Peds Capstone Review Questions and Answers.docx

  cleft palate post op care - Correct Answers: post surgery: -avoid having baby suck on nipple or pacifier -place baby laterally or on stomach to help prevent aspiration and facilitate drainage -apply restraints to prevent baby from disturbing operative site -Keep the infant pain-free to decrease crying and stress on repair -Feed w/ cups, Avoid sucking on nipple or pacifier -monitor I/O's daily -Change position frequently to facilitate breathing & place on abdomen in immediate post-op period -Maintain IV fluids until infant able to eat & drink meningitis care - Correct Answers: -implement droplet precautions right away -maintain for at least 24 hours following initiation of abx -keep pt npo if there is a decreased LOC (r/f aspiration) -dark quiet environment (photophobia) -admx medications (abx, corticosteroids) -mx for signs of increased ICP -Position the client without a pillow, and slightly elevate the head of the bed. The client can also be positioned side-lying to reduce neck discomfort. -keep room cool -Presence of petechial or purpuric-type rash requires immediate medical attention A nurse is caring for a child with a closed head injury. What clinical manifestations would suggest deterioration in this client's condition? - Correct Answers: -changes in vital signs -altered mental status -increased intracranial pressure -alterations of pupillary response -posturing -bradycardia -decreased motor response -decreased sensory response -Cheyne-Stokes respirations -coma A child has been admitted to the emergency department with a closed head injury. Identify the lab and diagnostic tests that will be ordered. - Correct Answers: -ABGs, -blood alcohol and toxicology screening, -CBC with differential -liver function tests; -cervical spine x-rays to rule out cervical spine injury, -CT and/or MRI of head and/or neck might be performed with and without contrast if indicated -measurement of ICP A child has been admitted to the emergency department with a closed head injury. What medications should the nurse anticipate the provider to prescribe and why? - Correct Answers: -Mannitol to treat cerebral edema -Antibiotics: Use r/t CSF leakage, laceration, or penetration injuries -Analgesics: Used of HA/pain management -Corticosteroids: Used to decrease cerebral edema -Antiepileptics: Used to prevent/treat seizures A nurse is assessing for strabismus in a pediatric client. Identify three (3) clinical findings noted with strabismus. - Correct Answers: -Eyes that appear crossed or an eye that seems to wander -Uncoordinated eye movements -Asymmetric corneal light reflex misaligned eyes, inward deviation of eye frowning or squinting difficulty seeing print clearly one eye closed to enable better vision head tilted to one side headache, dizziness diplopia photophobia crossed eyes. What is a Wilm's tumor and what are manifestations of this type of cancer? - Correct Answers: a Wilm's tumor or nephroblastoma (kidney cancer) is a malignancy that occurs in the kidneys or abdomen. Manifestations -firm, nontender abdominal swelling or mass -fatigue, malaise, weight loss -fever -hematuria -hypertension -avoid abdominal palpation or manipulation The nurse is caring for a child with epiglottitis. What are three (3) expected findings during the assessment of this client? - Correct Answers: -drooling, -difficulty/painful swallowing -high fever -inspiratory stridor The nurse is caring for a child with epiglottitis. List three (3) nursing interventions the nurse will be expected to carry out. - Correct Answers: protect airway: don't put anything in mouth, no throat culture, no tongue blade administer IV fluids, humidified oxygen and antibiotics, prepare for intubation continuous pulse oximetry What are defined gross motor skills for a 4-year-old client who is a preschooler? - Correct Answers: Skips and hops on one foot Throws a ball overhead Catches a ball reliably What is the expected growth mile markers for a 6-month infant? - Correct Answers: -Doubled birth weight -Starting to sit up alone -Sleeping 6 to 8 hours a night -Start eating solid foods -able to roll from back to front -holds bottle -starts to have stranger anxiety -16 lb avg -grow 1 in. per month w/in 6 months What are three (3) points the nurse should educate the parents of an epileptic client on regarding seizure medications? - Correct Answers: 1) a complication of seizure medications are CNS effects such as hyperactivity and irritability 2) seizure medications will control the seizures not cure the disorder 3) medications should be taken same time every day. 4) most common side effect of seizure medications is feeling sleepy (drowsiness, irritability, nausea, rash, and clumsiness) 5) Be aware of medication and food interaction Blood tests, urinalysis, and liver function tests will need to be performed at regular intervals to determine effect on organ function, 6) Medication should be administered at the same time every day What are three (3) measures the nurse will inform the mother about to address the infestation of pediculosis capitis? - Correct Answers: 1) teach about medications (1% permethrin shampoo, Spinosad 0.9% topical suspension). Both medicines kill only live lice, not the eggs, so they should be reapplied in 7-10 days to kill newly hatched lice 2) wash clothing and bedding in hot water with detergent and bag items that can't be laundered into tightly sealed bags for 14 days 3) boil combs, brushes and hair accessories for 10 min or soak in lice-killing products for 1 hr 4) Before applying the over-the-counter lotions, do not use conditioner on the hair, as this will coat the hair and protect the lice from the medicine. Also, do not wash the hair for 1-2 days after treatment. Identify three (3) clinical manifestations of hydrocephalus in an infant. - Correct Answers: -high pitched cry -bulging fontanels and widening cranial suture lines -increased head circumference -vomiting -"setting sun" sign A nurse is caring for a child with Hirschsprung disease. What are manifestations of this disease in an older child? - Correct Answers: -failure to thrive -abdominal distention -visible peristalsis -palpable fecal mass -constipation-foul-smelling -ribbonlike stool Identify five (5) nursing actions for a client who is in a hip spica cast. - Correct Answers: -Assess and monitor neurovascular status -Apply ice for the first 24 to 48 hrs. to prevent swelling -Turn the client frequently while supporting all extremities and joints -Assess for increased warmth or hot spots on the cast surface, which could indicate infection -Assess general skin condition and the area around the cast edges. What is a myringotomy? How is this procedure performed and what post-operative care should the nurse provide? - Correct Answers: placement of tympanoplasty tubes are indicated for a child who has multiple episodes of otitis media. It may be performed by laser treatment. A small incision is made in the tympanic membrane, and tiny plastic or metal tubes are placed into the eardrum to equalize pressure and minimize effusion. Post-operative care -Limit the child's activities for a few days following surgery. -Instruct the parents to notify the provider when tubes come out. -Inform the client/parents about comfort measures. -Encourage the parents to feed the child in an upright position when bottle or breastfeeding. -If drainage is present, clean the external ear with sterile cotton swabs. Apply antibiotic ointment. -Teach the parent to avoid exposure of child to risk factors if possible (secondhand smoke, exposure to infections). -Stress the importance of medical care at initial signs and symptoms of infections (change in behavior, tugging on ear) -Encourage parents to keep immunizations up to date. A child had tympanoplasty tubes placed and the nurse is completing discharge teaching for the family. List three (3) important points to include in the teaching. - Correct Answers: -Insert ear plugs into the canals when the child bathes -Low the nose forcibly during a cold -Administer the prescribed antibiotic while the tubes are in place -Disregard any drainage from the ear after 1 week What symptoms would the nurse expect to find if a child were having an acute hemolytic reaction during a blood transfusion? - Correct Answers: - chills, - fever, - hypotension, - uncontrollable bleeding, - increased heart rate, - constricting chest pain, - lumbar region pain, flank pain - hemoglobinuria - hyperbilirubinemia Identify two (2) initial clinical manifestations of RSV. - Correct Answers: -fever, -cough, -dyspnea, -hoarseness, -restlessness What are manifestations of a urinary tract infection (UTI) in infants? - Correct Answers: -increase in irritability -screaming with urination -poor feeding, vomiting, or failure to gain weight -increase in thirst-frequent urination -straining with urination -foul-smelling urine -fever -diaper rash -dehydration -seizure -pallor What are three (3) manifestations of osteomyelitis? - Correct Answers: -appearing ill -irritability -fever -tachycardia -edema -pain -not wanting to use affected extremity -site of infection tender/bone pain worse with movement Describe nursing care for a client with osteomyelitis - Correct Answers: -Assist with diagnosis and joint biopsy -Give IV/oral antibiotics as prescribed-proper positioning -Give analgesics as prescribed. -Asses home care needs. -Educate client on length of treatment, long term antibiotic therapy, avoidance of bearing weight, diversional activities, and proper nutrition. Identify three (3) points that the nurse should educate the parents on regarding measures to prevent SIDS. - Correct Answers: -Lie infants on their backs to sleep. -Make sure there are no blankets or other items in the crib. -Provide a firm mattress. -To keep your baby warm, try a sleep sack or other sleep clothing that doesn't require additional covers. A nurse is caring for a client with glomerulonephritis. What interventions regarding nutritional intake and restrictions should be taken? - Correct Answers: -Encourage adequate nutritional intake. -Possible restriction of sodium and fluid. -Restrict foods high in potassium during periods of oliguria. -Provide small, frequent meals of favorite foods due to a decrease in appetite. -Refer the child for dietary consultation if indicated. -Avoid added salt and salty foods such as chips. -Monitor daily weights; weigh the child on the same scale with the same amount of clothing daily. Identify 3 points to discuss with new mothers who are breastfeeding their newborn - Correct Answers: Wash her hands before to prevent infection Feed 8-12 times in 24 hrs fo at least 15-20 minutes Caffeine free non alch fluids to drink during and get comfortable Let-down reflex= stimulation of maternal nipple releases oxytocin that causes the let-down of milk