurse asks 12yo w/ GH deficiency to draw a pic off herself playing w/ children on a playground

Positive

Negative

Child standing off to side while other children are playing

Drawing indicates teasing &/or ridicule

Child appears much smaller than others

Dark picture that is scribbled

  • Child playing w/ other children
  • Child smiling
  • Interaction between children
  • True height discrepancy
  • Bright, colorful picture
match diagnostic test w findings r t growth disorders
Match diagnostic test w/ findings r/t growth disorders.
  • X-rays of wrist & hand
  • IGF-1
  • MRI
  • GH stimulation/ suppression test
  • Determines GH level
  • Id’s pituitary gland tumor
  • Determines bone age
  • Measures effect of glucose on GH
slide53

6yo who has been bladder trained w/o enuresis since age 4 has begun having accidents both at night & occasionally during the day. Which of the following should be ruled out as possible causes? (all that apply)

  • Glomerulonephritis
  • UTI
  • New onset D.M.
  • Epispadias
  • Bladder exstrophy
match structural gu disorder w definition
Match structural GU disorder w/ definition
  • Hypospadias
  • Epispadias
  • Phimosis
  • Bladder exstrophy
  • Cryptorchidism
  • Chordee
  • Hydrocele
  • Ventral curvature of penis
  • Narrowed opening in urinary meatus preventing retraction of foreskin over glans penis
  • Failure of 1 or both testicles to descend into scrotum
  • Collection of fluid in scrotal sac
  • Urethral meatus is located on ventral side of glans penis
  • Eversion of bladder through lower abd wall
  • Urethral meatus located on dorsal side of glans penis
slide55
Multiple surgeries will be required for child w/ bladder exstrophy to repair damage to bladder & pelvic area.
  • True
  • False
6yo admitted to acute care w dx of possible uti which of following should nurse expect to find
6yo admitted to acute care w/ dx of possible UTI. Which of following should nurse expect to find?
  • Dysuria, thirst, light colored urine, ammonia odor in urine
  • Dysuria, L sided pain, foul odor to urine, dark color to urine
  • Polyuria, lower abd pain, yellow urine, sweet odor to urine
  • Oliguria, epigastric pain, yellow skin tones, ammonia odor to breath
slide57
Nurse preparing discharge teaching for mother of 6yo girl who had severe UTI. Which instructions are beneficial? (all that apply)
  • Avoid bubble baths
  • Change child’s bathing suit immediately after swimming
  • Encourage child to go to BR q6hr
  • Have child wear cotton underpants rather than nylon
  • Observe child wiping back to front after voiding
child admitted w glomerulonephritis which of following indicates need to call pcp
Child admitted w/ glomerulonephritis. Which of following indicates need to call PCP?
  • Specific gravity decrease from 1.022 to 1.020
  • Crackles in bases bilaterally
  • Absence of S3 on auscultation
  • Wt gain of 0.91kg overnight
child admitted w nephrotic syndrome which of following classic symptoms should nurse observe for
Child admitted w/ nephrotic syndrome. Which of following classic symptoms should nurse observe for?
  • HTN, hypoNa, hemoconcentration
  • hyperNa, hypoalbuminenia, hyperlipidemia
  • Hematuria, hypoaldosteronemia, hyperNa
  • Hemodilution, hyperalbuminemia, hypoproteinemia
slide60
Parent of child w/ excess fluid vol & weeping skin tells nurse he would like to be more involved in cares. Which should nurse encourage?
  • Admin IV Lasix under supervision of nurse
  • Read to child from bedside chair
  • Reposition child q30min
  • Assist in changing linens as they become wet
toddler w nephrotic syndrome has plt count of 700 000mm 3 for which s s should nurse monitor
Toddler w/ nephrotic syndrome has plt count of 700,000mm3. For which s/s should nurse monitor?
  • Thrombosis
  • Bruising
  • Pulm congestion
  • Cardiac enlargement
slide62
3 yo w/ meningitis is documented as having photophobia. Which of following interventions is most effective in minimizing this symptom?
  • Avoid using the TV
  • Keep volume down on radio
  • Bandage both eyes temporarily
  • Elevate HOB
slide63
Child admitted w/ possible Reye syndrome. Which factors in health history might be supportive of this dx?
  • Recent h/o UTI
  • Recent h/o bacterial otitis media
  • Recent episode of gastroenteritis
  • Recent episode of haemophilus influenzae meningitis
which manifestations are indicative of stage ii of reye syndrome all that apply
Which manifestations are indicative of Stage II of Reye syndrome? (all that apply)
  • Coma
  • Fixed pupils
  • Hyperventilation
  • Combativeness
  • Hyperactive deep tendon reflexes
lack of which is a warning sign of palsy in 3mo old infant
Lack of which is a warning sign of palsy in 3mo old infant?
  • Crawling
  • Sitting up w/o assistance
  • Hold head upright
  • Babbling simple words
match type of cp w correct description
Match type of CP w/ correct description
  • Hemiplegia/ hemiparesis
  • Diplegia/ diparesis
  • Quadriplegia/quadriparesis
  • Dyskinetic/ athetoid
  • ataxic
  • Will cause child to experience difficulty w/ quick or precise mvmts (writing, buttoning)
  • Causes slow & uncontrollable writhing mvmts of hands, feet, arms, &/or legs
  • Delays ability to walk in children (may walk on tips of toes b/c of tight heel tendon)
  • Tightness in certain leg muscles makes legs move like arms of scissor (scissor walking)
  • Will interfere w/ child’s ability to speak (child often hard to understand)
slide67
Child w/ spina bifida should be instructed in intermittent bladder catheterization using clean latex catheter.
  • True
  • False
priority nursing dx for child who sits in wheelchair all day is risk for impaired skin integrity
Priority nursing dx for child who sits in wheelchair all day is risk for impaired skin integrity.
  • True
  • False
slide69
School-age child w/ spina bifida has shunt in place for hydrocephalus. Which s/s are manifestations of inc’d ICP? (all that apply)
  • Fever
  • Hypotension
  • Headache
  • Lethargy
  • Bulging anterior fontanel
  • Seizures
  • Change in school performance
match each type of seizure below w its definition
Match each type of seizure below w/ its definition.
  • Tonic-clonic
  • Absence seizure
  • Febrile seizure
  • Complex partial seizure
  • Occurs w/ temp > 38.8 (101.8)
  • Generalized mvmt of all extremities
  • Dec’d consciousness w/ staring, lip smacking, chewing during seizure
  • 5-10sec loss of consciousness that looks like daydreaming
a single seizure lasting 10mins or a series of seizures lasting 20 30mins is called
A single seizure lasting >10mins or a series of seizures lasting 20-30mins is called ________.
which vitals is indicative of cushing s reflex in a 6yo
Which vitals is indicative of Cushing’s reflex in a 6yo?
  • Temp 37.2 (99), pulse 100, RR 22, BP 100/70
  • Temp 37.9 (100.2), pulse 140, RR 26, BP 60/30
  • Temp 35.6 (96), pulse 50, RR 18, BP 80/50
  • Temp 37.8 (100), pulse 64, RR 20, BP 140/40
slide73
Child w/ concussion being discharged home w/ parent. Which statement indicates need for further teaching?
  • I will keep him awake all night to make sure there is no change
  • I should call the hospital if I cannot arouse him
  • His pupils should remain equal & get smaller when I shine a light into them
  • I should call the doctor if he starts to vomit
slide74
6mo old infant admitted to critical care w/ basilar skull fracture. Which findings should nurse expect? (all that apply)
  • Two black eyes
  • Nuchal rigidity
  • Split cranial sutures
  • Bruising of neck posterior to infants ear
  • Nosebleed
slide75
Which are priority assessments for adolescent postop for insertion of Harrington rod secondary to scoliosis?
  • Ability to eat a balanced diet
  • BP & pulse
  • O2 sat
  • Assess for body image disturbance
  • Neurvascular assessment
  • Pain assessment
  • Assess for wound infection
slide76

8 yr old R femur fracture after falling off skateboard. After 3 wks traction w/ pin, casted & discharged. Teaching instructions include: (all that apply)

  • Wash cast carefully if it becomes soiled
  • Allow cast to remain uncovered until it dries completely
  • Support wet cast carefully & avoid denting it
  • Make sure nothing is placed inside cast
  • Check leg frequently for signs of swelling
inc d pain erythema fever are 3 signs that compartment syndrome is occurring w in casted extremity
Inc’d pain, erythema & fever are 3 signs that compartment syndrome is occurring w/in casted extremity.
  • True
  • False
slide78

Adolescent w/ rheumatoid arthritis reports severe pain during PT exercises & states she doesn’t want to go back to PT again. Intervention to solve this problem:

  • Medicate w/ morphine sulfate before PT
  • Use ice packs before PT to dec inflammation
  • Take warm bath or use warm packs before PT
  • Perform passive ROM for adolescent before PT
what measures can be taken to dec pain prevent deformity during sleep for child w ra80
What measures can be taken to dec pain & prevent deformity during sleep for child w/ RA?
  • Splinting of knees, wrists, hands
  • Sleeping on firm matterss w/o pillows under knees may help dec pain & prevent flexion deformities
slide81

5 yo child unable to sit through meals, easily distracted. At night, gets up while family is sleeping & wanders about house. Doing poorly in kindergarten d/t inability to concentrate on work. Which should child be evaluated for?

  • Mental retardation
  • Down syndrome
  • ADHD
  • Autism
slide82

Nurse is discussing w/ parents of 3mo w/ Down syndrome ways to help prevent recurrent resp infections. Which interventions should nurse discuss? (all that apply)

  • Practice frequent handwashing
  • Keep infant in Fowler’s position most of time to prevent choking
  • Use bulb syringe to remove nasal mucus
  • Keep infant’s mouth moist by rinsing frequently w/ water
nurse assessing 4yo for autism should be alert for
Nurse assessing 4yo for autism. Should be alert for:
  • Constant talking & impulsive behavior
  • Poor language & interpersonal skills
  • Frequent resp & UTI’s
  • Constant clinging to parents & wanting to be cuddled
slide84

9yo w/ autism continually hits head on desk. During planning w/ teachers, school nurse has devised one outcome for the problem, which states child “will develop self-control measures to prevent behavior”. Nurse should evaluate this outcome to be met when child:

  • Wears his helmet continually to prevent injury
  • Begins cutting his arm instead of banging his head
  • Seeks out a staff member instead of head banging
  • Is placed in seat w/o desk to prevent this unacceptable behavior
3mo old ftt being bottle fed following techniques nurse should teach mom all that apply
3mo old FTT being bottle fed. Following techniques nurse should teach mom: (all that apply)
  • Simulate feeding environment in common dining room
  • Maintain eye contact w/ infant during feeding
  • Burp infant frequently during feeding
  • Give infant as much formula as she can hold during each feeding
  • Develop structured feeding routine
slide86

Nurse evaluating family in which child abuse has occurred. Which is best indicator that parents are making progress toward resolution of violence?

  • Parents plan weekly outings to park
  • Parents are attending parenting classes
  • Parents report high expectations for their children
  • Parents relate an understanding of normal growth & development
slide87
Nurse assessing family of child brought in for severe injuries. Which behaviors by parents indicates probable abuse?
  • Delay in seeking treatment for child’s injuries
  • Detailed description of events prior to injuries
  • Anxious, concerned attitude
  • Encouraging child to explain injuries