Which are signs and symptoms of respiratory distress in a two month old select all that apply?

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1. Science
2. Medicine
3. Pediatrics

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Terms in this set (252)

A 15-month-old is admitted to the pediatric unit with a history of a recent upper respiratory infection. Which symptom is consistent with the diagnosis of laryngotracheobronchitis (croup)? Select all that apply.
1.Reported inspiratory stridor which is worse at night.
2.Suprasternal retractions are present upon examination.
3.The toddler has a barking, seal-like, harsh cough.
4.Lung sounds have inspiratory wheezing.
5.Lung sounds with crackles in the bases bilaterally.

1,2,3

A four-year-old is presented to the urgent care center with a history of a sudden onset of a severe sore throat. He began drooling and has difficulty swallowing. The temperature is 102.2F (39.0C). Lung sounds are clear and there is no cough. The child is very anxious and flushed and is leaning forward in a tripod position. Based on these symptoms, the nurse anticipates a diagnosis of:
1.Acute Asthma Attack
2.Laryngotracheomalacia
3.Acute laryngotracheobronchitis (Croup)
4.Acute Epiglottitis

4

Which should the nurse expect to be included in the treatment of the client experiencing acute asthma symptoms? Select all that apply.
1.Bronchodilators
2.Corticosteroids
3.Oxygen
4.Montelukast (Singular)
5.Immediate Intubation

1, 2, 3

The nurse understands that in a child with cystic fibrosis (CF) which vitamin absorption is impaired? Select all that apply.
1.A
2.B
3.C
4.D
5.E

1, 3, 4, 5

Which indicates the earliest sign of hemorrhage in a child who has just had a tonsillectomy?
1.Frequent swallowing
2.Labored respirations
3.Tachypnea stridor
4.Dark brown emesis

1

A child with chronic otitis media has bilateral myringotomy tubes placed. Which statement would indicate that the parent understands education about myringotomy tubes?
1."The tubes have to be surgically removed in 9 months or so."
2."The tubes were placed to equalize pressure."
3."These tubes won't affect my child being able to go swimming in the summer."
4."My child will still need to be on Amoxicillin prophylactically for six months."

2

The nurse should instruct the parent whose child is diagnosed with respiratory syncytial virus (RSV) to notify the healthcare provider for which issue? Select all that apply.
1.The child is not eating
2.There is a decrease in wet diapers
3.There is increased work of breathing
4.The child develops yellow drainage from the nose
5.Only when the child wheezes

1, 2, 3

Which are signs and symptoms of respiratory distress in a two-month-old? Select all that apply.
1.Nasal flaring
2.Intercostal retractions
3.Coughing
4.Bronchovesicular lung sounds
5.Grunting

1, 2, 5

You are teaching a family with a child who has cystic fibrosis (CF) about chest physiotherapy treatment (CPT). Which of the following teaching points are correct to include? SATA
1.It should be performed three to four times a day.
2.It may cause bronchospasm.
3.It is all right to percuss over the spine or internal organs.
4.When manually percussing you should use a cupped hand.
5.CPT can be done at any time including after eating.

1, 2, 4

Which child does the nurse anticipate to be most at risk for being hospitalized for respiratory syncytial virus (RSV)?
1.A three-month-old who was born at 30 weeks gestation
2.A 18-month-old with a tracheostomy
3.A four-year-old with a ventricular septal defect (VSD)
4.A five-year-old who was term but has never received any immunizations

1

The nursing student asks the nurse about genetic implications related to cystic fibrosis (CF). How should the nurse respond?
1."It is inherited as an autosomal dominant trait."
2."It is a genetic defect found primarily in non-Caucasian people."
3."If it is present in a child, both parents are carriers of the defective gene."
4."There is a 50% chance the siblings of an affected child will also be affected."

3

what is the gold standard test in cystic fibrosis

sweat test

A measurement of the maximum flow of air that can be forcefully exhaled in 1 second, a key measurement of pulmonary function

Peak expiratory flow rate

provides an objective method of evaluating the presence and degree of lung dz, as well as the response of therapy

Pulmonary Function Test (PFT)

cessation of breathing for more than 20 sec or for a shorter period of time when associated w/ hypoxemia or bradycardia

apnea

a medical emergency that can result in respiratory failure and death if untreated

status asthmaticus

involves stimulating the production of sweat w/ a special device, collecting sweat and measuring the sweat electrolytes. Used in the diagnosis of cystic fibrosis

sweat chloride test

inability of the respiratory apparatus to maintain adequate oxygenation of the blood w/ or w/out carbon dioxide retention

respiratory failure

a serious obstructive inflammatory process in the upper airway may see absence of a cough but drooling and agitation

acute epiglottitis

in general applies to 2 conditions: increased work of breathing w/ near normal gas exchange function or the inability to maintain normal blood gas tensions that develops from carbon dioxide retention w/ subsequent hypoxemia and acidosis

respiratory insuffuecuency

upper airway infection characterized by hoarseness and a barking cough

croup

earliest manifestation of cystic fibrosis where the small intestine is blocked w/ thick meconium in the newborn

meconium ileus

the child insists on sitting upright and leaning foward w/ the chin thrust out, mouth open and tongue protruding to facilitate breathing

tripod

irritants such as house dust mites, tobacco smoke, mold or pets

allergens

a serious possibly life-threatening obstructive inflammatory process of the upper trachea w/ features of croup and epiglottitis

bacterial tracheitis

considered to be the corner stone treatment for children and adolescents w/ cystic fibrosis

airway clearance therapies

The nurse in the emergency department (ED) is assessing a school-age child with a new ventriculoperitoneal (VP) shunt. The child is being seen for lethargy, irritability, vomiting, severe headache, and a fever of 102.4°. What initial action should the nurse expect would be taken?
1.An admission to the hospital for IV fluids and monitoring
2.Give mannitol for increased intracranial pressure.
3.Obtain a CT scan of the brain with X-rays of the chest and abdomen.
4.A surgical intervention for hydrocephalus

3

A nurse in the emergency department (ED) is assessing a pre-school age client who had a febrile seizure at home. The parent is very concerned and asks the nurse if this is very serious. How should the nurse respond?
1."Yes, the child is likely to get brain damage when a fever gets too high."
2."Generally they are not. But it is best to treat a fever when it starts."
3."No, they don't cause any issues."
4."Yes, you should consider this a medical emergency any time something like this occurs."

2

The nurse is doing post-procedure education with a school-age child after a lumbar puncture. What factor is important for the nurse to emphasize?
1.The child will be NPO for 6 hours post-procedure.
2.The child will need to lay flat for 4 to 24 hours.
3.The child will need hourly vital signs for the first 6 hours post-procedure.
4.The child will need to be assessed for adequate urinary elimination within 4 hours post-procedure.

2

The nurse is assigned an adolescent client with newly diagnosed meningitis and is going in the client's room to hang the antibiotics. What personal protective equipment (PPE) should the nurse put on?
1.Gown and gloves
2.Gown, mask, and gloves
3.Gown, goggles, mask, and gloves
4.Gloves

2

A mother is talking to the nurse and is concerned that her infant will get meningitis and die like her cousin's child did many years ago. The mother asks the nurse, "What is the best way I can protect my child?" How should the nurse respond?
1."There is no way to prevent it, unfortunately, but you must be quick to respond to any symptoms."
2."You should avoid taking your baby anywhere."
3."Many strains are vaccine-preventable, so getting all your vaccinations is a good start."
4."Keep your baby away from anyone who is sick."

3

The nurse is reviewing the plan of care for an adolescent child with cerebral palsy. Which treatment modalities would the nurse expect? Select all that apply.
1.Speech therapy
2.Physical therapy
3.Respiratory therapy
4.Occupational therapy
5.Educational therapy

1, 2, 4, 5

The nurse is performing a home assessment on a preschool-age child. The nurse notices that when in a squatting position, the child has to use his hands and arms to "walk up" his own body, pushing as he goes, in order to stand. What condition should the nurse investigate further?
1.Cerebral palsy
2.Muscular dystrophy
3.Myasthenia gravis
4.Guillain-Barré

2

A school-age child is diagnosed with meningitis. What should the nurse expect to assess in this client? Select all that apply.
1.Stiff neck
2.Photosensitivity
3.Severe headache
4.Lower extremity weakness
5.Elevated body temperature

1, 2, 3, 5

A toddler is scheduled for a routine wellness examination. What should the nurse do before beginning the assessment?
1.Encourage the parent to hold the child.
2.Ask the child to state his or her name and age.
3.Allow the child to manipulate the stethoscope.
4.Watch the child play with an age-appropriate toy.

4

The nurse, caring for a school-age client recovering from a ventriculoperitoneal (VP) shunt implant, completes an assessment and immediately notifies the healthcare provider. Which assessment finding caused the nurse to be concerned?
1.Poor appetite
2.Blood pressure 110/70 mm Hg
3.Pain level 4 on a scale from 1 to 10
4.Blood tinged spot on the pillowcase encircled by a lighter ring

4

A 5-year-old client is being tested for muscular dystrophy. Which type of this disorder should the nurse expect the client to perform Gowers' sign?
1.Becker muscular dystrophy
2.Acquired muscular dystrophy
3.Duchenne muscular dystrophy
4.Facioscapulohumeral muscular dystrophy

3

A preschool-age client begins to experience a tonic-clonic seizure. What action should the nurse take first?
1.Apply oxygen.
2.Support the head.
3.Position the client on the side.
4.Place a padded tongue blade in the mouth.

3

A school-age client who has been on bed rest for several days becomes dizzy when moving to a sitting position. What type of hypotension should the nurse document in this client's medical record?
1.Cardiac
2.Vasovagal
3.Orthostatic
4.Psychogenic

3

The parent of a school-age child who is recovering from a concussion that took place several weeks ago reports the child fell off a bicycle and hit the head again. What direction should the nurse provide to the parent?
1.Place on bed rest.
2.Monitor for orientation.
3.Take to the nearest medical facility.
4.Provide an over-the-counter analgesic.

3

A 5-year-old client has been experiencing seizure activity for the last 20 minutes. What medication should the nurse prepare to administer to this client?
1.Diazepam
2.Clonazepam
3.Ethosuximide
4.Carbamazepine

1

The nurse is assessing motor skills of a preschool-age child. What method would best accomplish this goal?
1.Ask the parent what the child is able to do.
2.Offer age-appropriate toys to see if the child manipulates the toy appropriately.
3.Ask the child questions to determine the level of capability.
4.Give the child a physical exam.

2

The nurse is doing health promotion education with a group of young women. Because of the risk of neural tube defects, the nurse should stress the importance of taking which supplement daily while of childbearing age?
1.Calcium
2.Magnesium
3.Folic acid
4.Iron

3

The nurse is assessing a full-term newborn infant and notes the lack of a Moro reflex. What should this finding represent to the nurse?
1.A birth defect
2.A normal finding
3.An impairment of the central nervous system
4.A dysfunction of the neuromuscular junction

3

The nurse is providing education to a family who recently delivered a child with a myelomeningocele and the parents ask, "What issues can this cause?" How should the nurse respond?
1."This can cause paralysis of the legs, flaccid muscles, and problems with control of the bowel and bladder."
2."This can cause progressive muscle deterioration and mild mental delays."
3."This can cause spastic muscles, which can prompt difficulty with ambulation and cognitive deficits."
4."This can cause problems with mental abilities, a lack of coordination, and uncoordinated, jerky body movements

1

The nurse is assessing an infant for hydrocephalus. What signs and symptoms should the nurse identify to support this potential diagnosis? Select all that apply.
1.Rapid increase in head circumference or an unusually large head size
2.Bulging fontanel with crying
3.Vomiting
4.A high-pitched, shrill cry
5.Sunsetting eyes

1, 3, 4, 5

A nurse is providing anticipatory guidance to a parent of an adolescent about injury prevention. Which statement, when made by the parent, indicates they understand the teaching?
1."I will make sure that my teen sits in a booster seat in the car."
2."I will keep all medications out of reach."
3."I will make sure that my teen does not stay up past 10pm every night."
4."I will have ongoing conversations with my teen about rules they will need to follow when they begin to drive."

4

A nurse is providing care to a 14-year-old adolescent post-operatively. What is most significant in planning care for this child?
1.A child this age will miss being in school the most
2.A child this age will only want to be with their parents while in hospital
3.A child this age will be concerned about privacy
4.A child this age is learning to be independent with activities

3

A nurse is caring for a 17-year-old male in the outpatient clinic and takes his vital signs. His blood pressure (BP) reads 112/72 mm/Hg. What is the best nursing action based on these results?
1.This is an average reading for this age range. The nurse should record the BP reading and continue with the assessment.
2.This blood pressure is too high for this age range and the client should be evaluated by the physician.
3.The nurse should provide education about nutritional interventions that will lower BP.
4.The nurse should refer the client for a cardiology appointment.

1

What is a priority nursing assessment to use for the adolescent?
1.Blood pressure screening
2.Diabetes screening
3.Anthropomorphic measurements
4.Assessing adolescent's health, education, activity, sexuality, and safety

4

Which of the following assessment findings during a routine well child exam is most concerning?
1.Leukorrhea in a 12-year-old Hispanic female
2.Breast development in a 7-year-old Caucasian female
3.Breast tenderness in a 10-year-old African American female
4.Irregular menstrual cycles in an 11-year-old Asian female

2

A nurse is caring for an adolescent in the acute care setting. The nurse knows which term means obtaining agreement from the adolescent regarding the plan of care?
1.Consent
2.Health Care Proxy
3.Assent
4.Dissent

3

A 6-month-infant is hospitalized for a fever. What are important considerations for the infant's nursing care on the pediatric unit? Select all that apply.
1.Encourage the parents to room in.
2.Ask the parents to leave the room for the physical examination.
3.Tell the parents to go home at night and the nurse will check on the infant
4.Encourage the caregiver to leave the infant's toys at home.
5.Educate the parents that the infant may regress

1, 5

The pediatric nurse uses play with providing care with a 3-month-old infant. What important concepts will the nurse be mindful about when playing with an infant? Select all that apply.
1.Place on their stomachs for supervised play times.
2.Use musical toys for sensory stimulation.
3.Select any dully color toys.
4.Read a story to the infant in a soothing voice.
5.Put stuffed animals in the crib so the infant can play.

1, 2, 4

The nurse is discussing safe toy selection for a 13-month-old child with the parents. Which examples stated by the parents would be appropriate? Select all that apply.
1.A ride on animal car
2.A mobile with colorful animals and lights
3.A tricycle with large wheels
4.Marbles of various colors
5.A shape sorter with various blocks

1, 3, 5

The nurse is reviewing developmental stages when caring of a nine-year-old hospitalized client. Using Erikson's developmental stages, what are the best interventions? Select all that apply.
1.Encourage continuation of schoolwork.
2.Provide information on sexuality.
3.Help the child adjust to limitations.
4.Name objects and provide simple explanations.
5.Give clear instructions about treatments and interventions.

1, 3, 5

The nurse is preparing to teach a 10-year-old client about their Type I Diabetes. What is the best format to teach the child?
1.Show a video and ask them if they have any questions.
2.Lead the discussion through a picture book.
3.Demonstrate correct use of supplies and equipment. Allow for questions.
4.Sign them up for a web tutorial.

3

The nurse is working triage in the emergency department. She is about to perform a pain assessment on a seven-year-old client. Which statement shows the best age appropriate assessment?
1."Does it hurt a little or a lot?"
2."Can you point to the face that shows how much pain you are in?"
3."On a scale of 1 through 10, 10 being the worst pain ever, can you tell me what number your pain is at?"
4.The client is sleeping so the nurse determines pain during FLACC scale.

2

According to Piaget, a school-age child (age 7-11) is in a phase of concrete operation. Which information does the nurse understand to be describing this stage?
1.Can think of one idea at a time
2.Thought process more coherent and logical
3.Is egocentric
4.Thinks abstractly and rationally

2

Which skills would the nurse assessing appropriate developmental skills expect to see for a 2 year old? Select all that apply.
1.Climbing up and down stairs
2.Turning a door knob
3.Having conversations using two to three sentences
4.Following simple instructions
5.Demonstrating separation anxiety

1, 2, 4, 5

The nurse is educating the parents of a three-week-old infant being admitted for colic. What teaching interventions are included for the parents? Select all that apply.
1.Reinforce that intestinal gas is not a reflection of the caregiving skills.
2.Swaddle the infant during the crying times.
3.Educate the parents that the colic can persist for 12 months.
4.White noise may cause the infant to be fussier.
5.Limit the infant's time with a pacifier.

1, 2

A nurse is caring for a toddler on an inpatient unit. Which developmental milestones should be expected at this stage by the nurse? Select all that apply.
1.Gross motor development milestones include learning to ride a bike.
2.Speech and language milestones include learning to put three or more words together to form a sentence.
3.Fine motor development milestones include learning to use a fine pincer grasp.
4.Fine motor development milestones include stacking 6 or more blocks on top of one another.
5.Cognitive development milestones include understanding the concept of object permanence.

2, 4

The nurse is assessing a 6-year-old child. According to Piaget, what should the nurse expect to observe in the child at this stage? Select all that apply.
1.The child's thinking is influenced by fantasy.
2.The child understands the concept of time.
3.The child is able to think abstractly.
4.The child is able to think about things that are not in the present.
5.The child's language skills are fully developed.

1, 4

The nurse is caring for a 7-year-old client and obtains these vital signs: temperature 98.2°F, pulse 90, respirations 22, and blood pressure 93/60. What will the nurse do next?
1.Cover the client with a warm blanket.
2.Document these normal vital signs.
3.Contact the healthcare provider regarding the low blood pressure.
4.Repeat the vital signs for accuracy.

2

The 4-year-old sibling asks the nurse if she caused her brother to be sick because she "wanted him to go away." The nurse should recognize this as what?
1.Normal thinking for this age
2.A sign of potential abuse in the home
3.Concerning signs of emotional distress due to so much sibling anger
4.Highly developed language and thoughts for this age

1

Which technique should the nurse use when assessing a preschooler in order to ensure child comfort and effective nursing care?
1.Allow the child to select which finger to put the pulse oximeter on.
2.Ask the child to sit on the examination bed.
3.Begin with the most invasive procedure first to get it out of the way.
4.Make sure the child is fully undressed before the examination begins.

1

infants respond to nonverbal behaviors of adults like... (3)

1. touch
2. sound
3. tone of voice

infant is

birth - 1year

toddler is

1-3 years

preschool age is

3-6 years

school age

6-12years

adolescence

12-18years

when should the child be double and triple birth weight

double = 5-6mos
triple = 1year

when do teeth errupt

6mos

girls usually stop growing when

2years after the start of menstration

when does the main growth occur for teens

during puberty which can last 2-5years

Piaget has 5 stages of what

cognitive development

what are piagets 5 stages and the ages it goes with

1. sensorimotor stage birth-2yo
2. preoperational 2-4yo
3. intuitive thought 4-7yo
4. concrete operation 7-11yo
5. formal operational 11yo-adulthood

What is Piaget's sensorimotor stage?

birth - 2yo = child learns through motor and relex actions, and begins to understand that he or she is seperate from the environment and from others

What is Piaget's preoperational stage

2-7yo
- egocentric
- magical thinkers
- language
- thinking influenced by fantasy
- undeveloped since of time

what is Piage'ts concrete operational stage

7-11yo
- less self centered
- coherent and logical
- solves concrete problems
- give opportunity to ask questions
- increase in accommodation skills

what is Piaget's formal operational stage

11yo - adulthood
- adaptable and flexible
- thinks abstractly
- brings cognition to its final form
- can make rational judgments
- capable of hypothetical and deductive reasoning

what are Erikson's stages of ...

development theory

trust vs mistrust is age

birth - 1yo
- infancy

Autonomy vs. Shame and Doubt is age

1-3 yo
- toddler

initiative vs guilt is age

3-6 yo
- school age

industry vs inferiority is age

6-12 yo
- school age

identity vs role confusion is age

12-19 yo
- adolescent

trust vs mistrust is

- learns to trust as needs are met
- if needs are not met mistrust is learned
- play is solitary

autonomy vs shame and doubt is

- independent
- "i'm a big kid now"
- some control over body functions
- if criticized for showing independence they will develop shame and doubt about their abilities
- play is parallel

initiative vs guilt

- conscience
- learning right from wrong
- if criticized for their actions, leads to guilt and lack of purpose
- play is associative

industry vs inferiority

- rule following
- forming social relationships is important
- pride in accomplishments
- unable to be successful will lead to inferiority
- play is cooperative

identity vs role confusion

- changes in body are great
- preoccupied w/ appearance and what others think
- peers are very important
- working on own identity
- if unable to have meaningful definition of self may lead to role confusion

name 4 areas children may be abused or neglected that can lead to problems in growth and development

1. Medical
2. emotional
3. educational
4. abandonment

basic needs must be met to progress to the next level of growth and development. List 5 levels of Maslow's hierarchy of needs

1. physiological = food, air, water, rest
2. protection from harm = feeling safe
3. feeling loved and part of a group
4. esteem = respect yourself and be respected by others
5. self-actualization = becoming a complete person = reaching your greatest potential

by ___ the infant becomes aware of the absence of their parents

6mos

FLACC is used for what age and what does it stand for

F = face
L = legs
A = activity
C = crying
C = consolibility
Used for ages birth - 4yo

non-pharmacological pain prevention in infants (6)

- breastfeeding
- nonnutritive sucking
- kangaroo care
- swaddling
- limiting environmental stimuli
- attention to behavioral cues

___ is the leading cause of death in children under 19

accidents

types of accidents and injures (7)

1. falls
2. car
3. drowning
4. electrocution
5. suffocation
6. choking
7. burns

Toddlers normally begin walking alone by

15mos

toddlers begin to climb stairs by

21mos

toddlers can build towers of 4 or more blocks by ...
and more than 6 blocks by xxx

2yo
3yo

infant VS norms

Temp = 97.7 - 99.4
HR = 120-160
RR = 30-60
BP = 50-75 / 30-45

toddler VS norms

HR = 70-110
RR = 20-30
BP = 90-105 / 55-70

preschool VS norms

HR = 65-110
RR = 20-25
BP = 95-110 / 60-75

for what ages is the FLACC pain scale used

1-5yo

for what ages is the FACES pain scale used

3-7yo better starting at age 5

Newborns are nose breathers until

4wks

abd wall movement w/ breathing is normal until age

6

metabolic rate is ___ in newborns so the O2 demand is ___

higher
higher

fine crackles on inspiration

rales = fluid filled alveoli = pneumonia

rhonchi

snoring sound = low pitched heard throughout = thick secretions

stridor

high pitched on inspiration in upper airway = croup

wheezes

high pitched, musical = herd throughout = constricted bronchioles or narrow airway = asthma

upper airway (5)

pharyngitis, tonsillitis, croup aka: laryngotracheobronchitis, epiglotitis, flu

lower airway (3)

bronchiolitis = RSV, pneumonia, pertussis

what is pharyngitis

inflam of the throat mucosa and underlying structures

what is the triad of pharyngitis

1. sore throat
2. fever
3. pharyngeal inflam

flu is spread through what route

contact + droplet

flu is contagious for how many days before signs

1-2days

peak time for flu

dec - feb

age for tonsillitis

4-7yo

grading for tonsils

+1/+2 = normal
+3 = touching uvula
+4 = kissing

symptoms of tonsillitis

- red w/ exudate
- mouth breathing w/ halitosis
- difficulty swallowing
- enlarged adenoids may affect speech/snoring

post op care for tonsillectomy (7)

- side lying
- assess for hemorrhage = frequent swallowing
- avoid coughing
- dark brown blood tinged mucus = ok
- bright red is not normal
- avoid vomiting
- decrease crying

croup

general term for inflammatory process. Most commonly refers to : laryngotracheobronchitis

age for croup

3mo - 8yo

onset + symptoms of croup

- gradual + progressive
- early low-grade fever, hoarse, "croupy" cough, URI symptoms, moderate distress, inspiratory stridor,

most important intervention for croup

keep child calm + in position of comfort

interventions for croup (5)

- close monitoring of airway
- keep calm
- assess hydration
- cool mist + O2
- steroids

ages for epiglotitis

2-8yo

onset + symptoms of epiglotitis (5)

- abrupt + progresses rapidly to complete occlusion
- sudden high fvr, drooling, dysphonia (change in voice), dysphagia, stridor

bronchiolitis

inflammation of the bronchioles
- term used for kids <24mo w/ wheezing

common causes of bronchiolitis (3)

- RSV
- rhinovirus
- flu

what is happening w/ broncholitis

- virus enters mucosal cells + ruptures them = increase in mucus = bronchospasm + obstruction

there is a high risk of ___ w/ broncholitis

pneumonia

symptoms of bronchiolitis (4)

- wheezing
- crackles
- apnea = especially in premi's
- tachypnea = >60bpm

precautions for broncholitis

contact + airborn

interventions for broncholitis (4)

- high-flow or positive pressure humidified O2 if <90%
- surfactant
- chest physiotherapy
- suction

pneumonia is

inflammation of the lungs
- consolidation

pneumonia is caused by

viruses, bacteria, fungi

what causes consolidation in pneumonia

cellular destruction = accumulation of debris

what is pertussis

whooping cough
- highly contagious bacterial infection

who is most likely to get pertussis

younger kids <10yo

what is the gold standard for diagnosis of pertussis

culture

what type of precautions are needed for pertussis

droplet

what are the 2 immunizations for pertussis

DTap = infant to 6yo
TDaP = 7yo to adult

what is cystic fibrosis

autosomal recessive disorder = both parents are carriers
- increased mucus production
- decrease pancreatic enzyme production

what is one of the most common causes of childhood death

CF

what is going on in CF (3)

- increase in mucous in the lungs = secondary bacterial infections
- increased mucous in pancreatic ducts = blocks enzymes for digestion = decreased ability to absorb fat, protein + carbs
- metabolic issues = increase sodium chloride production by sweat glands = hyponatremia

symptoms of CF (6)

- salty skin
- recurrent URI
- increased appetite
- bulky stools
- clubbing + barrel chest = later signs

diagnosis of CF (5)

- prenatal DNA test
- newborn screening
- sweat chloride test
- CXR
- pulmonary function test

types of chest physiotherapy for CF (6)

- postural drainage = gravity
- percussion = cupped hands
- vibration
- breathing + coughing techniques
- vest
- forced exhalation + incentive spirometry

what is asthma

chronic obstructive inflammatory disorder caused by hyper-responsiveness

some triggers of asthma (6)

- cold air
- smoke
- URI
- pet dander
- exercise
- food allergies

symptoms of asthma (6)

- nonproductive cough
- SOB
- chest pain + tightness
- wheezing
- retractions
- anxiety

peripheral nervous system

- somatic = voluntary
- autonomic = involuntary

autonomic nervous system 2 parts

1. sympathetic = fight / flight
2. parasympathetic = rest / digest

cns is made up of (5)

brain
spinal cord
meninges
cranial nerves
ventricles

what is intellectual + developmental delay
- and type of milestones (5)

descriptive term not a diagnosis
- when a child is not meeting milestones
* fine motor
* gross motor
* language
* social skills
* adaptive skills

what is included in a physical exam for developmental delay (6)

1. head circumference abnormalities
- microcephaly = below avg
- macrocephaly = above avg
2. muscle tone abnormalities
- increased = hypertonia
- decreased = hypotonia
3. muscle atrophy
4. skin lesions
5. dysmorphic features
6. decrease in vision, hearing or use of tongue

what is a neural tube defect

occurs in brain + spinal cord during fetal development = folic acid deficiency

when is the normal closure of neural tubes

3-4weeks of pregnancy

2 most common neural tube defects

1. spina bifida
2. anencephaly

Types of Spina Bifida (3)

- spina bifida occulta- vertebrae are malformed but cord is normal = dimple
- meningocele - meningies only = doesn't always cause disability
- myelomeningocele - spinal cord + nerves are exposed + visible = is surgically repaired but doesn't repair deficit

What is hydrocephalus?

when CSF collects in an abnormal pattern in the brain

2 types of hydrocephalus

congenital = occurs before birth + is evident on US
acquired = after birth

symptoms of hydrocephalus and ICP in infants (9)

1. rapid increase in HC
2. bulging fontanel
3. vomiting
4. lethargy
5. irritability
6. shrill cry
7. sunsetting eyes
8. seizure
9. bradycardia initially then tachycardia as pressure increases

symptoms of hydrocephalus + ICP in children (8)

1. HA relieved w/ vomiting
2. papilledema = swelling of optic nerve
3. blurred vision
4. sunsetting eyes
5. lethargy
6. decrease in balance
7. irritability
8. bradycardia initially then tachycardia as pressure increases

treatment of hydrocephalus + ICP

surgery to place shunt
- ventriculoperitoneal shunt (VP)

what is seizure disorder

sudden abnormal electrical activity
classified by where in the brain + effects on kid

what is the highest trigger for seizure disorder

sleep deprivation

what are triggers for seizure disorders (3)

1. sleep deprivation
2. alcohol / drugs
3. not taking meds

if a seizure lasts longer then 2 mins + LOC you should

administer rectal diazepam gel or intranasal midazolam

if seizure is longer then 5mins or there is no reaction to meds

call 911

interventions for seizures (4)

1. turn on side
2. protect from injury
3. time it
4. IV access + oxygen + suction @ bedside

what is post-ictal period

- deep sleep period after seizure
- period of confusion

febrile seizures are caused by

- not how high the fvr is, but how quickly it rises

febrile seizures are most common at what ages

3mo - 5yo

what is meningitis

inflammation of the meninges
- can be life threatening infection

meningitis can lead to

encephalitits

symptoms of meningitis (6)

- sever HA
- stiff neck
- sudden high fever
- photo-sensitivity
- bulging fontanel in infants
- altered mental status

Kernig sign for meningitis

w/ child lying supine, flex hip + knee @ 90%
- positive sign is pain will prevent from straightening the legs

brudzinskis sign for menengitis

flexion on neck = involuntary flexion of knee + hip

How is menengitis diagnosed?

- increase WBC
- CSF (from LP) has protein + WBC's

treatment of menengitis

- antibiotics for pt and family
- antivirals

bacterial menengitis can be ___ while viral ___

B = fatal if untreated
V = rarely fatal and may resolve w/out treatment

cerebral palsy is

name given to a group of conditions that affect motor development

cerebral palsy is caused by

result of damage to the brain before, during or after birth

muscular dystrophy is

muscular weakness + a decrease in tone over time through gradual progressive degeneration

What is Duchenne Muscular Dystrophy? (3)

- more rapidly progressing
- usually diagnosed before 6yo
- xlink recessive inheritance through mom + expressed in male children

when and why do pt's w/ muscular dystrophy die

- usually in 20's
- respiratory / cardiac failure

what is gowers sign

in muscular dystrophy
- child "walks up" body w/ hands to stand up

what are rales?
a. fine-crackles noises heard on inspiration
b. low pitched sounds heard throughout respiration
c. high pitched sounds heard on inspiration
d. high pitched musical sounds heard throughout

a

on Nasal cannula
concentration level =
flow rate =

22-40%
0.25 - 6L = after 4L needs to be humidified

facemask
concentration % =
flow rate =

35-50%
6-10L = to push out CO2

non-rebreather
concentration %
flow rate

approaches 100%
10-15L

Select all of the clinical manifestations seen in a young child w/ croup
a. inspiratory stridor
b. high fvr
c. barking cough
d. increased respiratory rate
e. mild retractions
f. drooling

a,c,d,e

a 2yo is seen for acute laryngotracheobronchitis. Which of the following observations would most cause you to believe that airway occlusion is occuring
a. respiratory rate is gradually increasing
b. he falls asleep in moms arms
c. his cough is becoming harsher
d. nasal discharge is ingreasing

a

which of the following symptoms would a 3yo child who has epiglottitis most likely exhibit
a. exhaling through pursed lips
b. crackles upon auscultation
c. difficulty swallowing
d. blood tinged mucous

c

an 11mo is admitted to the hospital w/ broncholitis. Which toy is most appropriate for the nurse to recommend to the childs parents
a. a stuffed animal made from a washable fabric
b. plastic stacking toy w/ multicolored rings
c. set of wooden building blocks
d. train pull toy

b

which of the following clinical manifestations would the nurse expect for a 6mo w/ RSV
a. tachypnea
b. decreased HR
c. poor feeding
d. increased stooling
e. high grade fvr
f. fussiness
g. wheezing
h. apnea

a,c,f,g

a child w/ a diagnosis of pertussis is being admitted to the pediatric unit. As soon as the child arrives on the unit which action should the RN perform first
a. orient the child to the room
b. take the childs temp
c. place the child on a pulse ox
d. administer the prescribed antibx

c

a 2mo is admittied for observation w/ suspected pertussis. which of the following statements are true
a. no treatment for the baby + family is indicated until the test comes back positive
b. the baby + family should be started on antibx pending results
c. parents should avoid holding the baby
d. siblings are encouraged to visit since they have already been exposed

b

pancreatic enzyme supplements are given to a CF pt
a. between meals + @ bedtime
b. each time the child eats something
c. when the childs appetite begins to diminish
d. when stools become bulky + foul smelling

b

the rn is caring for a child w/ CF. Which of the following treatments would be used to promote mucus clearance through percussion or vibration
a. suctioning
b. chest tube
c. bronchoscopy
d. chest physiotherapy

d

when assessing a child admitted for an asthma attack what is the RN's priority
a. ask the childs parents about previous exacerbations
b. determine what medications have been given at home
c. inspect the childs throat for edema
d. auscultate lung bases for air movement

d

an 8yo child w/ a hx of asthma is seen in the school RN's office w/ coughing + wheezing. Which of the following actions should the RN perform first
a. assess the childs peak expiratory flow
b. educate he child to avoid triggers
c. transport the child to the closest ER
d. notify the childs parents of his condition

a

which statement by an 8yo w/ asthma indicates that the child understands the use of a PEF meter
a. my peak flow meter can tell me if an asthma attack might be coming, even though I might be feeling ok"
b. when i do my peak flow it works best when i do 3 breaths without pausing
c. I always start w/ the meter about halfway up, that way i don't waste time
d. if i use my peak flow meter every day I will not have an asthma attack

a

you are caring for a newborn w/ myelomeningocele who is awaiting surgical closure of the defect. which assessment finding is of most concern
a. bulging sac when infant cries
b. oozing of stool from the anal sphincter
c. flaccid paralysis of both legs
d. temo 101

d

what is the earliest indicator of change in neurological status

levels of consciousness

which class of medication is often prescribed to reduce inflam and ICP for a child w/ a severe head injury
a. antibx
b. corticosteriod
c. anticonvulsant
d. antihistamine

b

9mo w/ a VP shunt was admitted for shunt infection and malfunction. She presents w/ symptoms of ICP. select all that apply
a. decreased HR + RR
b. poor feeding
c. vomiting
d. decreased responsiveness
e. increased urine output
f. sunken fontanel
g. temp 99
h. signs of local inflam along the shunt tract

b, c, d, h

when do you pump the shunt

only when specifically ordered

a toddler is observed having a seizure. What is the priority nursing responsibility at this time
a. administer L of oxygen via a mask
b. insert a seizure stick to avoid biting the tongue
c. restrain the child to prevent injury
d. protect the child by clearing the area of any hazards

d

how are concussions dg

only by exam
- prior to injury pt (athlete) should have a baseline established

what has helped to decrease bacterial meningitis

HIB vaccine

what needs to be done for bacterial meningitis from dg to 24 after antibx have been on board

isolation

a 7yo has had LP in the ED for complaints of elevated temp + stiff neck. Which of the following cerebral fluid findings would indicate the child has bacterial meningitis
a. markedly lower than normal pressure
b.glucose 20mg/dL
c. WBC count 3
d. clear fluid

b

an infant has been admitted w/ a dg of meningitis. Which is the priority nursing assessment
a. nuchal rigidity
b. pupillary reaction
c. LOC
d. ability to maintain airway

d

child w/ bacterial meningitis has been placed in isolation. The parents ask how long the child will be in isolation
a. until the organism is cultured + identified
b. once antibx have been ordered and initiated
c. until antibx have been administered for 24hrs
d. after 10days of antibx therapy have been completed

c

what needs to be monitored carefully w/ meningitis

hydration
- strict I+Os

how should you feed a child w/ cerebral palsy + why

upright and support the lower jaw
- to prevent aspiration

what is reyes syndrom

when viral infection is treated w/ asprin

which of the following nursing observations would indicate pain on unconscious pt's
a. increased flaccidity
b. increased O2 sat
c. decreased BP
d. increased agitation

d

which of the following is appropriate care for the child who is unconscious
a. change the child's position frequently
b. avoid using narcotics or sedatives to provide comfort and pain relief
c. monitor I+O carefully to avoid fluid overload and cerebral edema
d. give tepid sponge baths to reduce fvr because antipyretics are contraindicated

c

signs of ICP are ___ of shock

opposite

Which statement is true about normal toddler growth and development.
A. They prefer to play alone
B. They are willing to share their toys
C. They like to play outside with older children
D.They prefer not to share their toys

d

. Which nursing interventions is appropriate when working with a preschool age child who has a terminal disease?
A. Give factual explanations of the disease, medications and procedures
B. Perform all the care for the child
C. Reinforce that being in the hospital is not a punishment for her behavior
D. Tell the child that everything will be ok

c

. For which of the following children should the nurse use the child's behavior rather than a self-report as an indication of pain?
A. 2-year-old
B. 6-year-old
C. 10-year-old
D. 12-year-old

a

Which of the following are NOT appropriate non-pharmacological pain management techniques for a nurse to use with a 5-year-old child who has a fractured femur?
A. distraction
B. relaxation techniques
C. positioning
D. watching TV

b

Which car safety device should be used for a child who is 8 years old and is 4 feet tall?
A. Rear-facing convertible seat
B. Front-facing convertible seat
C. Booster seat
D. Seat belt

c

Which of the following is a component of family centered care?
A. Reinforce all parenting practices
B. Recognize family strengths
C. Guarantee that financial needs are met
D. Accept all cultural practices and rituals

b

A 6-month old male is at his well-child checkup. The nurse weighs him and his mother asks if his weight is normal for his age. What is the nurse's best response?
A. "At 6 months his weight should be approximately triple his birth weight"
B. "Each child gains weight at his or her own pace"
C. "At 6 months his weight should be approximately twice his birth weight"
D. "At 6 months a child should weigh about 10 pounds more than his birth weight"

c

A seven-year-old child has just had an appendectomy. The nurse is monitoring his response to pain medication post-operative. Which tool is most appropriate for assessing the child's pain?
A. FLACC scale
B. CRIES neonatal scale
C. FACES pain rating scale
D. Numeric pain scale

a

Why is it important to preparing children for intrusive procedures?
A. This will increase their fear
B. This is increase their feelings of control
C. This will clear up any misconceptions
D. You shouldn't prepare children because this will increase stress

b

A nurse is caring for an adolescent client who has a long-leg cast applied following surgical repair of a fractured leg. She states "my leg hurts really badly" What is the next action the nurse should take next?
A. Obtain more information about the characteristics of the pain
B. Give her a dose of pain medicine per Dr. Order
C. Reassure her that the pain will diminish on a few days
D. Distract her by turning on the TV

a

What is one of the most common causes of injury and death for a 7-month old infant?
A. Dog bites
B. Child Abuse
C. Poisoning
D. Aspiration

d

Preschoolers engage in group play with similar or identical activities but without rigid organization or rules. What is this type of play called?
A. Associative
B. Dramatic
C. Parallel
D. Solitary

a

The nurse is helping parents prepare a healthy meal plan for their toddler. Which guidelines for promoting nutrition should be followed when planning meals?
A. Toddlers should have their fat restricted to help prevent obesity in school age children
B. Extending breast feeding into toddlerhood is believed to be beneficial to the child
C. Serve three meals a day without any snacks in between
D. Toddlers tend to have the highest daily iron intake of any age group

b

What measure would you suggest an infant's parents use to relieve teething discomfort?
A. Provide her/him with a fluid diet for 2 days
B. Offer her Aspergum to chew
C. Ask the pediatrician to order a sedative for her/him
D. Give her/him a cold teething ring to chew

d

. Which event should be reported to a risk management committee?

A. A patient's heparin lock becomes clotted between intermittent medication doses.
B. An uncooperative child spits out his oral medicine despite the nurse's best efforts..
C. A toddler pulls out his IV.
D. The nurse administers a double dose of a medication bases on an incorrect physician's order.

d

Match the following
1. Protest A. withdrawal and quietness
2. Despair B. Lack of protest when parents leave
3. Detachment C. Crying

A. 1-A, 2- B, 3-B
B. 1-B, 2-C, 3-A
C. 1-C, 2-A, 3-B
D. None of the above

c

A 15-year-old male seeks treatment for a sexually transmitted infection at a local clinic. With regard to informed consent, the nurse should perform which action?
A. Ask the client to sign the informed consent form.
B. Tell the client that parental consent is needed for treatment.
C. Tell the client a court order is needed for treatment.
D. Call the client's mother to obtain telephone consent for treatment.

a

Which VS would the nurse be most concerned about in a teenage admitted to the pediatric unit?
A. Heart rate 104
B. respiratory rate 24
C. Blood Pressure 84/62
D. Temperature 101 F

c

Which activity can provide the 10-year-old child who is hospitalized with a sense of industry?
A. Allow the child to complete school work
B. Allow the child to choose when he takes his/her medicine
C. Allow the child to help with bathing
D. Allow the child to help with his dressing change

a

The nurse is caring for a 5 week old infant who is "spitting up all the time". This is the mother's first child. What should be the priority nursing intervention?
A. Recommend the mother offer smaller and more frequent feedings
B. Assess and weigh the baby
C. Offer assurance that spitting up is normal
D. Observe the mother while she feeds and burbs the baby

b

. An eight-year-old is being seen in the pediatrician's office following a head injury. The nurse assesses the child's VS: temp 98, HR 52, RR 12, BP 88/50. Cap refill is 2 seconds. Which action would be appropriate for the nurse too take?
A. Ask the child or parent to describe how the head injury occurred.
B. Immediately administer 2 rescue breaths.
C. Carefully exam the child's head for any sign of fracture.
D. Immediately notify the health care provider of the findings.

d

A 3-year-old is admitted to the hospital with croup. VS- HR 90, RR 44, BP 95/52, temp 98.8 F. The parents ask if these are normal. What is the nurse's best response?
A. "The BP is elevated, but the rest of the VS are normal"
B. "The Temp is elevated, but the rest of the VS are normal"
C. "The HR is elevated, but the rest of the VS are normal"
D. "The RR is elevated, but the rest of the VS are normal"

d

A 1-month old infant is admitted to the hospital with vomiting and diarrhea. The infant's HR is 170, RR 44, BP 85/52, and temp 99 F. What is the nurse's best response to the parents who ask if the VS are normal?
A. "The BP is elevated, but the other VS are normal."
B. "The HR is elevated, but the other VS are normal"
C. "The RR is elevated, but the other VS are normal"
D. "The temp is elevated, but the other VS are normal"

b

The school nurse is providing an educational for parents of high school students. Which action should the nurse parents to perform in relation to moral development of their teenagers.
A. Threaten a severe consequence if the child breaks the rules.
B. Take their child on a trip to the local jail to show what happens when adults break the law.
C. Require the child to sign an honor pledge never to break house rules or the law.
D. Role-model ethical and moral behavior in their everyday lives.

d

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