Hema/Onc
A 9-year-old child is brought to the emergency department by their grandparent with severe pain in both legs and lower back, n/v, SOB and jaundice. The caregiver reports that the child has been complaining of pain since they arrived in Colorado and has been drinking very little. The child appears restless and rates the pain as 9/10. Grandparent is unsure of child's history and states they are here on a skiing trip. What condition do you expect and what could be causing this episode?
Sickle Cell Anemia
-altitude, dehydration, cold exposure
A 12-year-old child with obesity is seen in the clinic for increased thirst and frequent urination. The child has darkened, velvety skin around the neck and axilla. Laboratory results show an elevated fasting blood glucose and HbA1c. The nurse is providing initial education to the child and parents on treatment. What condition do you suspect and what interventions?
Diabetes mellitus type 2
Exercise, weight loss and possibly oral medications.
A 4-month-old infant is brought to the pediatric clinic for poor weight gain and feeding difficulties. The nurse notes central cyanosis, clubbing of the fingers, and a loud cardiac murmur. The parent reports that the infant becomes increasingly blue when crying. Which type of congenital heart defect is most consistent with these findings?
Cyanotic: transposition of the great arteries, tetralogy of fallout, hypoplastic L heart syndrome & tricuspid atresia
A 7-year-old child is brought to the clinic with a sore throat and fever. The child reports pain when swallowing. Assessment reveals red, swollen tonsils with white patches, enlarged cervical lymph nodes, and a temperature of 102.2°F (39°C). The child has decreased oral intake because swallowing is painful.
Tonsilitis
A 4-year-old child weighs 44 lb. The healthcare provider needs the child's weight in kilograms before prescribing a weight-based medication. What is the child's weight in kilograms? Round to the one decimal.
20 kg
A 7-year-old child presents with severe pain in both arms and legs. The child has a history of sickle cell anemia. The child is crying, has a heart rate of 124/min, and reports pain of 9/10. The nurse notes that the child has had poor oral intake today. What nursing intervention is priority?
Pain medication, hydration, oxygenation if required and monitoring.
The mother is changing the diaper and clothing of her newborn and you notice a musty scent. What condition do you expect and what teaching should be provided?
phenylketonuria
PT will need to avoid high protein foods (milk, eggs, meat, beans and nuts) Pt will require special formula.
A 10-month-old infant with Tetralogy of Fallot suddenly becomes extremely cyanotic and tachypneic after crying. The infant is irritable and has an oxygen saturation of 72%. The nurse recognizes that the child is experiencing a hypercyanotic ("Tet") spell. How should the nurse intervene?
Place the child in the knee-chest position, Administer oxygen as prescribed, Reduce stimulation and calm the child, Prepare to administer morphine as prescribed
A 2-year-old child is brought to the emergency department after waking during the night with a barking cough and noisy breathing. The parent reports that the child had a runny nose and low-grade fever earlier in the day. The child's symptoms become worse when the child is crying. What lung sounds do you expect to hear and what teaching will you give the parents?
Stridor; cool mist humidifier, steam from shower, cold outside air, encourage fluids and rest
breathing treatments & steroids
A 6-year-old child is prescribed amoxicillin 400 mg PO. The medication available is 250 mg/5 mL. How many mL should be administered? Round to whole number.
8 mL
A 2-year-old child is diagnosed with iron-deficiency anemia and is prescribed oral ferrous sulfate. Before discharge, the nurse should teach the parents what information about nutrition and administration of oral iron?
rinse mouth after taking, take with orange juice to improve absorption, can cause constipation, cause black stools, encourage well balanced meals and educate on relapses. Encourage less than 24 oz of milk a day.
A 9-year-old with newly diagnosed type 1 diabetes is preparing for discharge. The child's parent says, “My child goes to public school and I am not sure what I need to tell the teacher concerning hypoglycemic episodes." What could you do as the nurse and what would you teach the parent?
Provide material for the parent to give to the teacher
S/s of hypoglycemia: fatigue, pale, sweating, anxious, shakiness, confusion, irritability, visual disturbance
Treatment: administer 15-20g carbs (4oz juice) and send to the nurse
A 9-year-old child had untreated streptococcal pharyngitis several weeks ago. The child now presents with fever, painful migrating joint inflammation, fatigue, and a new cardiac murmur. What condition do you expect and what lab work do you expect to see?
Rheumatic fever; throat culture, CRP and ESR
An 8-year-old child develops wheezing, chest tightness, coughing, and difficulty breathing while playing outside. The child is sitting upright (tripod) and using accessory muscles to breathe. Oxygen saturation is 94%. What medication do you expect to administer and how?
Albuterol inhaler with a spacer. 1 puff wait 2 minutes next puff to allow medication to begin working.
A 5-year-old child is admitted with dehydration. The provider orders 750 mL of IV fluid to infuse over 6 hours and 30 minutes. What should the nurse set the IV pump at in mL/hr? Round to the nearest whole number.
115 mL/hr
A 6-year-old child receiving chemotherapy for leukemia has an low absolute neutrophil count. The child is fatigued and has several visitors wanting to come to the hospital room. The parents ask what they can do to protect their child from infection. What teaching would you provide?
reverse isolation: monitor closely for s/s of infections, maintain a clean environment to reduce infection risk, limit visitors, keep child away from public areas, do not use rectal thermometers/medications
A 14-year-old arrives in the emergency department with vomiting, abdominal pain, kussmal respirations, and fruity-smelling breath. The child's blood glucose is 485 mg/dL. The child is lethargic and has signs of dehydration. What condition do you expect and what would the treatment be?
Diabetic Ketoacidosis (DKA)
NS for dehydration
Insulin drip
A 3-year-old child is brought to the emergency department with a 6-day history of high fever that has not resolved. The nurse notes bilateral red eyes without drainage, red and cracked lips, a strawberry-colored tongue, a generalized polymorphous rash, enlarged cervical lymph nodes, and redness and swelling of the hands and feet. The parent reports that the child has been extremely irritable. What condition do you expect and what is your PRIORITY intervention?
Kawasaki disease; Obtain an IV and get ready to administer IVIG
A 5-year-old child with a history of recurrent respiratory infections is admitted for worsening cough. The nurse notes thick, sticky respiratory secretions, a persistent productive cough, and poor weight gain. The parent reports that the child's stools are frequently bulky, greasy, and difficult to flush. What condition do you expect and how do you diagnose?
Cystic Fibrosis; sweat test, genetic testing and CXR
A child weighs 22 kg. The provider prescribes cephalexin 350 mg PO four times daily. The medication is available as 250mg/5mL.
The Recommended pediatric dose: 25–50 mg/kg/day divided into 4 equal doses. Maximum daily dose: 4,000 mg/day.
Is the prescribed dose of 350 mg four times daily within the recommended safe range for this child?
What is the safe range of mL that you would administer as a safe dose? round to 1 decimal.
No, the dose is above the safe dose.
550-1100 mg/day
2.8 mL-5.5mL
A pt with a new diagnosis of hemophilia A is being discharged after rapid administration of clotting factors to treat a bleeding episode. What specific discharge instructions would you provide concerning hemophillia?
avoid rectal temperatures/medications, avoid skin punctures, hold pressure for at least 5 minutes after skin punctures, monitor body fluids for blood, child should only participate in low impact sports, monitor for headache or changes in HR (sign of bleeding)
A 3-week-old infant is brought to the pediatric clinic with poor feeding, vomiting, jaundice, and poor weight gain. The infant was switched from breastfeeding to a cow's-milk-based formula in the hospital due to poor feeding. What condition do you suspect and how would you intervene/teach?
galactosemia
recommend a casein based formula and inform the parents that the child may not tolerate breast/animal milk or any form of foods that contain galactose
A 6-month-old infant is diagnosed with a ventricular septal defect (VSD). During a feeding, the nurse observes tachypnea, tachycardia, diaphoresis, fatigue, and frequent pauses to rest. The infant has gained very little weight since the previous visit. Which complication should the nurse suspect?
Congestive heart failure
A 4-year-old child is brought to the ER after suddenly developing a high fever, severe sore throat, dysphagia, drooling, and a muffled voice. The child is sitting upright, leaning forward with the neck extended and appears anxious. The nurse hears a harsh sound when the child breathes in. What is the nurse hearing, what condition do you expect and what is the priority intervention.
stridor; Epiglottitis; Keep the child calm and prepare for emergency airway management (DO NOT STICK ANYTHING IN THE MOUTH)
A 6-year-old child weighs 18 kg and is prescribed ceftriaxone 75 mg/kg/day IV, divided into 2 equal doses. The medication is available as ceftriaxone 1 g in 100 mL after reconstitution. The nurse must administer the dose over 45 minutes using IV tubing with a drop factor of 15 gtt/mL. How many gtt/min should the nurse administer? Record answer as a whole number.
33 gtt/min
1350mg/day; 675mg/dose; 100mg/mL; 6.75mL