Peds Exam 2

1. Peds Exam 2

2. Clinical manifestations of increased ICP in children include all of the following except: • Headache • Vomiting, w/ or w/o nausea • Seizures • Setting-sun sign

3. FYI: late signs of inc’d ICP • Dec’d LOC • Dec’d motor response to command • Dec’d sensory response to painful stimuli • Alterations in pupil size & reactivity • Papilledema (optic nerve swelling) • Cheyne-Stokes repsirations • Decerebrate or decorticate posturing

4. Nurse caring for 8yo w/ dx of basilar skull fracture. Which order would nurse question? • Clear liquid intake • Maintain patent IV line • Daily weight • Suction as needed

5. Nurse monitoring child for bleeding post brain tumor resection. Checks head dressing & notes colorless drainage on back of dressing. Which would be most appropriate intervention? • Circle area of drainage & continue to monitor • Reinforce dressing • Notify physician • Document findings & continue to monitor

6. Post op removal of brain tumor, physician order to maintain child in flat position. Nurse monitoring notes child is restless, pulse rate is elevated & BP has dropped significantly from baseline. Suspects shock. Which would be most appropriate nursing action? • Place child in Trendelenburg’s position • Elevate head of bed • Increase IV fluids • Notify physician

7. Lumbar puncture performed on child w/ suspected bacterial meningitis. Which of the following CSF results would verify dx? • Cloudy CSF, dec’d protein, dec’d glucose • Cloudy CSF, inc’d protein, dec’d glucose • Clear CSF, inc’d protein, dec’d glucose • Clear CSF, dec’d pressure, elevated protein

8. Which statement regarding meningitis is true? • Both viral & bacterial meningitis may have an associated fever • Stiff neck is the most common symptom in infants w/ bacterial meningitis • Headaches only occur w/ bacterial meningitis • Viral meningitis is more easily detected than bacterial meningitis is children

9. Which of the following vaccine(s) protects infants from bacterial meningitis (there may be more than one)? • IPV (polio) • PCV (pneumococcal) • DTaP (diptheria, tetanus, pertussis) • Hib (haemophilus influenzae type b)

10. Which of the following positions is the most effective in preventing a further increase in ICP? • Left side lying, head flexed, knees drawn up • Trendelenburg position • Fowlers position • Supine w/ 30o head elevation

11. Adolescent discharged w/ prescription for phenytoin (Dilantin). Which of the following by father indicates discharge teaching has been effective? • I need to admin her medicine in the morning & evening • I will keep the annual appt for f/u on her med • I will be sure to encourage good oral care & regular dental visits • I can allow her to stop taking the med after 6wks, as long as there are no seizures

12. Parent of 9yo w/ GH deficiency asks nurse how long son will need to take injections for his growth problem. Which is most appropriate? • Injections are usually cont’d until age 10 for girls & 12 for boys • Injections need to continue until child reaches the 5th percentile on the growth chart • Injections should be cont’d until bone maturation is complete, usually between 14-16yrs • The injections will need to be administered throughout the child’s entire life.

13. During which of the following periods of growth & dev’t should a nurse anticipate behavioral problems form a child w/ untreated GH deficiency? • Infant • Preschooler • School-age • Adolescent

14. When providing health teaching to group of adolescents w/ type 1 d.m., a nurse instructs them that a hypoglycemic reaction can occur b/c of: • Too much glucose in the body • Eating too much junk food • Exercising strenuously • Not enough insulin in the body

15. Nurse caring for child w/ type 1 d.m. who has been taking insulin for 3 mos. Which diagnostic study will provider likely order to determine how well child’s diabetes is being managed? • Morning faster blood glucose • 2hr oral glucose tolerance test • Hb1Ac • Diary of child’s daily blood glucoses

16. Place the following steps in order when treating hypoglycemia: • Recheck blood glucose • Treat w/ 15g carbs • If still low, give 15g more carbs • Stop activity & sit down • Recheck blood glucose

17. Child brought by parents to ER w/ 1st degree burns to shoulders from sun exposure. Which interventions are indicated? • Start IV of NS • Apply cool, wet compresses • Scrub area w/ soft-bristle brush • Admin morphine sulfate for pain relief

18. Child experiences 3rd degree burns to both legs after they were immersed in boiling water. Which nursing diagnoses will receive priority during the first 24 hours? • Deficient fluid volume • Imbalanced nutrition: less than body requirements • Impaired breathing pattern • Disturbed body image

19. Mother of 3yo arrives at clinic & tells nurse that child has been scratching the skin continuously & has developed a rash. Nurse assess & suspects scabies. Nurse bases this suspicion on which finding: • Clusters of fluid filled vesicles • Fine, threadlike lines • Purple-colored lesions • Thick, honey colored crusts

20. Which of the following orders should a nurse implement first for a child w/ a UTI? • Ampicillin 250mg IV q 12hr • Blood & urine cultures • Sitz bath prn for pain • Voiding cystourethrogram (VCUG)

21. 3yo being admitted w/ nephrotic syndrome. Best roommate is: • 16yo recovering post-op from ruptured appendix • 8yo w/ leukemia • Another toddler w/ rheumatic fever • No roommate because isolation is required

22. Admission assessment on 2yo who has been dx’d w/ nephrotic syndrome. Nurse knows that most common characteristic assoc’d w/ it is? • Generalized edema • Frank bright red blood in urine • Inc’d urinary output • hypertension

23. Parents of child w/ glomerulonephritis concerned about activity restrictions after discharge. Nurse bases response on the fact that urinary findings are near normal. • Activity must be limited for 1 mo • Child must not play active games • Child must remain in bed for 2 wks • Activity does not affect course of disease

24. Which nursing intervention has highest priority when caring for child w/ acute glomerulonephritis? • Assess for dysuria • Monitor BP • Monitor temp • Assess for jaundice

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

26. Failure to repair hypospadias can lead to testicular cancer later in life. • True • False

27. To prevent swelling of casted extremity, elevate the extremity above heart level & apply ice to cast. • True • False

28. Which of the following is an early sign of impaired neurovascular function in a child w/ an arm cast? • Cool, cold fingers • Pain • Inability to detect a pulse distal to cast • Inability to move distal extremity

29. Choose the most appropriate roommate for a 16yo in a full body cast. • 12 yo w/ inguinal hernia repair • 9 yo w/ gastroenteritis • 6 yo w/ fractured femur • 15 yo w/ pneumonia

30. When caring for child in Bryant’s traction, nurse should be aware that this traction is: • Skin traction to the affected leg • Attached to a pin placed in the affected femur • Used to allow child to turn from side to side • Skin traction & elevates hips slightly from bed

31. Nurse detects a positive Ortolani sign in a newborn. What is the nurse assessing? • Broadening of perineum • Shortening of one leg • Audible click on hip manipulation • Unilateral droop of hip

32. 13mo old dx’d w/ L hip dysplasia & scheduled for surgery & spica cast. Child’s mother questions why a pavlik harness is not being used. Appropriate response is: • Pavlik harness is used for children w/ scoliosis, not hip dysplasia • Pavlik harness is used for school-age children • Your child’s condition is too severe for a pavlik harness • Pavlik harness is only used for infants <6mos

33. Mother brings 2wk old to clinic for tx following dx of clubfoot made at time of birth. Which statements, indicates need for further teaching? • I need to bring my infant back to clinic in 1 mo for a new cast • Tx needs to be started as soon as possible • I need to come to clinic every week w/ my infant for casting • I realize my infant will require follow-up care until full grown

34. Nurse providing instructions to parents of child w/ scoliosis regarding use of a brace. Which statement indicated need for further instructions? • I should apply lotion under the brace to prevent skin breakdown • I should avoid the use of powder b/c it will cake under the brace • I will have my child wear soft fabric clothing under the brace • I will encourage my child to perform prescribed exercises

35. To prevent loss of joint fxn in a child w/ JRA, nurse should teach parents to avoid letting child: • Ride a bike • Walk to school • Do frequent isometric exercises • Watch TV for prolonged periods

36. Child scheduled for debridement of leg wounds. In what order should nurse perform procedures? • Remove dressing • Medicate for pain • Pour water on dressing to loosen it • Assess need for dressing supplies

37. Which of the following are manifestations of scabies? (all that apply) • Nits present • Threadlike rash between fingers & other moist areas • Circular rash on extremities • Pruritus • Eczematous eruption in infants

38. Match skin disorder w/ cause • Impetigo contagiosa • Scabies • Lyme disease • Cold sore, fever blister • ringworm • Fungal infection • Bacterial infection • Viral infection • Caused by spirochete • Caused by burrowing mite

39. Match type of dermatitis w/ it’s description • Diaper dermatitis • Infantile eczema • Acne • Seborrheic dermatitis • Weeping, red vesicles & papules • Comedones & pustules • Red, inflamed skin • Thick, yellow scaly areas

40. Which of the following meds can be used for children w/ eczema? (all that apply) • Corticosteroids • Accutane • Peroxide • Antihistamines • Calamine lotion

41. Diaper dermatitis can be largely prevented by changing an infant’s diapers frequently & keeping the diaper area clean & dry. • True • False

42. Eczema usually appears on cheeks of a 4yo child. • True • False

43. A complication that may occur w/ acne & most types of dermatits is cellulitis. • True • False

44. Nurse reviewing sick day mangement w/ parent of a child w/ type 1 diabetes. Which of following should be included in teaching? (all that apply) • Monitor blood glucose every 4 hr • Discontinue taking insulin until feeling better • Drink 8 oz fruit juice every hour • Test urine for ketones • Call PCP if blood glucose is >250mg/dL

45. Providing health teaching to group of adolescents w/ D.M., nurse teaches them to observe for s/s of hypoglycemia. Which of following should be included? (all that apply) • Frequent urination • Inc’d energy level • Nausea • Nervousness & irritability • Sweating & pallor • Deep, rapid & labored respirations

46. Hypoglycemic rx can occurs b/c of: • Too much glucose in body • Eating too much junk food • Exercising strenuously • Not enough insulin in body

47. Child w/ type 1 D.M. on insulin for 3 months. Which of the following diagnostic studies will provider order to how well child’s D.M. is being managed? • Morning fasting blood glucose • 2hr oral glucose tolerance test • Hb1Ac • Diary of child’s daily blood glucoses

48. When teaching child w/ newly dx’d type 1 D.M., priority should be placed on: • Wt loss measures • Self-monitoring of blood glucose • Need to reduce physical activity • Elimination of sugar from diet

49. During scheduled exam, child’s HbA1c level is 9%. Child has had type 1 D.M. for 1 yr. Which of the following actions should nurse take? • Assess signs of infection & child’s intake for past 24hr • Explore child’s general dietary patterns for past 3 mos • Review parents’ understanding of diabetic foot care • Immediately admin child’s rapid acting insulin dose.

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