PEDS Final questions ATI questions and answers; ATI peds remediation study guide; ATI Pediatrics Proctored Exam (correct and verified 100%)

PEDS Final questions ATI questions and answers; ATI peds remediation study guide; ATI Pediatrics Proctored Exam (correct and verified 100%) The doctor observes an infant for signs that he is developing ICP while he waits for surgery. What vital sign changes should most prompt the nurse to report findings? - Increased temperature and decreased pulse rate A nurse is caring for an infant who has a myelomeningocele. Which of the following actions should the nurse include in the preoperative plan of care? - Apply a sterile, moist dressing on the sac. The nurse is assessing a preschooler for hip dysplasia. Which assessment would the nurse include? - Trendelenburg sign- child bears weight on the affected leg while holding on to something for balance. Examiner observes from behind for abnormal downward tilting of the pelvis on the unaffected side. Which disorder would require the infant to be placed on the side to sleep to avoid airway obstruction? - Pierre Robin Syndrome (small mandible, cleft palate, and glossoptosis) An accumulation of cerebrospinal fluid in the ventricles or subarachnoid space is known as what? - Hydrocephalus The best way in which a nurse can detect congenital hydrocephalus prior to brain tissue damange is to....? - Measure the infants head circumference at birth, then compare the measurement prior to discharge Baby born with cleft lip. How can the nurse be a role model to the mother? - Hold the infant warmly, smile and play/talk with baby A father brings his 18 month old son to the clinic. He asks the nurse why his son is so difficult to please, has temper tantrums, and annoys him by throwing food from the table. Which principle of growth should the nurse explain? - The child is learning to assert independence and his behavior is considered normal for his age Which is the best way for an infants father to help his child complete the developmental task of the first year? - Respond to her consistently Child 6 years old, school aged, according to Erickson, the nurse should identify which developmental tasks to integrate health promotion activities with during this period? - How to do things well It is important to teach families of infants about preventing what type of injuries? - Aspirations and falls 10 month old infant, which fine motor skills should the nurse expect of the infant? - grasp rattle by hand and crude pincer grasp What type of new foods should a parent of a 4 month of introduce? - Iron fortified cereals A nurse is assessing a 12 month old infant at a well child visit. What should the birth weight have been? - Should triple An infants mother asks the nurse, "When should I expect my daughter to being to walk?" - most children walk around 12 months The nurse is discussing object permanence with the mother of a 2 month old infant. Which action would the infant illustrate that he understands object permanence? - The child looks for the mother after she walks away A nurse is teaching a parent about parallel play in children. Which of the following statements should the nurse include in teaching? - The child plays independently when in a group A toddler seems unable to remain dry despite being toilet trained. Which patient teaching should be included in his plan of care? - He probably is not yet physically ready for toilet training A nurse is providing teaching about age appropriate activities to the parents of a 2 year old. Which of the following statements by the parent indicates an understanding of the teaching? - "I will send my childs favorite stuffed animal when she will be napping away from home" The parent of a 2 year old child are concerned becuase their childs back seems curved. What is the best respone? - This is normal for that age A toddlers mother is concerned because her toddler takes her blanket everywhere. Which advice is most appropriate? - Understand that this is probably a normal event. Preschool children tend to center on information. Which is the best description of this action? - They may concentrate on one part of the procedure and appear not to hear another A previously toilet trained 4 year old child has many episodes of incontinence while in the hospital. What action should the nurse implement? - Explain that children will usually quickly regain control over a previously mastered skill once home again (regression) A nurse is performing a developmental screening on a 3 year old child. Which of the following skills should the nurse expect the child to perform? - Ride a tricycle A nurse is caring for a preschool age child who says she needs to leave the hospital because her doll is scared to be at home alone. Which of the following characteristics of preoperational thought is the child exhibiting? - Animism A nurse is caring for a preschooler. Which of the following is an expected behavior of a preschool age child? - Relating fears to magical thinking A 4 year old boy will not stop throwing sand at his sister. Which of the following punishments would be most effective with this child? - Time out for 4 minutes Which patient education should the nurse provide to the mother of a preschooler with broken fluency? - Allow the preschooler to have time to talk What would a game you might play to urge a school aged child to ingest a high fluid intake? - Simon says An 8 year old eats lunch daily in the school cafeteria. What is the best way to feel assured that he will eat a balanced lunch daily? - Use visual aids to demonstrate appropriate food selections. A 10 year old becomes very upset and expresses sympathy for his friend whose dog has just died. This kind of reaction is an indication that he has achieved which step in cognitive thinking? - Decentering A 12 year old recently began smoking cigarettes. What patient teaching should the nurse provide at a health maintenance visit? - Cigarette smoking is associated with long term respiratory and cardiovascular effects. In developing a plan for peri-operative teaching for an adolescent, which is important for the nurse to recognize? - Adolescents may act as if they know more then they actually do. The parents of an adolescent boy are concerned about the amount of sleep he seems to require. What advice would you give them? - As long as he seems otherwise well, this sounds like a typical teenager. The nurse working with adolescents understands which to be the most widely used drug amoung adolescents? - Alcohol When encouraging an adolescent who is hospitalized and physically challenged or chronically ill to develop and maintain a sense of identity, which is the best nursing action? - Providing the opportunity for the individual to make decisions. Pressing a tongue blade against the back of the throat causes a gag reflex. When would the nurse know not to elicit a gag reflex? - When the child has symptoms of epiglottitis When preparing a varicella vaccine what questions should a nurse ask? - "Are you currently taking a corticosteroid medication?" (or allergic to eggs) A nurse is preparing to administer immunizations to a 4 month old infant. Which of the following is an appropriate action for the nurse to take in providing automatic care? - Provide sucrose solution on the pacifier. A nurse reviews a immunization record at what age would HPV be recommended? - 11-12 years of age A nurse is checking VS on a 3 year old child. Which finding should be reported to provider? - Respiration of 30/min (20 average) Exclude BP assessment until what age? - 3 years old The nurse wants Barry, a 16 year old, to increase his cognitive understanding of his condition. After teaching sATI peds remediation study guide How to deal with Negativism in the toddler period - Avoid asking yes-or-no questions, as the toddler's usual response will be "no," whether he or she means it or not. Offering the child simple choices will give the toddler a sense of control. The parent should not ask the toddler if he or she "wants" to do something, if there is actually no choice. "Do you want to use the red cup or the blue cup?" is more appropriate than "Do you want your milk now? What type of restraint for Wrist or ankle restraint to prevent range of motion of extremities - Soft limb restraint what type of restraint prevents child from flexing and reaching face, head, IV, and other tubes - Elbow restraint what type of restraint is used for a Body restraint using a sheet/blanket folded in a square appropriate to size of infant or young child to secure the whole body of the child or every extremity except for one - mummy restraint Type of restraint when a jacket worn by child with ties attached to the child's back and to side of bed. Used to keep children flat in bed, such as after surgery, or safe in chair - Jacket (vest) restraint . The typical 5-year-old has visual acuity of - 20/40 or 20/30. Color vision is intact at this age. The normal infant may exhibit intermittent strabismus (crossing of the eyes) until about 3 months of age. However, persistent strabismus at any age or intermittent strabismus after how many months of age should be evaluated by a pediatric ophthalmologist - 6 month The "cover test" is also a useful tool for the identification of - strabismus. Urinalysis may reveal what in Hemolytic-uremic syndrome include - presence of blood, protein, pus, and/or casts. Elevated BUN and creatinine Moderate to severe anemia (with the presence of Burr cells, schistocytes, spherocytes, or helmet cells), mild to severe thrombocytopenia Increased reticulocyte count Increased bilirubin and lactic dehydrogenase (LDH) levels Negative Coombs test (except in cases of Streptococcus pneumoniae infection) Leukocytosis with left shift Hyponatremia Hyperkalemia Hyperphosphatemia Metabolic acidosis Preventing Hemolytic-Uremic Syndrome, teaching - Proper hand washing is necessary. Teach children to wash their hands after using the bathroom, before eating, and after petting farm animals. Encourage the use of "swim diapers," which contain feces, for children who are not toilet trained. Teach parents to thoroughly cook all meats to a core temperature of 155°F, or until the meat is gray or brown throughout and the juices from the meat are clear rather than pink. Wash all fruits and vegetables thoroughly. Ensure that drinking water and water used for recreation are treated appropriately. Avoid unpasteurized dairy products and fruit juices (including cider). pg.1650 Blood urea nitrogen (BUN) levels and meaning - 10 to 20 mg/dL; indirect renal function test; BUN is made up of urea, which is an end product of the metabolism of protein (from both muscle and dietary intake) by the liver. Fluctuates with hydration status Creatinine level and meaning - 0.7 to 1.4 mg; Creatinine is the end product of muscle metabolism. It is a better indicator of renal function; Serum creatinine levels increase when renal function decreases. aspirin (acetylsalicylic acid) toxicity interventions - - activated charcoal -gastric lavage -sodium bicarbonate -o2 and ventilation -vitamin K -hemodialysis in severe cases antidote for acetaminophen toxicity - acetylcysteine Iron supplement toxicity interventions - -emesis, or lavage -chelation therapy hyrdrocarbons ingestion (gasoline, kerosine, lighter fluid, paint thinner, turnpentine) intervention. - -intubation with cuffed et tube prior to any gastric decontamination -do not induce vomiting -tx of chemical pneumonia Lead toxicity - chelation therapy (removal of heavy metals from the body via chelating agents), using calcium EDTA (calcium disodium versenate) post op tonsillectomy nursing intervention For the first 24 hours after surgery - throat is very sore. Adequate pain relief is essential to establish adequate oral fluid intake. An ice collar may be prescribed, as well as analgesics with or without narcotics. Counsel parents to maintain pain control upon discharge from the facility, not only for the child's sake, but also to enable the child to continue to drink fluids. - To avoid trauma to the surgical site, discourage the child from coughing, clearing the throat, blowing the nose, & using straws - To maintain fluid volume postoperatively, encourage children to take any fluids they desire; popsicles and ice chips are particularly soothing. - place the child in a side-lying or prone position to facilitate safe drainage of secretions (once alert they may be in semi fowlers) - monitor for continuous swallowing which is a sign of early bleeding Meckel Diverticulum definition and post op care - Meckel diverticulum is the result of an incomplete fusion of the omphalomesenteric duct during embryonic development. This causes a fibrous band to connect the small intestine to the umbilicus Postop? umbilical hernia interventions and education - -Most children will have spontaneous closure of the umbilical hernia by 4 years of age therefore Surgical correction is necessary only for the largest umbilical hernias that have failed to close by the time the child is 4 years old. -NO belly bands -NO taping a quarter over a reduced umbilical hernia moderate vs severe dehydrtion vitals - Moderate: Sunken fontanels, tachycardia, normal BP, altert but listless Severe: alert to comotose, sunken fontanels, tachy progressing to bradycardia, tenting turgor, BP Normal, progressing to hypotension Vulvovaginitis teaching - -should wash the genital area thoroughly on a daily basis with mild soap and water. -rinse area well -encourage to wipe after urination or BM -COTTON underwear and change them at least once a day -topical or oral medications -do not wear tight clothing Hemolytic-uremic syndrome (HUS) is defined by three features - hemolytic anemia, thrombocytopenia, and acute renal failure. Head physical assessment evaluation of an infant. (Torticollis) - Note limited movement of the neck while performing passive range of motion. Palpate the neck, noting a mass in the sternocleidomastoid muscle on the affected side. -Teach parents gentle neck-stretching exercises to be performed several times a day. -Prevent flatness of one side of the head by varying the infant's head position, and do not always turn the infant's head to one side while he or she is in the infant seat, in the swing, or lying supine vision screening tool: preschool - "Tumbling E" -The child points in the direction that the "E" is facing. or LEA symbols or Allen figures -The child should first identify the pictures with both eyes at a comfortable distance prior to monocular testing to ensure validity of the test.) or/and Color Vision Testing Made Easy (CVTME) -Uses dot pictures like the Ishihara, but instead of numbers has easily identified shapes imbedded in the dots Vision screening tool: school age - Snellen letters or numbers -The child must know his or her letters or numbers for the test to be valid. or Ishihara -Screens for color discrimination (numbers composed of dots, hidden within other dots) amblyopia - lazy eye When using any vision screening chart, several simple steps - -Place the chart at the child's eye level. -Make sure there is sufficient lighting. -Place a mark on the floor approximately 300 to 600 cm (10 to 20 feet) from the chart (distance depends on what the tool is calibrated for). -Align the child's heels on the mark. -Have the child read each line with one eye covered and then with the other eye covered. -Explain to the child to keep the eye covered but open -Have the child read each line with both eyes. Digoxin administration - -BEFORE admin take apical pulse for 1 min -withhold if <60 in adolescents and <90 in infants -avoid giving with meals -therapeutic range 0.8-2 ng/mL -toxicity s/s: N/V, diarrhea, lethargy and bradycardia -Ginseng, hawthorn, and licorice intake increases risk for drug toxicity. -Contraindications (ventricular fibrillation and hypersensitivity to digitalis) - Avoid rapid IV administration, as this may lead to systemic and coronary artery vasoconstriction. -Give digoxin at regular intervals, every 12 hours, such as at 8 AM and 8PM, 1 hour before or 2 hours after a feeding. -If a digoxin dose is missed and more than 4 hours have elapsed, withhold the dose and give the dose at the regular time; if less than 4 hours have elapsed, give the missed dose. -If the child vomits digoxin, do not give a second dose. - Monitor potassium levels, as a decrease enhances the effects of digitalis, causing toxicity Iron supplements: ferrous sulfate nursing implication - -Dosage is based on milligrams of elemental iron -Give with vitamin C-containing foods to increase absorption -Do not administer with milk or milk products -May color stools and urine black -Liquid can stain the teeth; mix with a small amount of juice; drinking with straw decreases tooth staining -May cause constipation; increase fiber and fluid intake Corrosives (household cleaners, batteries, denture cleaners, and bleach) management - -airway -NPO -no attempt to to neutralize acids -do not induce vomiting -analgesics for pain two step approach for pharmacologic management for pain in children - 1- above 3 months of age with mild pain administer a nonopioid. Ex: Naproxen, ketorolac, ibuprofen (>6mo.) 2- mod-severe pain administer a strong opioid. Morphine is the golden standard. Cardiac Cath sx pre procedure teaching - Use a variety of teaching methods as appropriate, such as videotapes, books, and pamphlets. Adapt these teaching methods to the child's developmental stage. For example, introduce the younger child to equipment through play therapy. For school-age and older children and their parents, offer a tour of the cardiac catheterization laboratory. Mention sounds and sights they may experience during the procedure. Explain the use of intravenous fluid therapy, sedation, and, if ordered, anesthesia to the child and parents. Tell the child that he or she may feel a sensation of the heart racing when the catheter is inserted. Also warn the older child that he or she may experience a feeling of warmth or stinging when the contrast material is injected. Encourage the child to use familiar ways to help him or her relax. If necessary, teach the child simple relaxation measures. Typically, food and fluid are withheld for 4 to 6 hours before the procedure. Prescribed medications may be taken with a sip of water. Explain to the child that he or she will have a dressing over the catheter site and that he or she will need to keep the leg straight for several hours after the procedure. Teach the child and parent that frequent monitoring will be required after the procedu cardiac cath post procedure - -closely monitor the child for complications of bleeding, arrhythmia, hematoma, and thrombus formation and infection. -After the procedure, evaluate the child's vital signs, the neurovascular status of the lower extremities, and the pressure dressing over the catheterization site every 15 minutes for the first hour and then every 30 minutes for 1 hour. -Vital signs should remain within acceptable parameters. Hypotension may signify hemorrhage due to perforation of the heart muscle or bleeding from the insertion site. ATI Pediatrics Proctored Exam study guide hand preference - all kids normally show hand preference by 1 year old plaster casts - -heavy -not water resistant -dry in 10-72 hrs fiberglass casts - -light weight -water resistant -dry in 15-20 min types of traction - Skin traction: -Buck -Bryant -Russell Skeletal traction Halo traction -cervical traction care for traction - -assess pin sites -ensure hardware is tight -ensure bed is in correct position -ensure weights do not touch floor Halo: ensure wrench is readily available surgical intervention for scoliosis - -realign (2 rods on either side of spine) -internal fixation -fusion The child is prescribed lanoxin (Digoxin) 75 mcg PO qd. The pharmacy supplies lanoxin (Digoxin) 0.05mg scored tablets. How many tablets will the nurse administer? Record your answer using one decimal place. - 1.5 tablets The physician orders the patient a 10-mL/kg normal saline bolus to infuse over 2 hours. The child weighs 36 kg. Calculate the infusion rate in mL/hr. - 180 mL/hr What happens to the voice during epiglottitis? - it becomes hoarse Leukotreine modifiers - -Blocks leukotriene receptors or synthesis of leukotrienes (Singulair) -Side effects: headache, nausea, abdominal pain, increase infections if over age 55, depression, suicidal, aggression -Generally well tolerated. -Monitor for improvement in symptoms Cromolyn (Intal) and nedocomil (Tilade) - -Anti-inflammatory agents that inhibit release of histamine, leukotrienes, -Prevention or maintenance drugs -Administered by inhalation, onset of action in 2-4 weeks -Side effects: cough, headache, throat irritation, GI upset Long acting beta-adrenergics - -Salmeterol (Serevent) -used twice daily -Added to anti-inflammatory therapy -Not for acute symptoms due to onset of action in 20 minutes with peak in 3-4 hours Lortab - tylenol with hydrocodone dornase alpha - decreases viscosity of secretions (thins mucous) for CF patients tobramycin - aerosolized antibiotics used for CF Norwood procedure - -Treats hypoplastic left heart -3 stages -done shortly after birth -Right ventricle is