ALL PEDS HESI EXAM/ QUESTIONS & ANSWERS TEST BANK/A+ GUIDE /Latest Updated

“A mother tells the nurse that her child does not want anything to do with toilet training and yells “NO!” consistently when she tries to toilet train. The child is 2 years old. According to Erikson, the nurse interprets that the child is experiencing which psychosocial crisis?”
a. autonomy vs shame and doubt
b. initiative vs guilt
c. industry vs inferiority
d. trust vs mistrust
Autonomy vs shame and doubt

A 2-year-old child is admitted to the hospital with juvenile rheumatoid arthritis (JRA). During the focused assessment, the nurse makes it a priority to note the presence of which of the following?”
a. increased irritability and the child’s insistence to be carried out
b. complaints of joint stiffness
c. history of daily temperature elevations
d. description of how difficult it is to move around after periods of inactivity
increased irritability and the child’s insistence to be carried out

A mother of a toddler who is hospitalized with mild dehydration must leave her child to go to work. Which behavior would the nurse expect to observe in the toddler immediately after the mother’s departure?
a. silently curled in bed with a blanket
b. loudly crying and kicking both legs
c. playing quietly with a favorite toy
d. sucking thumb and rocking back and forth
loudly crying and kicking both legs

“A newborn infant is diagnosed with hypospadias, and the mother asks the nurse about the disorder. The nurse bases the response on which of the following?”
a. it is a congenital anomaly in which the actual opening of the urethra meatus is below the normal placement on the glans penis
b. it occurs when one or both testes fail to descend through the inguinal canal into the scrotal sac
c. it is a congenital anomaly in which the actual opening of the urethral meatus is dorsal to the urethral opening
d. it is a congential anomaly characterized by the extrusion of the urinary bladder to the outside of the body
it is a congenital anomaly in which the actual opening of the urethra meatus is below the normal placement on the glans penis

A home care nurse is providing instructions to a child with cystic fibrosis about how to perform the “huff” maneuver; the child asks the nurse about the purpose of this type of breathing. The nurse makes which response to the child?
a. “this type of breathing is used to mobilize secretions so that they can be easily coughed out”
b. “this type of breathing prolongs inspiration time”
c. “this type of breathing moves air out of the lower lungs”
d. “this type of breathing moves air through the lungs”
“this type of breathing is used to mobilize secretions so that they can be easily coughed out”

A home care nurse is instructing the mother of a child with cystic fibrosis (CF) about the appropriate dietary measures. The nurse tells the mother that the child needs to consume a:
a. low calorie, low fat diet
b. high calorie, high protein diet
c. low calorie, low protein diet
d. high calorie, restricted fat
high calorie, high protein diet

Breathing exercises and postural drainage is prescribed for a child with cystic fibrosis. A nurse implements these procedures by telling the child to:
a. perform the postural drainage, then the breathing exercises
b. perform the breathing exercises, then the postural drainage
c. schedule the procedures so they are 4 hours apart
d. perform postural drainage in the morning and breathing exercises in the evening
perform the postural drainage, then the breathing exercises

A nurse is reviewing the results of a sweat test performed on a child with cystic fibrosis (CF). The nurse would expect to note which finding?
a. a sweat sodium concentration less than 40 mEq/L
b. a sweat potassium concentration less than 40 mEq/L
c. a sweat potassium concentration greater than 40 mEq/L
d. a sweat sodium concentration greater than 60 mEq/L
a sweat sodium concentration greater than 60 mEq/L

Methylphenidate (Ritalin) is prescribed for a child with a diagnosis of attention deficit hyperactivity disorder (ADHD). The nurse provides instructions to the mother regarding the administration of the medication and tells the mother to administer the medication:
a. before dinner and at bedtime
b. before breakfast and before the noontime meal
c. in the morning after breakfast and at bedtime
d. at the noontime and evening meals
before breakfast and before the noontime meal

“Methylphenidate hydrochloride (Ritalin) is prescribed for a 10-year-old child diagnosed with attention deficit hyperactivity disorder, and the nurse provides instructions to the mother about administration of the medication. The nurse determines that the mother understands the instructions when the mother states:”
a. I will give my child the medication at bedtime so that he will be rested and alert for school the next day
b. I will give my child the medication after meals to obtain the full effects of the medication
c. I will give my child the medication at breakfast and lunch to prevent insomnia
d. I will give my child the medication with water to prevent kidney damage
I will give my child the medication at breakfast and lunch to prevent insomnia

Methylphenidate (Ritalin) is prescribed for a child with attention deficit hyperactivity disorder (ADHD). The nurse provides instructions to the mother regarding the administration of the medication. Which statement by the mother would indicate a need for further instructions?
a. I will administer the medication with the noontime meal
b. I will keep the medication tightly capped and away from direct heat
c. I should inform the school nurse that my child is taking this medication
d. I should avoid giving the medications on Saturdays and Sundays to provide a medication holiday
I should avoid giving the medications on Saturdays and Sundays to provide a medication holiday

A client with diplopia has been given an eye patch to promote better vision and prevent injury. The nurse teaches the client to do which of the following as part of correct use of this item?
a. wear the patch continuously, alternating eyes each day
b. wear the patch continuously, alternating eyes each week
c. use the patch only when vision is exceptionally blurry
d. put the patch on for an hour, and then take it off for an hour
wear the patch continuously, alternating eyes each day

A student nurse examines an Asian American infant’s eyes and notes that the infant’s eyes are crossed. The registered nurse asks the student to interpret the finding. Which statement by the student indicates an understanding of this assessment finding?
a. it probably isn’t strabismus but appears that way because of the child;s ethnic background
b. you will want to call the pediatrician immediately because this could lead to detached retina
c. it probably is strabismus because the baby’s mother has abused tranquilizers
d. strabismus isn’t life threatening but it requires surgery in the first 2 months to prevent the crossed eyes from being a life long condition
it probably isn’t strabismus but appears that way because of the child;s ethnic background

A nurse notes that a client’s eyes are continuously moving back and forth within the eye sockets. The nurse documents in the medical record that the client has:
a. ataxia
b. nystagmus
c. pronator drift
d. hyperreflexia
nystagmus

“A nurse is providing instructions to the mother of a child with a diagnosis of strabismus of the left eye, and the nurse reviews the procedure for patching the child. The nurse determines that the mother understands the procedure if the mother makes which statement?”
a. I will place the patch on the right eye
b. I will place the patch on both eyes
c. I will place the patch on the left eye
d. I will alternate the patch from the right to the left eye every hour
I will place the patch on the right eye

A nurse develops a plan of care for a one-month-old infant hospitalized for intussusception. Which nursing measure would be most effective to provide psychosocial support for the parent-child relationship?
a. encourage the parents to go home and get some sleep
b. encourage the parents to room-in with their infant
c. provide educational materials
d. initiate home nutritional support as early as possible
encourage the parents to room-in with their infant

“A 12-year-old child is seen in the health care clinic. During the assessment, which finding would suggest to the nurse that the child is experiencing a disruption in the development of self-concept?”
a. the child has a part-time babysitting job
b. the child enjoys playing chess and mastering new skills with this game
c. the child has many friends
d. the child has an intimate relationship with a significant other
the child has an intimate relationship with a significant other

A nurse is preparing to care for a child from a culture different from the nurse’s. What is the best way to address the cultural needs of the child and family when the child is admitted to the health care facility?
a. ask questions and explain to the family why the questions are being asked
b. explain to the family that while the child is being treated, they need to discontinue cultural practices because they may be harmful to the child
c. ignore cultural needs because they are not important to health care professionals
d. only address those issues that directly affect the nurse’s care of the child
ask questions and explain to the family why the questions are being asked

“A 4-year-old child with cancer is admitted to the hospital for radiation therapy and surgery. To assess adequacy of support for the child’s psychosocial needs, the nurse would ask the parents which question?”
a. what signs and symptoms has your child been having?
b. Will a family member be able to stay with the child most of the time?
c. How long have you known your child’s diagnosis?
d. what are your child’s favorite books, activities and toys?
Will a family member be able to stay with the child most of the time?

A community health nurse is providing instructions to a group of mothers regarding the safe use of car seats for toddlers. The nurse determines that the mother of a toddler understands the instructions if the mother states which of the following?
a. The care seat can be placed in a face-forward position when the height of the toddler is 27 inches
b. The car seat should never be placed in a face-forward position
c. the car seat can be placed in a face-forward position at any time
d. The car seat is suitable for the toddler until the toddler reaches the weight of 40 pounds
The car seat is suitable for the toddler until the toddler reaches the weight of 40 pounds

“When administering a liquid medication to an uncooperative toddler, the nurse would implement which strategy?”
a. allow the parents to remain the room
b. remove the child to another room away from the parents
c. restrain the child in a high chair
d. restrain the child in a papoose restraining device
allow the parents to remain the room

A toddler is admitted to the hospital for fever of unknown origin. The mother’s time at the hospital is limited to the hours that her other children are in school. The nurse shows an understanding of a toddler’s psychosocial development by making which statement to the mother?
a. it is better to leave without saying good-bye, so your child will not be upset
b. your child is too old to be having separation anxiety. Crying is just a way for children to control parents
c. your child is egocentric, which allows a child to self comfort
d. games like peek-a-boo and hide and seek will help your child understand that you will return
games like peek-a-boo and hide and seek will help your child understand that you will return

A mother of a 3-year-old child calls a neighbor who is a nurse and tells the nurse that her child just ate the mouse poison that was stored in a cabinet. The nurse would instruct the mother to take what action immediately?
a. call the poison control center
b. give the child a glass of carbonated beverage to drink
c. take the child to the ER
d. try to determine how much mouse poison the child consumed
call the poison control center

The community health nurse is providing a yearly summer educational session to parents in a local community. The topic of the session is prevention and treatment measures for poison ivy. The nurse instructs the parents that if the child comes in contact with poison ivy they should:
a. immediately bring the child to the ER
b. not be concerned if a rash is not noted on the skin
c. shower the child immediately, lathering and rinsing the child several times
d. apply calamine lotion immediately to the exposed skin areas
shower the child immediately, lathering and rinsing the child several times

A home care nurse visits a 3-year-old child with chickenpox. The child’s mother tells the nurse that the child keeps scratching the skin at night and asks the nurse what to do. The nurse tells the mother to:
a. apply generous amounts of cortisone cream to prevent itching
b. place soft cotton gloves on the child’s hands at night
c. keep the child in a warm room at night so the covers will not cause the child to scratch
d. give the child a glass of warm milk at bedtime to help the child sleep
place soft cotton gloves on the child’s hands at night

A clinic nurse is providing home care instructions to the mother of a 3-year-old child with a diagnosis of vomiting and diarrhea due to gastroenteritis. The nurse instructs the mother to give the child which of the following to maintain hydration status?
a. popsicles
b. soda pop
c. apple juice
d. pedialyte
pedialyte (oral electrolyte solution)

A nurse is collecting data on a child suspected of having rheumatic fever. The nurse plans to obtain specific data regarding recent illnesses in the child and asks the parent which question?
a. has the child had a recent streptococcal infection of the throat?
b. has the child had a recent ear infection?
c. has the child had a recent case of otitis media?
d. has the child had a recent case of pneumonia
has the child had a recent streptococcal infection of the throat?

A child is admitted to the hospital with a diagnosis of acute rheumatic fever. The nurse analyzes the laboratory results and determines that which of the following findings would confirm the likelihood of acute rheumatic fever?
a. increased leukocyte count
b. decreased hemoglobin count
c. increased antibody level
d. decreased erythrocyte sedimentation rate
increased antibody level

A child is admitted to the hospital with a diagnosis of acute rheumatic fever. The nurse reviews the blood laboratory findings knowing that which of the following will confirm the likelihood of this disorder?
a. increased leukocyte count
b. decreased hemoglobin count
c. increased antistreptolysin-O (ASO)
d. decreased erthrocyte sedimentation rate
increased antistreptolysin-O (ASO)

A nurse is assessing a child admitted to the hospital with a diagnosis of rheumatic fever. The nurse asks the child’s mother which significant question during the assessment?
a. has your child had difficulty urinating?
b. has any family member had a sore throat within the past few weeks?
c. has any family member had a gastrointestinal disorder in the past few weeks?
d. has your child been exposed to anyone with chickenpox?
has any family member had a sore throat within the past few weeks?

An infant brought to the emergency room is unresponsive and in respiratory distress. The nurse opens the infant’s airway by which method?
a. hyperextension
b. jaw thrust
c. tongue-jaw lift
d. head tilt/ chin lift
tongue-jaw lift

“A child with a tracheal obstruction is brought to the emergency room by emergency medical services. The child has aspirated a marble, and the foreign body is removed in the emergency room by direct laryngoscopy. After the procedure, the nurse informs the mother of the child that:”
a. the child will need to be hospitalized for observation
b. the child may go home with a prescription for antibiotics
c. the child will need to return to the hospital for a chest x-ray in 1 week
d. the child will require a bronchoscopy for follow up evaluation in 1 month
the child will need to be hospitalized for observation

A nurse is teaching the client taking medications by inhalation about the advantages of a newly prescribed spacer device. The nurse determines the need for further teaching if the client states that the spacer device:
a. reduces the frequency of medication to only once per day
b. reduces the chance of yeast infection because large drops arn’t deposited on the oral tissues
c. disperses medication more deeply and uniformly
d. reduces the need to coordinate timing between pressing the inhaler and inspiration
reduces the frequency of medication to only once per day

A client is taking albuterol (Ventolin) by inhalation but cannot cough up secretions. The nurse teaches the client to do which of the following to best help clear the bronchial secretions?
a. administer an extra dose before bedtime
b. take in increased amounts of fluids every day
c. get more exercise each day
d. Use a dehumidifier in the home
take in increased amounts of fluids every day

“A client taking albuterol (Ventolin) experiences a severe episode of wheezing, which the nurse interprets as bronchospasm. A telephone call is made to the physician’s office to report the occurrence. The nurse does which of the following while waiting for the physician to return the call?”
a. administer the next dose of albuterol as scheduled
b. withholds the next dose of albuterol
c. administer a double dose of albuterol
d. administers half the dose of albuterol
withholds the next dose of albuterol

“A client is unable to expectorate sputum for a sputum sample, and the nurse is preparing to obtain the sample via saline inhalation. The nurse instructs the client to inhale the warm saline vapor via nebulizer by:”
a. hold the nebulizer under the nose
b. keeping the lips closed lightly over the mouthpiece
c. keeping the lips closed tightly over the mouthpiece
d. alternating one vapor breath with one breath from room air
keeping the lips closed lightly over the mouthpiece

A 5-year-old child is admitted to the hospital for heart surgery to repair the tetralogy of Fallot. The nurse reviews the child’s record and notes that the child has clubbed fingers. The nurse understands that the clubbing is most likely caused by:
a. peripheral hypoxia
b. delayed physical growth
c. chronic hypertension
d. destruction of bone marrow
peripheral hypoxia

“A 10-month-old infant is hospitalized for respiratory syncytial virus (RSV). Using knowledge of growth and development according to Erik Erikson and Jean Piaget, the nurse should do which of the following to meet the infant’s developmental needs?”
a. wash hands, wear a mask and keep the infant as quiet as possible
b. follow the home feeding schedule and allow the infant to be held only when the parents visit
c. restrain the infant continuously to prevent tubes from being dislodged
d. provide a consistent routine, as well as touching, rocking, and cuddling throughout the hospitalization
provide a consistent routine, as well as touching, rocking, and cuddling throughout the hospitalization

A nurse is developing a postoperative plan of care for an infant who will undergo a pyloromyotomy for the treatment of hypertrophic pyloric stenosis. The nurse documents in the plan that the infant should be placed in which position in the postoperative period?
a. supine with the head of the bed elevated
b. prone with the head of the bed elevated
c. flat on the nonoperative side
d. flat on the operative side
prone with the head of the bed elevated

A clinic nurse is performing an assessment on a child. Which finding indicates the presence of an inguinal hernia?
a. painless inguinal swelling that appears when the child cries or strains
b. complaints of difficulty defecating
c. complaints of a dribbling urinary stream
d. absence of the tests with scrotum
painless inguinal swelling that appears when the child cries or strains

The nurse is providing instructions to the parents of a child with a hernia regarding measures that will aid in reducing the hernia. The nurse determines that the parents understand these measures if they state which of the following?
a. we will be sure to give our child a fleet enema every day to prevent constipation
b. we will make sure that our child participates in physical activity every day
c. we will provide comfort measures to reduce any crying periods by our child
d. we will encourage our child to cough every few hours on a daily basis
we will provide comfort measures to reduce any crying periods by our child

A nurse is caring for a child after an inguinal hernia repair. Which finding would indicate that the surgical repair was effective?
a. abdominal distention
b. absence of inguinal swelling with crying
c. a clean, dry incision
d. an adequate flow of urine
absence of inguinal swelling with crying

A nurse is providing home care instructions to the parents of an infant who had surgical repair of an inguinal hernia. The nurse instructs the parents to do which of the following to prevent infection at the surgical site?
a. change the diapers as soon as they become damp
b. report a fever immediately
c. soak the infant in a tub bath twice a day for the next 5 days
d. restrict the infant’s physical activity
change the diapers as soon as they become damp

“When obtaining a history from parents of a 5 month old child suspected of having intussusception, which assessment area would be most important for the nurse to address?”
a. pattern of abdominal pain
b. known allergies
c. dietary intake during the past 24 hours
d. usual pattern of bowel movements
pattern of abdominal pain

A nurse is assessing a child after hydrostatic reduction for intussusception. The nurse would expect to observe which finding after this procedure?
a. severe colicy-type pain with vomiting
b. currant jelly like stools
c. passage of barium or water soluble contrast with stools
d. severe abdominal distention
passage of barium or water soluble contrast with stools

“A nurse is caring for a child with intussusception. During care, the child passes a normal brown stool. The most appropriate nursing action is to:”
a. report the passage of a normal brown stool to the physician
b. prepare the child and parents for the possibility of surgery
c. note the child’s physical symptoms
d. prepare the child for hydrostatic reduction
report the passage of a normal brown stool to the physician

A nurse is preparing a plan of care for a child being admitted to the hospital with a diagnosis of congestive heart failure (CHF). The nurse avoids including which of the following in the plan?
a. limiting the time the child is allowed to bottle-feed
b. elevating the head of the bed
c. waking the child for feeding to ensure adequate nutrition
d. providing oxygen during stressful periods
waking the child for feeding to ensure adequate nutrition

A nurse caring for a child with congestive heart failure provides instructions to the parents regarding the administration of digoxin (Lanoxin). Which statement by the mother indicates a need for further instructions?
a. if my child vomits after I give the medication, I will not repeat the dose
b. I will check my child’s pulse before giving the medication
c. I will check the dose of the medication with my husband before I give the medication
d. I will mix the medication with food
I will mix the medication with food

A nurse prepares to administer digoxin (Lanoxin) to a newborn infant with a diagnosis of congestive heart failure. The nurse notes that the apical rate is 140 beats per minute. Which of the following nursing actions is appropriate?
a. administer the digoxin because the apical rate is within normal limits
b. recheck the apical rate in 1 hour and administer the medication at that time
c. notify the physician because the apical rate is lower than the normal range
d. hold the medication, because the apical rate is normal, indication that the medication is not needed
administer the digoxin because the apical rate is within normal limits

A nurse is caring for a child with a diagnosis of congestive heart failure (CHF). The nurse avoids which action in caring for the child?
a. allowing uninterrupted rest periods
b. limiting the time the child is allowed to bottle-feed
c. providing oxygen during stressful periods
d. keeping the head of the bed flat
keeping the head of the bed flat

list two contraindications to live virus immunization
immunocompromised child
a child in a household with an immunocompromised individual

list three classic signs and symptoms of measles
photophobia
confluent rash that begins on the face and spreads downward
Koplik spots on the buccal mucosa

list the signs and symptoms of iron deficiency
anemia; pale conjunctive; pale skin; atrophy of papillae on tongue; brittle, ridged, or spoon-shaped nails; and thyroid edema

identify food sources of vitamin A
liver, sweet potatoes, carrots, spinach, peaches and apricots

what disease occurs with vitamin C deficiency?
Scurvy

What measurements reflect present nutritional status?
weight, skin-fold thickness, and arm circumference

List the signs and symptosm of dehydration in an infant
Poor skin turgor, absence of tears, dry mucous membranes, weight loss, depressed fontanel, and decreased urinary output

list the laboratory findings that can be expected in a dehydrated child
loss of bicarbonated/decreased pH
loss of sodium (hyponatremia)
loss of potassium (hypokalemia)
elevated Hct and elevated BUN

How should burns in child be assessed?
by using the Lund-Browder chart, which takes into account the changing proportions of the child’s body

How can the nurse best evaluate the adequacy of fluid replacement in children?
monitoring urine output

how should a parent be instructed to child-proof a house?
lock all cabinets
safely store all toxic household items in a locked cabinets
examine the house from the child’s point of view

What intervention should the nurse perform first in caring for a child who has ingested a poison?
assessment of the child’s respiratory, cardiac, and neurological status

What early signs should the nurse assess for if lead poisoning is suspected?
anemia, acute cramping, abdominal pain, vomiting, constipation, anorexia, headache, lethargy, hyperactivity, aggression, impulsiveness, decreased interest in play, irritability, short attention span

describe the purpose of bronchodilators
to reverse bronchospasm

what are the physical assessment findings for a child with asthma?
Expiratory wheezing, rales, tight cough, and signs of altered blood gases

What nutritional support should be provided for a child with cystic fibrosis?
pancreatic enzyme replacement, fat-soluble vitamins, and moderate to low carbohydrates, high protein, moderate to high fat diet

Why is genetic counseling important for the family of a child with cystic fibrosis?
because the disease is autosomal recessive in its genetic pattern

List seven signs of respiratory distress in a pediatric client
restlessness
tachycardia
tachypnea
diaphoresis
flaring nostrils
retractions
grunting

describe the care of a child in a mist tent
monitor child’s temperature, keep tent edges tucked in, keep clothing dry, assess respiratory status, look at child inside tent

what position does a child with epiglottitis assume?
upright sitting, with chin out and tongue protruding (tripod positioning)

Why are IV fluids important for a child with an increased respiratory rate?
The child is at risk for dehydration and acid-base imbalances

Children with chronic otitis media are at risk for developing what problem?
hearing loss

What is the most common postoperative complication following a tonsillectomy? Describe the signs and symptoms of this complication
Hemorrhage
frequent swallowing, vomiting fresh blood, and clearing throat

Differentiate between right-to-left and a left-to-right shunt in cardiac disease
a right-to-left shunt bypasses the lungs and delivers unoxygenated blood to the systemic circulation causing cyanosis
a left-to-right shunt moves oxygenated blood back through the pulmonary circulation

list the four defects associated with tetralogy of fallot
VSD
overriding aorta
pulmonary stenosis
right ventricular hypertrophy

list the common signs of cardiac problems in an infant
poor feeding
poor weight gain
respiratory distress
infections
edema
cyanosis

what are the two objectives in treating CHF?
reduce the workload of the heart
increased cardiac output

Describe nursing interventions to reduce the workload of the heart
give small, frequent feedings or gavage feedings
plan frequent rest periods
maintain a neutral thermal environment
organize activities to disturb child only as indicated

what position would best relieve the child experiencing a tet spell?
knee-chest position or squatting

what are common signs of digoxin toxicity?
diarrhea
fatigue
weakness
nausea
vomiting
check for bradycardia before administering

list five risks in cardiac catheterizaiton
arrhythmia
bleeding
perforation
phlebitis
obstruction of the arterial entry site

what cardiac complications are associated with rheumatic fever?
aortic valve stenosis and mitral valve stenosis

What medications are used to treat rheumatic fever?
penicllin, erythromycin, and aspirin

What are the physical features of a child with down syndrome?
simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes

Describe scissoring
a common characteristic of spastic cerebral palsy in infants; legs are extended and crossed over each other, feet are plantar flexed

What are two nursing priorities for a newborn with myelominingocle?
prevention of infection of the sac and monitoring for hydrocephalus (measure head circumference, check fontanel, assess neurologic functioning)

List the signs and symptoms of increased ICP in older children
irritability
change in LOC
motor dysfunction
headache
vomiting
unequal pupil response
seizures

What teaching should parents of a newly shunted child receive?
information about signs of infection and increased ICP; understanding that shunt should not be pumped and that child will need revisions with growth; guidance concerning growth and development

State the three main gals in providing nursing care for a child experiencing a seizure
maintain patent airway, protect form injury and observe carefully

what are the side effects of Dilantin?
gingival hyperplasia
dermatitis
ataxia
GI distress

Describe the signs and symptoms of a child with meningitis
fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig sign, positive brudzinski signs; infant may not show all

What antibiotics are usually prescribed for bacterial meningitis?
ampicilin, ceftriazzone, chloramphenicol

How is a child usually positioned after brain tumor surgery?
Flat or on either side

Described the function of an osmotic diuretic
osmotic diuretics remove water form the CNS to reduce cerebral edema

What nursing interventions increase intracranial pressure?
suctioning and positioning, turning

describe the mechanism of inheritance of Duchenne muscular dystrophy
duchenne muscular dystrophy is inherited as an X-linked recessive trait

What is the Gowers sign?
Gowers sign is an indicator of muscular dystrophy; to stand, the child has to “walk” hands up legs

compare the signs and symptoms of acute glomerulonephritis (AGN) with those of nephrosis
AGN: gross hematuria, recent strep infection, hypertension and mild edema
Hephrosis: severe edema, massive protinuria, frothy-appearing urine, anorexia

What antecedent event occurs with AGN?
Beta-hemolytic streptococcal infection

Compare the dietary interventions for AGN and nephrosis
AGN: low sodium diet
nephrosis: high protein, low salt diet

what is the physiologic reason for the lab finding of hypoproteinemia in nephrosis?
hypoproteinemia occurs because the glomeruli are permeable to serum protieins

Describe safe monitoring of prednisone administration and withdrawal
long-term prednisone should be given every other day. Signs of edema, mood changes, and GI distress should be noted and reported. The drug should be tapered, no discontinued suddenly

What interventions can be taught to prevent UTI in children?
avoid bubble baths; void frequently; drink adequate fluids, especially acidic fluids such as apple or cranberry juice; and clean genital area form front to back

describe the pathophysiology of vesicoureteral reflux
a malfunction of the valves at the end of the ureters, allowing urine to reflux out of the bladder into the ureters and possibly into the kidneys

What are the priorities for a client with a Wilms tumor?
protect the child from injury to the encapsulated tumor. Prepare the family and child for surgery

Explain why hypospadias correction is performed before the child reaches preschool age
preschoolers fear castration, achieving sexual identity, and acquiring independent toileting skills

describe feeding techniques for a child with cleft lip or palate
use lamb’s nipple or prosthesis
feed child upright, with frequent bubbling

list the signs and symptoms of esophageal atresia with TEF
chocking, coughing, cyanosis, and excess salivaiton

What nursing actions are initiated for the newborn with suspected esophageal atresia with TEF?
maintain NPO immediately and suction secretions

Describe the postoperative nursing care for an infant with pyloric stenosis
maintain IV hydration and provide small, frequent feedings of glucose or electrolyte solutions or both within 4 to 6 hours. Gradually increase to full-strength formula
Position infant on right side in semi-fowler position after feeding

describe why a barium enema is used to treat intussusception
reduces the telescoping of the intestine through hydrostatic pressure without surgical interventions

Describe the preoperative nursing care for a child with Hirschsprung disease
check vital signs and take axillary temperatures
provide bowel cleansing program and teach about colostomy
observe for bowel perforation
measure abdominal girth

What care is needed for a client with a temporary colostomy?
family needs education about skin care and appliances
referral to an enterostomal therapist is appropriate

What are signs of anorectal malformation?
newborn who does not pass meconium within 24 hours; meconium appearing through a fistula or in the urine; an unusual appearing and dimple

what are the priorities for a child undergoing abdominal surgery?
maintain fluid balance (I/O, NG suction, monitor electrolytes); monitor vital signs; care for drains; if present assess bowel function; prevent infection of incision area and other postoperative complications; and support child and family with appropriate teaching

describe the information families should be given when a child is receiving oral iron prepartions
give oral iron on an empty stomach and with vitamin C
use straws to avoid discoloring teeth
tarry stools are normal
increase dietary sources of iron

list dietary sources of iron
meat, green leafy vegetables, fish, liver, whole grains, legumes

what is the genetic transmission pattern of hemophilia?
it is an X-linked recessive chromosomal disorder transmitted by the mother and expressed in male children

Describe the sequence of events in a vaso-occulsive crisis in sickle cell anemia
a vaso-occulsive crisis is caused by the clumping of red blood cells, which blocks small blood vessels; therefore, the cells cannot get through the capillaries, causing pain and tissue and organ ischemia. Lowered oxygen tension affects HgbS, which causes sickling of the cells

explain why hydration is a priority in treating sickle cell disease
hydration promotes hemodilution and circulation of the red cells through the blood vessels

what should families and clients do to avoid triggering sickling episodes?
keep child well hydrated
avoid known sources of infection
avoid high altitudes
avoid strenuous exercises

Nursing interventions and medical treatment for a child with leukemia are based on what three physiologic problems?
anemia (decreased erythrocytes)
infection (neutropenia)
bleeding thrmbocytopenia (decreased platelets)

How is congenital hypothyroidism diagnosed?
newborn screening revealing a low T4 and a high TSH

What are the symptoms of congenital hypothyroidism in early infancy?
large, protruding tongue; coarse hair; lethargy; sleepiness and constipation

What are the outcomes of untreated congenital hypothyroidism?
Mental retardation and growth failure

What are the metabolic effects of PKU?
CNS damage, mental retardation and decreased melanin

What two formulas are prescribed for infants with PKU?
Lofenalac
Phenex-1

List foods high in phenylalanine content
meat, milk, diary products, and eggs

What are the three classic signs of diabetes?
polydipsia
polyphagia
polyuria

Differentiate the signs of hypoglycemia and hyperglycemia
hypoglycemia: tremors, sweating, headache, hunger, nausea, lethargy, confusion, slurred speech, anxiety, tingling around mouth, nightmares
hyperglycemia: polydipsia,polyuria, ployphagia, blurred vision, weakness, weight loss, and syncope

describe the nursing care of a child with ketoacidosis
provide care for an unconscious child, administer regular insulin IV in normal saline, monitor blood gas values and maintain strict I/O

describe developmental factors that would impact the school-age child with diabetes
need to be like peers; assuming responsibility for own care; modification of diet; snacks and exercise in school

what is the relationship between hypoglycemia and exercise?
during exercise, insulin uptake is increased and the risk for hypoglycemia occurs

list normal findings in a neurovascular assessment
warm extremity, brisk capillary refill, free movement, normal sensation of the affected extremity and equal pulses

what is compartment syndrome?
damage to nerves and vasculature of an extremity due to compression

What are the signs and symptoms of compartment syndrome?
abnormal neurovascular assessment; cold extremity, severe pain, inability to move the extremity and poor capillary refill

Why are fractures of the epiphyseal plate a special concern?
Fractures of the epiphyseal plate (growth plate) may affect the growth of the limb

How is skeletal traction applied?
skeletal traction is maintained by pins or wires applied to the distal fragment of the fracture

What discharge instructions should be included concerning a child with spica cast?
check child’s circulation
keep cast dry
do no place anything under cast
prevent cast soilage during toileting or diapering
do not turn child using an abductor bar

what are the signs and symptoms of congenital dislocated hip in infants?
unequal skin folds of the buttocks, ortolani sign, limited abduction of the affected hip and unequal leg lengths

How would the nurse conduct a scoliosis screening?
Ask the child to bend forward form the hips, with arms hanging free. Examine the child for a curve in the spine, a rib hump, and hip asymmetry

What instructions should a child with scoliosis receive about a skeletal brace?
the child should be instructed to wear brace 23 hours per day; wear T-shirt under brace; check skin for irritation; perform back and abdominal exercises; and modify clothing. The child should be encouraged to maintain normal activities as able

What care is indicated for a child with juvenile rheumatoid arthritis?
prescribed exercise to maintain mobility; splinting of affected joins; and teaching about medication management and side effects of drugs

“A hospitalized toddler cries when anyone enters the room, and kicks, yells, and clings to the parents if they try to leave. Based on these data, the nurse determines that the priority nursing diagnosis is:”
a. fear related to unfamiliar surroundings
b. deficient divisional activity related to developmental stage
c. compromised family coping related to the sick child
d. delayed growth and development related to overprotective parenting
a. fear related to unfamiliar surroundings

A 9-month-old infant is admitted to a pediatric unit with a diagnosis of dehydration and malnutrition and suspected failure to thrive. Child neglect is suspected. Which of the following would be most important for the nurse to observe when the parents visit the infant?
a. the parents’ level of concern about the child
b. the parents’ patterns of visitation
c. the parents’ interactions with one another
d. clues regarding the nutritional patterns of the other children in the family
a. the parents’ level of concern about the child

A nurse instructs a parent regarding the appropriate actions to take when the toddler has a temper tantrum. Which statement by the parent indicates a successful outcome of the teaching?
a. I will send my child to a room alone for 10 minutes after every tantrum
b. I will reward my child with candy at the end of each day without a tantrum
c. I will give frequent reminders that only bad children have tantrums
d. I will ignore the tantrums as long as there is no physical danger
d. I will ignore the tantrums as long as there is no physical danger

When giving an intramuscular injection to a 4-year-old child the nurse should:
a. use the vastus lateralis muscle only
b. allow the child to choose between a lying or a standing position
c. obtain assistance to administer the injection
d. distract the child with conversation or a toy
c. obtain assistance to administer the injection

“A 4-year-old child with cancer is admitted to the hospital for radiation therapy and surgery. To assess adequacy of support for the child’s psychosocial needs, the nurse would ask the parents which question?”
a. what signs and symptoms has your child been having?
b. Will a family member be able to stay with the child most of the time?
c. how long have you known your child’s diagnosis?
d. What are your child’s favorite books, activities and toys?
b. Will a family member be able to stay with the child most of the time?

A 4-year-old child is reluctant to take deep breaths after abdominal surgery. The most effective measure to encourage deep breathing is to:
a. have the child pretend he is the big, bad wolf blowing the little pig’s house down
b. give the child colorful latex balloons to blow up
c. tell the child to exhale forcefully through the peak flow meter
d. administer chest percussion in several postural drainage positions
a. have the child pretend he is the big, bad wolf blowing the little pig’s house down

A 4-year-old child who was recently hospitalized is brought to the clinic by his mother for a follow-up visit. The mother tells the nurse that the child has begun to wet the bed ever since the child was brought home from the hospital. The mother is concerned and asks the nurse what to do. The appropriate nursing response is which of the following?
a. you need to discipline the child
b. this is a normal occurrence following hospitalization
c. we will need to discuss this behavior with the physician
d. the child probably has developed a urinary tract infection
b. this is a normal occurrence following hospitalization

A client with gastroesophageal reflux disease (GERD) has just received a breakfast tray. The nurse setting up the tray for the client notices that which of the following foods is the only one that will increase the lower esophageal sphincter (LES) pressure and thus lessen the client’s symptoms?
a. fresh scrambled eggs
b. nonfat milk
c. whole wheat toast with butter
d. coffee
b. nonfat milk

A nurse instructs a mother on measures to take to reduce the incidence of gastroesophageal reflux (GER) in a child. Which statement by the mother indicates a need for further teaching?
a. I will give my child small feedings often throughout the day
b. I will buy bottle nipples that have smaller holes for my child
c. I will add a small amount of cereal to my child’s formula
d. I will give my child a pacifier and maintain an upright position after meals
b. I will buy bottle nipples that have smaller holes for my child

“A client with gastroesophageal reflux disease (GERD) complains of chest discomfort that feels like heartburn, especially following each meal. After teaching the client to take antacids as prescribed, the nurse suggests that the client lie in which position during sleep?”
a. with the head of the bed elevated 6 to 8 inches
b. flat
c. supine with the head of the bed flat
d. on the stomach with the head of the bed flat
a. with the head of the bed elevated 6 to 8 inches

“A nurse gathers assessment data from a client admitted to the hospital with gastrointestinal reflux disease (GERD) who is scheduled for a Nissen fundoplication. Based on an understanding of this disease, the nurse determines that the client may be at risk for which complication?”
a. diarrhea
b. belching
c. aspiration
d. abdominal pain
c. aspiration

A nurse is preparing a plan of care for a child being admitted to the hospital with a diagnosis of congestive heart failure (CHF). The nurse avoids including which of the following in the plan?
a. limiting the time the child is allowed to bottle-feed
b. elevating the head of the bed
c. walking the child for feeding to ensure adequate nutrition
d. providing oxygen during stressful periods
c. walking the child for feeding to ensure adequate nutrition

A nurse prepares to administer digoxin (Lanoxin) to a newborn infant with a diagnosis of congestive heart failure. The nurse notes that the apical rate is 140 beats per minute. Which of the following nursing actions is appropriate?
a. administer the digoxin because the apical rate is within normal limits
b. recheck the apical rate in 1 hour and administer the medication at that time
c. notify the physician because the apical rate is lower than the normal range
d. hold the medication, because the apical rate is normal, indicating that the medication is not needed
a. administer the digoxin because the apical rate is within normal limits

When does birth length double?
By 4 years.

When does the child sit unsupported?
8 months.

When does a child achieve 50% adult height?
2 years.

When does a child throw a ball overhand?
18 months.

When does a child speak two- to three-word sentences?
2 years.

When does a child use scissors?
4 years.

Note: I had this question on my OB HESI.

When does a child tie his or her shoes?
5 years.

When does the infant develop stranger anxiety?
7 to 9 months.

Fine pincer grasp appears…?
…at 10 to 12 months.

When should the infant be expected to start crawling?
10 months.

The infant (birth to 1 year) is in what stage of psychosocial development?
Trust vs. Mistrust

The toddler (1-3 years) is in what stage of psychosocial development?
Autonomy vs. Shame and Doubt

The preschool child (3-6 years) is in what stage of psychosocial development?
Initiative vs. guilt.

The school-age child (6-12 years) is in what stage of psychosocial development?
Industry vs. Inferiority

The adolescent (12-18 years) is in what stage of psychosocial development?
Identity vs. role confusion

Concepts of bodily injury:

Toddlers (1-3 years) fear…?
…intrusive procedures.

Concepts of bodily injury:

Preschoolers (3-6 years) fear…?
…body mutilation.

Concepts of bodily injury:

School-age (6-12 years) children fear..?
…Loss of control of their bodies.

Concepts of bodily injury:

Adolescents (12-18 years) fear…?
…Major concern is change in body image.

Moro reflex disappears when?
Around 4 months of age.

Handedness is established during what age bracket?

(Infant, toddler, preschool, school-age, adolescent)
Handedness is established in the preschool-age child (3-6 years)

Appropriate toys and play for the hospitalized infant (birth to 1 year)?
Mobiles, rattles, squeaking toys, picture books, balls, colored blocks, activity boxes.

Appropriate toys and play for the hospitalized toddler (1 to 3 years)?
Push-pull toys, toy telephones, stuffed animals, etc

Toddlers benefit from being taken to the hospital playroom when able, because mobility is important to their development.

Appropriate toys and play for the hospitalized preschooler (3-6years)?
Coloring books, puzzles, cutting and pasting, clay… etc.

Appropriate toys and play for the hospitalized school-aged child (6-12 years)?
Board and card games, hobbies, video games.

Children can be expected to dress themselves completely when they reach what age group?
School-age children (6-12 years)

When can a child be expected to feed themselves with a spoon and cup?
2 years.

When does the anterior fontanel close?
12-18 months. (1 – 1 1/2 years)

When does the posterior fontanel close?
Sometime between birth and 8ish weeks (2-3 months)

(Yellow NCLEX-RN Review book, pg. 339)

Which fontanel closes first?
The POSTERIOR fontanel.

It closes in birth to 2-3 months. The anterior fontanel closes in 12-18 months.

A baby has a steady head by __
4 months

How would you elicit the rooting reflex?
Touch infants lip, cheek, or corner of mouth with finger.

What would you expect to observe when eliciting the rooting reflex in an infant?
Infant turns head toward stimulus and opens mouth.

Note: Reflex is difficult to elicit when infant has been fed.

How would you elicit the palmar reflex?
Place finger in palm of hand.

How would you elicit the Tonic Neck or “Fencing” reflex, and what is the characteristic response?
With the infant supine, turn their head to one side. The arm and leg on that side should extend; opposite arm and leg should flex.

What is a positive Babinski reflex?
All toes hyperextended, with dorsiflexion of big toe.

When should the Babinski reflex disappear?
SHOULD disappear by 1 year of age.

Two to three word sentences should be expected when a child is how many years old?
2 years.

Three to four word sentences should be expected when a child is how many years old?
3 years.

Visual acuity approaches 20/20 when the child reaches what age group?

(infant, toddler, preschooler, school-age, adolescent)
Preschooler (3-6 years)

Use facts and principles related to ___ in planning teaching interventions.
growth and development

School age children are in Erickson’s stage of , meaning they like to do and accomplish things. _ are also becoming important for children of this age
industry, peers

Age group concepts of bodily injury:

Infants: after 6 months, their development allows them to _ __
Toddler: they fear _ procedures
School-age children: they fear loss of control of _ _
Adolescents: their major concern is _ _ __
Age group concepts of bodily injury:
Infants: after 6 months, their cognitive development allows them to remember pain
Toddler: they fear intrusive procedures
School-age children: they fear loss of control of their bodies
Adolescents: their major concern is change in body image

_ are a major cause of death in children and adolescents. Teach parents and children and prevention techniques
Accidents, developmentally appropriate safety

Pertinent information should be obtianed prior to giving certain because _ to previous ____ or current health condition may contraindicate current __
immunizations, reactions, immunizations, immunizations

What contraindicates administration of DTAP?
history of reactions, siezures, neurologic symptoms after previous vaccine, or systemic reactions

What contraindicates administration of MMR?
history of anaphylactic reaction to eggs or meomycin contraindicate administration

Pertussis fatalities continue to occur in ________ in the US
nonimmuniized infants

Common cold does not contraindicate for _
TB testing

Children with __ pose a serious threat to their unborn siblings.
Ruebella (German measles), the nurse should counsel all expectant mothers, especially those with young children, to be aware of the serious consquenses of exposure to German measles during pregnancy

Common childhood problems are encountered by nurses caring for children in community of hospital settings. The child’s __ directly influences the severity and management of these problems
age

Add _ to fluids in peds with diarrhea only when there is adequte urine output
potassium

Urinary output for infants and children should be _
1-2 ml/kg/hr

The use of _ is no longer recommended
ipecac syrup

More _ is absorbed on an empty stomach.
lead, Hot water can contain higher levels of lead because it dissolves lead more quickly than cold water, so use only cold water for consumption (drinking and especially for making infant formula)

A child needs _ of the usual calorie intake for normal growth and development
150%

Do not examine the throat of a child with
epiglotitis (i.e. do not put a tongue blade or any object into the throat) because of the risk of obstructing the airway completely. Prepare for intubation or trach

In planning and providing nursing care a _____ is always the priority of care regardless of the age!
Patent airway

The nurse should be sure _ _ have been determined prior to tonsillectomy. More importantly, the nurse should ask whether there has been
…PT and PTT, history of bleeding (prolonged or excessive), and whether there is a history of any bleeding disorders in the family

A child from birth to two years conceptualizes the death process as
Cannot grasp the concept of illness and death

A preschool child conceptualizes the death process as
Involving physical harm

Involving death, a schoolage child can
begin to understand something is wrong

Involving death, an adolescent may
express fear, withdrawal, and denial

Rubeola (Measles)

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Paramyxovirus (viral)
Incubation period: 10-20 days
Communicable period: from 4 days before to 5 days after rash appears.
Source: Respiratory tract secretions, blood, or urine
Transmission: Airborne particles or direct contact with infectious droplets; transplacental

Rubeola (Measles)

5 Signs and symptoms

Fever
Malaise
The three “C’s” – coryza, cough, conjunctivitis
Red, erythematous maculopapular eruption starting on face and spreading down towards feet; blanches with pressure and gradually turns brownish color (1 week)
Koplik’s spots: small red spots with a bluish white center and red base, located on buccal mucosa

Remember: Three “Cs” & Koplik’s spots are the key for identifying measles.

Roseola (Exanthema Subitum)

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Human herpesvirus type 6 (viral)
Incubation period: 5-15 days
Communicable period: unknown, but thought to be from febrile stage to time rash appears
Source: unknown
Transmission: unknown

Roseola (Exanthema Subitum)

2 Signs and symptoms?

Sudden high (>38.8 C / >102 F) fever of 3 to 5 day’s duration in a child that appears well, followed by a rash (rose-pink macules that blanch with pressure.
Rash appears several hours to 2 days after fever subsides and lasts 1 to 2 days.

Disease is self-limiting and treatment is supportive. Remember: fever first, then rash.

Mumps

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Paramyxovirus (viral)
Incubation period: 14-21 days
Communicable period: Immediately before and after parotid gland swelling begins.
Source: Saliva of infected persons.
Transmission: Direct contact or droplet spread

Mumps

5 signs and symptoms

Fever
Headache and malaise
Anorexia
Jaw or ear pain aggravated by chewing, followed by parotid gland swelling.
Orchitis (inflamed testes) may occur

Remember: Key is parotid gland swelling.

Pertussis (Whooping Cough)

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Bordetella pertussis (Gram negative bacteria)
Incubation period: 5-21 days (usually 10)
Communicable period: greatest during the catarrhal stage
Source: Discharge from resp. tract of infected person
Transmission: Direct contact or droplet spread

Scarlet Fever

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Group A beta-hemolytic streprococci (Gram positive bacteria)
Incubation period: 1 to 7 days
Communicable period: About 10 days during the incubation period and clinical illness; during the first 2 weeks of the carrier stage, although may persist for months.
Source: Nasophayngeal secretions of infected person and carriers.
Transmission: Direct contact or droplet spread; indirectly by contact with contaminated articles.

Scarlet Fever

7 signs and symptoms

Abrupt high fever, flushed cheeks, vomiting, headache, enlarged lymph nodes in neck, malaise, ab. pain
Red, fine, sandpaper-like rash develops in the axilla, groin, and neck that spreads to cover the entire body except face.
Rash blanches with pressure, except in areas of deep creases and folds of joints.
Desquamanation of skin on palms and soles appears by weeks 1-3
Tongue is initially coated by white, furry covering with red papillae; by fifth day, white coat sloughs off leaving red, swollen tongue (White strawberry tongue -> Red strawberry tongue)
Tonsils are reddened and covered with exudate.
Pharynx is edematous and beefy red

Remember: Key is the strawberry tongue

Erythema Infectiosum (Fifth Disease)

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Human Parvovirus B19 (viral)
Incubation period: 4 – 14 days, may be 20 days
Communicable period: Uncertain, but before onset of symptoms in most children.
Source: Infected persons
Transmission: Unknown mode of transmission, possibly resp. secretions and blood.

Erythema Infectiosum (Fifth Disease)

Signs and symptoms
Fifth Disease is marked by a rash that appears in three stages. Just prior to the rash appearance the child may experience mild fever, malaise, headache or runny nose.

Stage 1: Erythema on face, chiefly on cheeks. “Slapped cheek” appearance. Disappears by 1 – 4 days.
Stage 2: About 1 day after rash appears on face, maculopapular red spots appear, symmetrically distributed on the extremities; the rash progresses from proximal to distal surfaces and may last a week or more.
Stage 3: The rash subsides, but may reappear if skin becomes irritated by sun, heat, cold, exercise, or friction.

REMEMBER: Pregnant women need to avoid infected persons. Key to identification is “slapped cheek” appearance. Child is not usually hospitalized as disease is self-limiting.

Infectious Mononucleosis

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Epstein-Barr virus (viral)
Incubation period: 4 to 6 weeks
Communicable period: Unknown
Source: Oral secretions
Transmission: Direct intimate contact

Infectious Mononucleosis

3 signs and symptoms and 1 important complication to teach parents to monitor for.

Fever, malaise, headache, fatigue, nausea, abdominal pain, sore throat, enlarged red tonsils.
Lymphadenopathy and hepatosplenomegaly
Discrete macular rash most prominent over the trunk may occur.

TEACH PARENTS TO MONITOR FOR SPLENIC RUPTURE: Marked by abdominal pain, left upper quadrant pain, referred left-shoulder pain.

Chickenpox (Varicella)

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Varicella-zoster virus (viral)
Incubation period: 13 to 17 days
Communicable period: From 1 to 2 days before the onset of rash to 6 days after the first crop of vesicles, when crusts have formed.
Source: Respiratory tract secretions of infected persons; skin lesions.
Transmission: Direct contact, droplet, contaminated objects

REMEMBER: Child is no longer contagious once lesions have dried and crusts have formed.

Chickenpox (Varicella)

3 signs and symptoms

Slight fever, malaise, and anorexia are followed by a macular rash that first appears on the trunk and scalp and move to the face and extremities.
Lesions become pustules, begin to dry, and develop a crust.
Lesions may appear on mucous membranes of mouth, genital area, or rectum.

Rubella (German Measles)

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Rubella virus (viral)
Incubation period: 14 to 21 days
Communicable period: From 7 days before to about 5 days after rash appears.
Source: Nasopharyngeal secretions; virus is also present in blood, stool, urine.
Transmission: Airborne or direct contact w/infectious droplets. Indirectly via articles freshly contaminated. Also transplacental.

Rubella (German Measles)

4 signs and symptoms and 1 very important intervention to remember

low-grade fever
Malaise
Pinkish red maculopapular rash the begins on face and spreads to the entire body within 1 to 3 days.
Petechial, red, pinpoint spots may appear on the soft palate.

Key for identification is rash covering entire body and spots on soft palate.

REMEMBER: ISOLATE CHILD FROM PREGNANT WOMEN.

Diphtheria

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Corynebacterium diptheriae
Incubation period: 2 to 5 days
Communicable period: Variable. Until virulent bacteria are no longer present (three consecutively negative cultures of pharyngeal secretions); usually 2 weeks, can be 4 weeks.
Source: Discharge from mucous membranes of nose and nasopharynx, skin and other lesions.
Transmission: Direct contact with infected person, carrier, or contaminated articles

Diphtheria

4 signs and symptoms and 2 important interventions

low-grade fever, malaise, sore throat
Foul-smelling, mucoprurulent nasal discharge
Dense pseudomembrane formation of the throat that may interfere with eating, drinking and breathing.
Lymphadenitis, neck edema, “bull neck”

Interventions: Strict isolation for hospitalized child. Administer diphtheria antitoxin only AFTER a skin or conjunctival test rules out sensitivity to horse serum.

Rocky Mountain Spotted Fever

Agent?
Incubation period?
Communicable period?
Source?
Transmission?
Agent: Rickettsia rickettsii (Gram negative bacteria)
Incubation period: 2 to 14 days
Communicable period: NOT CONTAGIOUS
Source: Tick bite from mammal, usually wild rodents and dogs.
Transmission: Tick bite

Rocky Mountain Spotted Fever

2 signs and symptoms

Fever, malaise, anorexia, vomiting, headache, myalgia
Maculopapular OR petechial rash primarily on the extremities (ankles and wrists), but may spread to other areas, characteristically on the palms and soles.

Key: Rash on ankles, wrists, palms and soles. Remember it is not communicable. Provide parents teaching about preventing tick bites.

H1N1 Vaccine: When are children old enough to receive it?
6 months. Children younger than six months are not old enough, but family members and caregivers should be vaccinated.

Human Papillomavirus Vaccine

How many injections comprise the full course of vaccination and at what age should girls receive it? What age should boys receive it?
HPV vaccine is administered in three injections over six months. First dose, then the second dose 2 months later, followed by the final dose 6 months after the first.

Girls can receive it around age 11 to 12.
Boys can receive it from age 9 to 18.

Guards against cervical cancer and genital warts in females and genital warts in males.

Contraindications for HPV vaccine?

Individuals with a reaction to a previous injection.
PREGNANT WOMEN should not receive HPV vaccine.

Pinworm Infection
Obtain rectal specimen by tape test in the morning when the child awakens

Simple fx
Fx of the bone across its entire shaft with some possibly displacement without breaking the skin

Greenstick fx
Incomplete fracture

Communated fx
Complete fx across the shaft of the bone with splintering of the bone fragments

Compound fx
Skin or mucous membrane has been broken

Birth weight _ at 6 months and at 12 months
Doubles at 6 months, and triples at 12 months

Birth length increases by _ at 12 months
50%

A baby will turn their head over at _ months
5-6

Hand-to-hand transfers occur when?
7 months

An infant will crawl at
10 months

An infant will walk at
10-12 months

Cooing will be seen at
2 months

Monosyllabic Babbling will happen at _ months. Links syllables at __.
3-6 months
links syllables at 6-9 months

Babies can say “mama” and “dada,” plus a few other words at
9-12 months

Daytime toilet training should be taught at
18months to 2 years

Girls’ growth spurt as early as _ years. Boys catch up around age
girls: 10 years, boys: ~ 14

Girls finish growing around . Boys finish growing around .
Girls ~ 15
Boys ~ 17

Concerning new foods, babies should ________________
Be introduced one new food at a time.

Autosomal Recessive Diseases
CF, PKU, Sickle Cell Anemia, Tay-Sachs, Albinism

Concerning Autosomal Recessive Diseases, there is a _ chance a child will inherit the disease if the parents have: AS (trait only) X AS (trait only)
25%

Concerning Autosomal Recessive Diseases, there is a _ chance a child will inherit the disease if the parents have: AS (trait only) X SS (disease)
50%

Some Autosomal Dominant Diseases are
Huntington’s, Marfans, Polydactyl, Achondroplasia, Polycystic Kidney Disease

If one parent has the disease/trait of Autosomal Dominant Diseases there is a _ chance the child will inherit (and express) the disease.
50%

X-linked recessive diseases are
Muscular Dystrophy, Hemophilia A

In X-Linked Recessive Diseases, females are but _ have the disease.
carriers, dont ever

In X-Linked Recessive Diseases, males the disease but cannot _.
Have, pass it on

X-Linked Recessive Diseases there is _ chance daughters will be carriers, even though they cant ______
50%, have the disease

X-Linked Recessive Diseases there is _ chance sons will have the disease, even though they cant __
50%, pass it on

X-Linked Recessive Diseases there is an overall _ chance that each pregnancy will result in a __________
25%, child that has the disease

With Scoliosis, the child should be in a _ for _ hours a day, and after Surgery
Milwaukee Brace, 23 hrs/day, Log rolling

You would expect a child with Down Syndrome, or Trisomy 21, will have these characteristics
Simian creases on palms, hypotonia, protruding tongue, upward outward slant of eyes

You would expect a child with Cerebral Palsy to present with
Scissoring = legs extended, crossed, feet plantar-flexed

Hypothyroidism can lead to
Mental Retardation

PKU can lead to
Mental Retardation

Aspartame (NutraSweet) has __ in it and should not be given to a PKU patient
phenylalanine

The __ will test the dried blood heel stick and screen for PKU
Guthrie Test

In a child with _ the nurse should cover it with moist sterile water dressing, and __ of it.
Myelomeningocele, keep pressure off

In Hydrocephalus the signs of increased ICP are ____
Opposite of shock

Indications of shock are ________. Indications of IICP are ________.
Shock = Increased pulse and decreased BP
IICP = Decreased pulse and increased BP

The most sensitive sign of IICP is

Altered LOC

IICP can be caused by
suctioning, coughing, straining, and turning

Signs of IICP in infants include
Bulging fontanels, high pitched cry, increased hd circum, sunset eyes, wide suture lines, lethargy

For infants with IICP, treat with _ shunt. Do not __ the shunt.
peritoneal shunt, do not pump

Older kids with IICP will have
a widened pulse pressure

Muscular Dystrophy is an _ diease characterized by
X-linked Recessive, waddling gait, hyper lordosis, and fat pseudohypertrophy of calves.

Children with Muscular Dystrophy will display __ sign.
Gower’s Sign (walking up own body)

Bacterial Meningitis is diagnosed with a
Lumbar puncture which shows increased WBC, protein, IICP and decreased glucose

Bacterial Meningitis can lead to because of . The following signs will be seen:
SIADH, too much ADH; Water retention, fluid overload, and dilutional hyponatremia

CF Kids taste and need _________ on their food.
salty, enzymes sprinkled

Children with Rubella can be a ________________
= threat to unborn siblings (may require temporary isolation from Mom during PG)

No MMR immunization for kids with Hx of allergic rxn to or __
eggs or neomycin

Immunization Side Effects include ___. For this, ________
T < 102, redness and soreness at injection site for 3 days; give Tylenol and bike pedal legs (passively) for child

After immunization, call the physician if the patient experiences
A seizure, high fever, or high-pitched cry

For all cases of poisoning, ____. DO NOT give _.
Call Poison Control Center, No Ipecac!

Epiglottitis is caused by _. The child will sit ________.
H. influenza B., Child sits upright with chin out and tongue protruding (maybe Tripod position)

For a patient with RSV, use a _ to provide O2 and .
Mist tent, Ribavirin

_ RSV with contact precautions.
Isolate

Acute Glomerulonephritis: after antigen-antibody complexes clog up _ and reduce . This results in the presence of ___ and proteinuria.
Strep B, glomeruli, GFR, dark urine

Wilm’s Tumor is a _. If you know a patient has this ____.
Large kidney tumor, Don’t palpate

TEF =
The 3 C’s of TEF
Tracheoesophageal Atresia, coughing, choking, cyanosis

For cleft lip and palate, the _ will be corrected first. Post-op both procedures, place on and maintain _ and _.
lip, side, Logan Bow, elbow restraints

If a child has no meconium within 24 hrs or ribbon-like foul smelling stools suspect or __. This is caused by a _ due to absence of ganglionic cells in colon.
Congenital Megacolon = Hirschsprung’s Disease; lack of peristalsis

With Iron Deficiency Anemia, nursing care should include _____. Be sure to use a _ to avoid __
Give Iron on empty stomach with citrus juice (vitamin C enhances absorption), straw, staining teeth.

With Iron Deficiency Anemia, expect stools to be _ and limit _
Tarry, milk intake to <32 oz/day

In Sickle Cell Disease, _ is most important inorder to avoid a _____.
Hydration, SC Crisis

Sickle Cell Crisis is characterized by
fever, abd pain, painful edematous hands and feet (hand-foot syndrome), arthralgia

In a Sickle Cell Crisis, the treatment is
Rest, hydration, and avoid high altitude and strenuous activities

Tonsillitis is usually caused by . Pre-Op be sure to get __ and ask about a history of bleeding.
Strep, PT and PTT

Post-Op tonsillectomy if frequent swallowing, vomiting blood, or clearing throat ____. The highest risk of __ is in the first 24 hours and 5-10 days post-op with the cloughing of scabs.
Suspect bleeding, hemorrhage

Primary meds in ER for respiratory distress
Sus-phrine (Epinephrine HCl) and Theophylline (Theo-dur) … Both bronchodilators

Primary reason for most medical/ER visits for kids is ___.
Respiratory disorders

Normal respiratory rates for kids-
Newborn, 1-11 months, 1-3 years, 3-5 years, 6-10 years, 11-16 years
Newborn … 30-60

1-11 mo … 25-35
1-3 years … 20-30
3-5 years … 20-25
6-10 years … 18-22
11-16 years …16-20

Concerning Pediatric Cardiovascular Disorders, if the child is Acyanotic, suspect
VSD, ASD, PDA, Coarc of Aorta, Aortic Stenosis

__ cause closure of PDA. (aorta – pulmonary artery)
Antiprostaglandins

Concerning Pediatric Cardiovascular Disorders, if the child is cyanotic, suspect ______________. _ is common in cyanotic disorders.
Tetralogy of Fallot, Truncus Arteriosis, TVG; Polycythemia

Truncus Arteriosis is when
one main vessel gets mixed blood

TVG is
Transposition of Great Vessels

The 3 T’s of Cyanotic Heart Disease
Tetralogy, Truncus, Transposition

Tetralogy of Fallot is when
Unoxygenated blood pumped into aorta

Tetralogy of Fallot can cause
Pulmonary Stenosis, VSD, Overiding Aorta, Right Ventricular Hypertrophy, TET Spells, and CHF

TET Spells are
Hypoxic episodes that are relieved by squatting or knee chest position

is the treatment for CHF. A TR is for kids.
Digoxin, TR = 0.8-2.0 for kids

Ductus Venosus is when the
Umbilical Vein to Inferior Vena Cava

Ductus Arteriosus is when the
Aorta to Pulmonary Artery

Rheumatic Fever is an which affects _____.
Acquired Heart Disease, aortic and mitral valves

Rheumatic Fever is preceded by _____. A large Rheumatic Fever characteristic is __________. Other characteristics are _______________.
beta hemolytic strep infection, erythema Marginatum = Rash; Chest pain, shortness of breath (Carditis), migratory large joint pain, tachycardia (even during sleep)

Rheumatic Fever labs show _____________. Treat with _ which is a _ for recurrence of RF
Elevated ASO titer and ESR, Penicillin G, Prophylaxis

List 2 contraindications to live virus immunization

Immunocompromised child.
Child in household with immunocompromised indiv

List 3 class S/S of measles

Photophobia
Confluent rash that begins on face and spreads downwards
Koplik spots on buccal mucosa

List S/S of iron deficiency
Anemia, pale conjunctive, pale skin color, atrophy of papillae on tongue, brittle, ridges, or spoon-shaped nales, and thyroid edema

ID food sources of Vit A
liver, sweet potatoes, carrots, spinach, peaches, apricots

What dz occurs with Vit C deficiency?
Scurvy

What measurements reflect present nutritional status?
Weight, skinfold thickness, and arm circumference

List the S/S of dehydration in an infant
Poor skin turgor, absence of tears, dry mucous membranes, weight loss, depressed fontanels, and decreased UO

List the lab findings that can be expected in a dehydrated child
Loss of bicarb/decreased serum pH, loss of Na (hyponatremia), loss of K (hypokalemia), elevated Hct, and elevated BUN

How should burns in children be assessed?
By using the Lund-Browder chart, which takes into account the changing proportions of the child’s body

How can the nurse best evaluate the adequacy of fluid replacement in children?
By monitoring UO

How should a parent be instucted to childproof a house?
By being taught to lock all cabinets, to safely store all toxic household itemsin locked cabinets, and to examine the house fromt he child’s POV

What interventions should the nurse perform first in caring for a child who has ingested a poison?
Assessment of the child’s respiratory, cardiac, and neuro status

What early signs should the nurse assess for if lead posioning is suspected?
Anemia, acute cramping, abdominal pain, vomiting, constipation, anorexia, headache, lethargy, hyperactivity, aggression, impulsiveness, decreased interest in play, irritability, short attn span

Describe the purpose of bronchodilators
To reverse bronchospasm

What are the physical assessment findings for a child with asthma?
Expiratory wheezing, rales, tight cough, and signs of altered ABGs

What nutritional support should be provided for a child with CF?
Pancreatic enzyme replacement, fat-soluble vitamins, and a moderate- to low-carb, high-protein, mod- to high-fat diet

Why is genetic counseling important for the family of a child with CF?
Because the dz is autosomal recessive

List 7 signs of resp distress in a pedi client
Restlessness, tachycardia, tachypnea, diaphoresis, flaring nostrils, retractions, grunting

Describe the care of a child in a mist tent
Monitor child’s temp; keep tent edges tucked in; keep clothing dry; assess resp status; look at child inside tent

What position does a child with epiglottitis assume?
Upright sitting, with chin out and tongue protruding (‘tripod position”)

Why are IV fluids important for a child with an increased resp rate?
The child is at riisk for dehydration and acid-base imbalance

Children with chronic OM are at risk for developing what problem?
Hearing loss

What is the most common postop complication following a tonsillectomy? Describe the s/s of this complication
Hemorrhage. S/S: frequent swallowing, vomiting fresh blood, and clearing throat

Differentiate between a right-to-left and a left-to-right shunt in cardiac dz
A R-to-L shunt bypasses the lungs and delivers unoxygenated blood to the systemic circulation, causing cyanosis. A L-to-R shunt moves oxygenated blood back through the pulmonary circulation.

List the 4 defects assoc’d with tetralogy of Fallot
VSD, overriding aorta, pulm stenosis, and right ventricular hypertrophy

List the common signs of cardiac problems in an infant
Poor feeding, poor wt gain, resp distress and infections, edema, and cyanosis

What are the 2 objectives in treating congestive heart failure?

Reduce the workload of the heart
Increase cardiac output

Describe nursing interventions to reduce the workload of the heart
Give small, frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutral thermal environment. Organize activities to disturb child only as indicated.

What position would best relieve the child experiencing a tet spell?
Knee-chest position or squatting.

What are common signs of digoxin toxicity?
Diarrhea, fatigue, weakness, N/V; the nurse should check for bradycardia prior to Dig administration

List 5 risks in cardiac catheterization
Arrhythmia, bleeding, perforation, phlebitis, and obstruction of the arterial entry site

What cardiac complications are assoc’d with rheumatic fever?
Aortic valve stenosis and mitral valve stenosis

What medications are used to tx rheumatic fever?
Penicillin, erythromycin, and aspirin

What are the physical features of a child with Down syndrome?
Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes

Describe scissoring.
A common characteristic of spastic cerebral palsy in infants; legs are extended and crossed over each other, feet are plantarflexed

What are 2 nursing priorities for a newborn with myelomeningocele?
Prevention of infn of the sac and monitoring for hydrocephalus (measure head circumference, check fontanels, assess neuro functioning)

List the S/S of increased ICP in older children
Irritability, change in LOC, motor dysfunction, headache, vomiting, unequal pupil response, and seizures

What teaching should parents of a newly shunted child receive?
Information about signs of infn and increased ICP, understanding that shunt should not be pumped and that child will need revisions with growth, guidance concerning growth and development

State the 3 main goals in providing nsg care for a chile experiencing a seizure

Maintain patent airway
Protect from injury, and
Observe carefully

What are the side effects of Dilantin (Phenytoin)?
Gingival hyperplasia, dermatitis, ataxia, GI distress

Describe the S/S of a child with meningitis
Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig sign, positive Babinski sign (toes should not fan on stimulation, a positive sign, after 18mos), infant may not show all classic signs even though very ill

What ABX are usually prescribed for bacterial meningitis?
Ampicillin, penicillin, or chloramphenicol

How is a child usually positioned after brain tumor surgery?
Flat or on either side

Describe the function of an osmotic diuretic
Osmotic diuretics (i.e. Manitol) remove water from the CNS to reduce cerebral edema

What nsg interventions increase intracranial pressure?
Suctioning and positioning, turning

Describe the mechanism of inheritance of Duchenne muscular dystrophy
Duchenne muscular dystrophy is inherited as an X-linked recessive trait

What is the Gowers sign?
Gowers sign is an indicator of muscular dystrophy; to stand, the child has to “walk” hands up legs

Compare the S/S of acute glomerulonephritis (AGN) with those of nephrosis
AGN: gross hematuria, recent Strep infn, HTN, and mild edema.
Nephrosis: severe edema, massive proteinuria, frothy-appearing urine, anorexia

What antecedent event occurs with AGN?
Beta-hemolytic Streptococcal infn

Compare the dietary interventions for AGN and nephrosis
AGN: low-sodium diet with no added salt.
Nephrosis: high-protein, low-salt diet

What is the physiologic reason for the lab finding of hypoproteinemia in nephrosis?
Hypoproteinemia occurs because the glomeruli are permeable to serum proteins

Describe safe monitoring of prednisone administration and withdrawal
Long-term prednisone (a corticosteroid) should be given every other day. Signs of edema, mood changes, and GI distress should be noted and reported. The drug should be tapered, not discontinued suddenly.

What interventions can be taught to prevent urinary tract infns in children?
Avoid bubble baths, void frequently, drink adequate fluids (especially acidic fluids such as apple or cranberry juice), and clean genital area from front to back

Describe the pathophysiology of vesicoureteral reflux
A malfunction of the valves at the end of the ureters, allowing urine to reflux out of the bladder into the ureters and possibly into the kidneys

What are the priorities for a client with a Wilms tumor?
Protect the child from injury to the encapsulated tumor. Prepare the family and child for surgery.

Explain why hypospadias correction is performed before the child reaches preschool age.

Preschoolers fear castration
To achieve sexual identity, and
To acquire independent toileting skills

Describe feeding techniques for a child with cleft lip or palate
Use lamb’s nipple or prosthesis. Feed child upright, with frequent bubbling

List the S/S of esophageal atresia with TEF
Choking, coughing, cyanosis, and excess salivation

What nsg actions are initiated for the newborn with suspeted esophageal atresia with TEF?
Maintain NPO immediately, and suction secretions

Describe the postop nsg care for an infant with pyloric stenosis
Maintain IV hydration, and provide small, frequent oral feedings of glucose or electrolyte solutions or both w4ithin 4-6 hours. Gradually increase to full-strength formula. Position infant on right side in semi-Fowler position after feedings

Describe why a barium enema is used to tx intussusception
A barium enema reduces the telescopign of the intestine through hydrostatic pressure without surgical intervention

Describe the preop nsg care for a child with Hirschsprung dz
Check VS and take axillary temperatures. Provide bowel cleansing program, and teach about colostomy. Observe for bowel perforation; measure abd girth

What care is needed for a child with a temporary colostomy?
Family needs education about skin care and appliances. Referral to an enterostomal therapist is appropriate

What are the signs of anorectal malformation?
A newborn who does not pass meconium within 24 hours, meconium appearing through a fistula or in the urine; an unusual-appearing anal dimple

What are the priorities for a child undergoing abd surgery?
Maintain fluid balance (I&O, nasogastric suction, monitor electrolytes); monitor VS; care for drains, if present; assess bowel function; prevent infn of incisional area and other postop complications; and support child and family with appropriate teaching

Describe the info families should be given when a child is receiving oral Fe preparations
Give oral Fe on an empty stomach and with Vitamin C. Use straws to avoid discoloring teeth. Tarry stools are normal. Increase dietary sources of Fe

List dietary sources of Fe.
Meat, green leafy vegetables, fish, liver, whole grains, legumes

What is the genetic transmission pattern of hemophilia?
It is an X-linked recessive chromosomal disorder transmitted by the mother and expressed in male children

Describe the sequence of events in a vaso-occlusive crisis in sickle cell anemia
A vaso-occlusive crisis is caused by the clumping of red blood cells, which blocks small blood vessels; therefore, the cells cannot get through the capillaries, causing pain and tissue and organ ischemia. Lowered oxygen tension affects HgbS, which causes sickling of the cells

Explain why hydration is a priority in treating sickle cell dz
Hydration promotes hemodilution and circulation of the red cells through the blood vessels

What should families and clients do to avoid triggering sickling episodes?
Keep child well hydrated. Avoid known sources of infns. Avoid high altitudes. Avoid strenous exercise.

Nsg interventions and medical txs for a child with leukemia are based on what 3 physiologic problems?

Anemia (decreased erythrocytes)
Infection (neutropenia)
Bleeding thrombocytopenia (decreased platelets)

How is congenital hypothyroidism diagnosed?
Newborn screening revealing low T4 and high TSH

What are the symptoms of congenital hypothyroidism in early infancy?
Large, protruding tongue, couarse hair, lethargy, sleepiness, and constipation

What are the outomes of untx’d congenital hypothyroidism?
Mental retardation and growth failure

What are the metabolic effects of PKU?
CNS damage, mental retardation, and decreased melanin

What 2 formulas are prescribed for infants with PKU?
Lofenalac and Phenex-I

List foods high in phenylalanine content
Meat, milk, dairy products, and eggs

What are the 3 classic signs of diabetes?
Polydipsia, polyphagia, and polyuria

Differentiate the signs of hypoglycemia and hyperglycemia
Hypoglycemia: tremors, sweating, HA, hunger, nausea, lethargy, confusion, slurred speech, anxiety, tingling around moth, nightmares.
Hyperglycemia: polydipsia, polyuria, blurred vision, weakness, wt loss, and syncope

Describe the nsg care of a child with ketoacidosis
Provide care for an unconscious child, administer regular insulin IV, monitor ABGs (Na bicarb for met acidosis), and maintain strict I&O

Describe developmental factors that would impact the school-age child with diabetes
Need to be like peers, assuming responsibility for own care, modification of diet, snacks and exercise in school

What is the relationship between hypoglycemia and exercise?
During exercise, insulin uptake is increased and the risk for hypoglycemia occurs (give less insulin before exercise, insulin causes hypoglycemia)

List normal findings in a neurovascular assessment
Warm extremity, brisk capillary refill, free movement, normal sensation of the affected extremity, and equal pulses

What is compartment syndrome?
Damage to nerves and vasculature of an extremity due to compression

What are the S/S of compartment syndrome?
Abnormal neurovascular assessment: cold extremity, severe pain, inability to move the extremity, and poor capillary refill

Why are fractures of the epiphyseal plate a special concern?
Fractures of the epiphyseal plate may affect the growth of the limb

How is skeletal traction applied?
Skeletal traction is maintained by pins or wires applied to the distal fragment of the fracture

What D/C instructions should be included concerning a child with a spica cast?
Check child’s circulation. Keep cast dry. Do not place anything under cast. Prevent cast soilage during toileting or diapering. Do not turn child using an abductor bar.

What are the S/S of congenital dislocated hip in infants?
Unequal skin folds of the buttocks. Ortolani sign, limited abduction of the affected hip, and unequal leg lengths

How would the nurse conduct a scoliosis screening?
Ask the child to bend forward form the hips, with arms hanging free. Examine the child for a curve in the spine, a rib hump, and hip asymmetry

What instructions should a child with scoliosis receive about the Milwaukee brace?
The child should be instructed to wear the brace 23 hours per day; wear a T-shirt under brace; check skin for irritation; perform back and abd exercises, and modify clothing. The child should be encouraged to maintain normal activities as able

What care is indicated for a child with juvenile rheumatoid arthritis?
Prescribed exercise to maintain mobility, splinting of affected joints, and teaching about medication management and side effects of drugs.

Which vaccine has decreased the incidence of epiglottitis?
Haemophilus influenzae type b (Hib) conjugated vaccine

When is the Hib vaccine series started?
Started at two months of age. 3 to 4 subsequent doses are given at two-month intervals after the first does. Children should complete the Hib vaccine series by 15 months of age.

The pneumococcal conjugate vaccin (PCV) prevents infection due to which bacterium.
Streptococcus pneumoniae
Epiglottitis can result from Streptococcus pneumoniae infection.

How many doses of PCV are given?
Four doses. started at two months of age. two subsequent doses are given at two-month intervals. should be completed by 15 months of age

At what age is a child’s airway fully developed?
eight years of age

Haemophilus influenzae type b (Hib) is transmissible through which contact?
Nasopharyngeal/resiratory secretions. Droplet precautions and standard precautions are needed.

What are the signs of air flow restriction and impaired tissue oxygenation?
physiologic compensation: respiratory rate increases, heart rate increases

What is the best way to administer oxygen to a toddler?
blow-by oxygen

After how many hours on antibiotics, will epiglottitis due to Hib will no longer be communicable?
24 hr.

Is bronchiolitis caused by a virus?
Yes, respiratory syncytial virus (RSV)
peaks from mid-winter to early spring
Occurs in infants and young children
inflammation of the bronchiloes (lower airway structures)

Clinical manifestations of bronchiolitis include?
tachypnea, tachycardia, adventitious breath sounds, retractions, apneic episodes

Are RSV infections contagious?
yes

List the precautions used for a pt. with RSV in the hospital.
Private room, hand washing, use of clean gloves by carergivers, masks, gown

Nursing diagnosis for RSV
Ineffective airway clearance related to increased respiratory secretions.
Risk for deficient fluid volume
Activity intolerance
Interrupted family processes related to hospitalization.

The best way to administer oxygen to a child three month old is by?
oxygen hood

The isotonic intravenous solution dextrose 5% in .45% NS is used to?
Replenish fluid losses, maintain fluid balance, and provide calories probalby

What are clinical manifestations following foreign body aspiration?
Sudden, violent cough, gagging, vomiting, wheezing, brief episodes of apnea, and cyanosis

Foreign body aspirations is common in which age group?
six months to five years

Signs and symptoms in croup include:
wheezing, harsh cough, hoarseness, dyspnea

Treatment for croup includes?
coll mist therapy and Racemic epinephrine with normal saline delivered with humidified oxygen

How does epinephrine alleviate symptoms of croup?
vasoconstriction, causes a decrease in blood flow to highly vascular larynx and surronding repiratory tissues

when does the birth length double ?
by four years

when does the child sit unsupported?
8 months

when does a child achieve 50% of adult height?
2 years

WHEN DOES A CHILD THROW A BALL OVERHAND?
18 MONTHS

when does a child speak two-to three word sentences
2 years

what is the eriksons stage for an infant?
trust vs mistrust

when does a child use sissors
4 years

whe does a child tie his/her shoe
5 years

at what age does the birth weight double?
by 6 months

at what age does birth weight triple?
12 months

the posterior fontanel closes by?
8 weeks

social smile occurs by ?
2 months

steady head controls is achieved by?
4 months

what is the age range for a todddler?
1-3 years

the birth weight quadruples by ?
30 months

the child appears to be bowlegged and potbellied by which age?
1-3

what is common with the toddler age group?
temper tantrums

what is the Erickson’s theory for toddlers ?
autonomy vs doubt and shame

during hospitalization, __(what) from parents is the greatest threat to the toddlers psychological and emotional integrity
enforced separation

with toddlers what is the main type of toy as far as toys are concered?
push-pull

what should be supported by providing guided choices when appropriate ?
autonomy

toddlers are learning to name body parts and are concerned about their? _(what)?
body parts

what age is the preschool child?
3-6 years

the preschool child’s thinking becomes?
more egocentric and concrete

at what age does the child learn sexual identity?
3-6 years (preschool child)

at what age are imaginary playmates and fears common?
3-6 years (preschool child)

what is the erikson’s theory for a preschool child?
initiative vs guilt

when caring for a preschool child explain that he or she did not ? and that painful procedures are not a ? for misdeeds
cause the illness; punishment

this allows for the preschool child to act out his or her experiences and may be helpful?
therapeutic play

_____by procedures is common. a______may be quite helpful in restoring body integrity
fear of mutilation; band-aide

what task could a 5 year old boy with diabetes expect to accomplish by himself?
let him choose the injection sites

what is the age range for the school-age child?
6-12

girls may experience what?
menarche

at what age does the loss of primary teeth and eruption of most permanent teeth occurs
school-age child

at what age is egocentric thinking replaced by social awareness of others?
school age

what is the Erickson’s theory?
industry vs inferiority

what is the Erickson’s theory for the adolescent?
identity vs role confusion

at what age is the infant able to remember pain?
6 months

which age group fear intrusive procedures?
toddlers

which age group fear body mutilation?
preschoolers

which age group fear loss of control of their bodies?
school-age

which age group has their major concern being a change in body image
adolescents

what is a major cause of death in children and adolescents?
accidents

with the pediatric client physiologic responses to pain are most on seen in response to______rather than in response to chronic pain
acute pain

what should be verified prior to administration a pain medication to a pediatric client ?
safe does based on weight

which vaccine should be held if a child has a history of an anaphylactic reaction to eggs or neomycine
MMR

which reflex? baby turns toward stimulus when cheek or corner of lip is touched. how long does it last?
rooting; 3-4 months

when startled, baby symmetrically extends and abducts all extremities forefingers form a c shape? how long does this last for?
Moro; 3-4 months

when neck is turned to side, baby assumes fencing posture, how long does it last for?
tonic neck; 3-4 months

when sole of foot is stoked from heel to ball, toes hyper-extend and fan apart from big toe. how long does it last for? how long does it last for
babinski; 1 year to 18 months

when examiners finger is placed in the infants palm, the newborn will curl his or her fingers around the examiners finger? how long will this last for?
palmar grasp; 3-4 months

a finger at base of toes causes them to curl downward? how long does it last for?
plantar; 8 months

when infant is held in upright position with feet touching a hard surface, walking motions are made? how long does it last for?
stepping; 3-4 months

what is the normal temp of an infant
97.7-99.4f ; 36.5-37.5 c

what is the normal BG for an infant? when do you report at BG?
40-80; when it gets below 40

When does birth length double?
By 4 years.

When does the child sit unsupported?
8 months.

When does a child acheive 50% adult height?
2 years.