I Want To Be A Peds Nurse

OH The Bleeding

100

An adolescent diagnosed with thalassemia major (Cooley's anemia) is at risk for which condition? 1. Hypertrophy of the thyroid 2. Hypertrophy of the thymus 3. Polycythemia vera and thrombosis 4. Chronic hypoxia and iron overload

4. Chronic hypoxia and iron overload RATIONALE: Thalassemia major increases destruction of red blood cells (RBCs), shortens the life span of RBCs, and causes anemia. The body responds by increasing RBC production, but it can't produce adequate numbers of mature cells. This process results in chronic hypoxia. In addition, children with thalassemia major require multiple transfusions of packed RBCs. The combination of excessive RBC destruction and multiple transfusions deposits excess iron that damages organs and tissues.

200

A toddler is diagnosed with iron deficiency anemia. When teaching the parents about using supplemental iron elixir, the nurse should provide which instruction? 1. "Give the iron preparation with milk." 2. "Give the elixir with water or juice." 3. "Monitor the child for episodes of diarrhea." 4. "Give the iron preparation before meals."

2. "Give the elixir with water or juice." RATIONALE: Because iron preparations may stain the teeth, the nurse should instruct the parents to give the elixir with water or juice. The iron preparation shouldn't be given with milk because milk impedes iron absorption. This preparation may darken the stools and cause constipation, not diarrhea; parental instruction regarding increased fluid intake and fiber intake can relieve constipation. To prevent GI upset, the nurse should instruct the parents to mix the iron preparation with water or fruit juice and have the child take it with, not before, meals. (Giving it with fruit juice may be preferable because vitamin C enhances iron solubility and absorption.)

300

When assessing a child with hemophilia, the nurse identifies which condition as an early sign of hemarthrosis? 1. Decreased peripheral pulses 2. Active bleeding 3. Joint stiffness 4. Hematuria

3. Joint stiffness RATIONALE: Joint stiffness is an early sign of hemarthrosis. Hemarthrosis doesn't affect pulses and bleeding into the joints can't be observed directly. Hematuria is incorrect because this sign indicates bleeding in the urinary tract.

400

How should the nurse respond when asked by the mother of a child with beta-thalassemia why the child is receiving deferoxamine? 1."To improve the anemia." 2."To decrease liver and spleen swelling." 3."To eliminate excessive iron being stored in the organs." 4. "To prepare your child for a bone marrow transplant."

What is 3."To eliminate excessive iron being stored in the organs." Deferoxamine is given to chelate iron and prevent organ damage.

500

A child who has been in good health has a platelet count of 45,000/mm, petechiae, and excessive bruising that covers the body. The nurse is aware that these signs are clinical manifestations of 1. Erythroblastopenia 2. von Willebrand disease 3. Hemophilia 4. Immune thrombocytopenic purpura (ITP)

What is 4. Immune thrombocytopenic purpura (ITP)

My Hearts Broken

100

A 30-month-old toddler is being evaluated for a ventricular septal defect (VSD). Identify the area where a VSD occurs.

A VSD is a small hole between the right and left ventricles. It's a common congenital heart defect and accounts for 20% to 30% of all heart lesions.

200

A nurse is caring for a 2½-year-old child with tetralogy of Fallot (TOF). Which abnormalities are associated with TOF? 1. Aortic stenosis, atrial septal defect, overriding aorta, and left ventricular hypertrophy 2. Pulmonic stenosis, intraventricular septal defect, overriding aorta, and right ventricular hypertrophy 3. Pulmonic stenosis, patent ductus arteriosus, overriding aorta, and right ventricular hypertrophy 4. Transposition of the great vessels, intraventricular septal defect, right ventricular hypertrophy, and patent ductus arteriosus

2. Pulmonic stenosis, intraventricular septal defect, overriding aorta, and right ventricular hypertrophy RATIONALE: TOF consists of four congenital anomalies: pulmonic stenosis, intraventricular septal defect, overriding aorta, and right ventricular hypertrophy. The other combinations of defects aren't characteristic of TOF.

300

A toddler is hospitalized for evaluation and management of congenital heart disease (CHD). During discharge preparation, the nurse should discuss which topic with the parents? 1. The need to withhold childhood immunizations 2. The importance of restricting the child's fat intake 3. How to perform postural drainage 4. When to administer prophylactic antibiotics

4. When to administer prophylactic antibiotics RATIONALE: In CHD, areas of turbulent blood flow provide an optimal environment for bacterial growth. Therefore, a child with CHD is at increased risk for bacterial endocarditis, an infection of the heart valves and lining, and requires prophylactic antibiotics before dental work and invasive procedures. These children should receive all childhood immunizations. They don't require postural drainage or dietary fat restriction.

400

A nurse is caring for a young child with tetralogy of Fallot (TOF). The child is upset and crying. The nurse observes that he's dyspneic and cyanotic. Which position would help relieve the child's dyspnea and cyanosis? 1. Sitting in bed with the head of the bed at a 45-degree angle 2. Squatting 3. Lying flat in bed 4. Lying on his right side

2. Squatting RATIONALE: Placing the child in a squatting position sequesters a large amount of blood to the legs, reducing venous return. Sitting with the head of the bed at a 45-degree angle, lying flat, and lying on the right side don't reduce venous return; therefore, they won't relieve the child's dyspnea and cyanosis. A child with TOF may also assume a knee-chest position to reduce venous return to the heart

500

An infant in distress with a suspected ductal-dependent cardiac lesion should receive IV prostaglandins (PGE1) 1. Only after a neonatology consult 2. Even prior to echocardiography 3. As an adjunct to CPR in the event of a lethal arrhythmia 4. After proper sedation has been achieved.

2. Even Prior to a echo

These Blood Cells Ain't Right

100

A nurse is giving instructions to parents of a school-age child diagnosed with sickle cell anemia. The instructions should include: 1. applying cold to affected areas to reduce the child's discomfort. 2. restricting the child's fluids during crisis situations. 3. avoiding areas of low oxygen concentration such as high altitudes. 4. encouraging the child to exercise to reduce the likelihood of crisis.

3. avoiding areas of low oxygen concentration such as high altitudes. RATIONALE: The child should avoid areas of low oxygen, such as high altitudes, because they may precipitate sickle cell crisis. Applying warm compresses will reduce discomfort to the affected area; cold compresses, however, may add to discomfort by increasing sickling and impairing circulation. The child should be encouraged to drink fluids to rehydrate cells. Strenuous exercise may induce, not reduce, sickle cell crisis.

200

Name the three types of sickle cell crisis

What is Vaso-occulsive, Acute Sequestration Crisis, Aplastic Crisis

300

The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? a. Autoimmune reaction complicated by hypoxia b. Lack of oxygen in the red blood cells c. Obstruction to circulation d. Elevated serum bilirubin concentration.

What is C. Obstruction to circulation Characteristic sickle cells tend to cause “log jams” in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.

400

A 9 year old girl with sickle cell disease presents with complaints of chest pain and joint pain, fever and cough. Vital signs are an oral temp of 102.1, HR 138, RR 40, BP 116/82 and SPo2 90% on room air. She rates her pain 8/10. Which of the following interventions represents the highest priority for her? 1. Obtain IV access and treat her pain with morphine, fentanyl or dilaudid. 2. send blood to the blood bank for type and screen to prepare her for possible transfusion of PRBCs 3. Prepare her for a chest xray, send blood for CBC/culture and begin IV antibiotics 4. Apply high flow oxygen at 10-15 lpm via nonrebreather mask and monitor her O2.

4. Apply high flow oxygen at 10-15 lpm via nonrebreather mask and monitor her O2. She is demonstrating signs of acute chest syndrome.

500

A nurse is teaching home care instructions to parents of a child with sickle cell disease. Which instructions should the nurse include? Select all that apply 1. limit fluid intake 2. administer aspirin for fever 3. administer pcn as ordered 4. avoid cold and extreme heat 5. provide for adequate rest periods.

What is 3. administer pcn as ordered 4. avoid cold and extreme heat 5. provide for adequate rest periods.

This Caused That

100

A school-age child with fever and joint pain has just received a diagnosis of rheumatic fever. The child's parents ask the nurse whether anything could have prevented this disorder. Which intervention is effective in preventing rheumatic fever? 1. Immunization with the hepatitis B vaccine 2. Isolation of individuals with rheumatic fever 3. Use of prophylactic antibiotics for invasive procedures 4. Early detection and treatment of streptococcal infections

4. Early detection and treatment of streptococcal infections RATIONALE: Rheumatic fever is a systemic inflammatory disease that follows a group A streptococcal infection. Therefore, early detection and treatment of streptococcal infections help prevent the development of rheumatic fever. Hepatitis B vaccine provides immunity against the hepatitis B virus — not streptococci. Because rheumatic fever isn't contagious, isolation measures aren't necessary. Prophylactic antibiotics are used before invasive procedures only in clients with a history of carditis to prevent bacterial endocarditis.

200

A school-age child is being discharged with a diagnosis of rheumatic fever. Which instructions should be included in the teaching plan for the family? 1. The child should stay on penicillin and return for a follow-up appointment. 2. At home, be sure to keep the child on bed rest. 3. All children with rheumatic fever need monthly blood tests. 4. The child should stay out of school until the source of the infection is determined

1. The child should stay on penicillin and return for a follow-up appointment. RATIONALE: A child with rheumatic fever, which is caused by group A beta-hemolytic streptococci, should stay on penicillin — either oral daily or an injection monthly — to prevent a recurrence. A follow-up appointment is needed to determine how the child is responding to treatment. Neither bed rest nor monthly blood tests will be ordered for all children. Rheumatic fever is caused by group A beta-hemolytic streptococci, so the source of the infection is already known

300

A child, age 3, is hospitalized for treatment of Kawasaki disease. Which of these nursing diagnoses should receive priority in the child's care plan: 1. Self-care deficit 2. Diarrhea 3. Risk for injury 4. Caregiver role strain

3. Risk for injury RATIONALE: Kawasaki disease, which affects young children, is characterized by acute systemic vasculitis. Risk for injury should receive priority because this inflammation of blood vessels leads to platelet accumulation and the formation of thrombi or obstruction in the heart and blood vessels. Approximately 10 days after the onset of the disease process, the platelet count rises and thrombi may form in the coronary arteries, leading to a myocardial infarction. The nurse must monitor the child closely for chest pain, cyanosis or pallor, and changes in the blood pressure. Diarrhea isn't a symptom of Kawasaki disease. Although Self-care deficit and Caregiver role strain may be appropriate diagnoses for this child, they don't take priority over Risk for injury

400

The nurse is admitting a child who has been diagnosed with Kawasaki disease. What is the most serious complication for which the nurse should assess in Kawasaki disease? 1. Cardiac valvular disease 2. Cardiomyopathy 3. Coronary aneurysm 4. Rheumatic fever

What is 3. Coronary aneurysm

500

What is the most common causative agent of bacterial endocarditis? 1. Staphylococcus albus 2. Streptococcus hemolyticus 3. Staphylococcus albicans 4. Streptococcus viridans

What is 4. Streptococcus viridans S. viridans and S. aureus are the most common causative agents for bacterial endocarditis

Cancer Sucks

100

During chemotherapy, a boy, age 10, loses his appetite. When teaching the parents about his food intake, the nurse should include which instruction? 1. "Offer dry toast and crackers." 2. "Withhold all food and fluids." 3. "Ignore your child's lack of food intake." 4. "Let your child eat any food he wants."

4. "Let your child eat any food he wants." RATIONALE: The nurse should instruct the parents to let the child eat any food he wants because any form of intake is better than none. Dry crackers or toast would be appropriate for a child experiencing nausea. Withholding all foods and fluids or ignoring lack of food intake would be inappropriate.

200

A physician diagnoses leukemia in a child, age 4, who complains of being tired and sleeps most of the day. Which nursing diagnosis reflects the nurse's understanding of the physiologic effects of leukemia? 1. Ineffective airway clearance related to fatigue 2. Activity intolerance related to anemia 3. Imbalanced nutrition: More than body requirements related to lack of activity 4. Ineffective cerebral tissue perfusion related to central nervous system infiltration by leukemic cells

2. Activity intolerance related to anemia RATIONALE: A nursing diagnosis of Activity intolerance related to anemia reflects the nurse's understanding of leukemia's physiologic effects because a child with leukemia may experience anemia from bone marrow depression, such as from chemotherapy or replacement of normal bone marrow elements by immature white blood cells. Anemia results in fatigue, lack of energy, and activity intolerance. The nurse's findings don't support the other diagnoses of Ineffective airway clearance related to fatigue, Imbalanced nutrition: More than body requirements related to lack of activity, and Ineffective cerebral tissue perfusion related to central nervous system infiltration by leukemic cells

300

A 4-year-old child has recently been diagnosed with acute lymphocytic leukemia (ALL). What information about ALL should the nurse provide when educating the client's parents? Select all that apply. 1. Leukemia is a rare form of childhood cancer. 2. ALL affects all blood-forming organs and systems throughout the body. 3. Because of the increased risk of bleeding, the child shouldn't brush his teeth. 4. Adverse effects of treatment include sleepiness, alopecia, and stomatitis. 5. There's a 95% chance of obtaining remission with treatment. 6. The child shouldn't be disciplined during this difficult time.

2. ALL affects all blood-forming organs and systems throughout the body. 4. Adverse effects of treatment include sleepiness, alopecia, and stomatitis. 5. There's a 95% chance of obtaining remission with treatment. RATIONALE: In ALL, abnormal white blood cells (WBCs) proliferate, but they don't mature past the blast phase. These blast cells crowd out the healthy WBCs, red blood cells, and platelets in the bone marrow, leading to bone marrow depression. The blast cells also infiltrate the liver, spleen, kidneys, and lymph tissue. Common adverse effects of chemotherapy and radiation include nausea, vomiting, diarrhea, sleepiness, alopecia, anemia, stomatitis, mucositis, pain, reddened skin, and increased susceptibility to infection. There's a 95% chance of obtaining remission with treatment. Leukemia is the most common form of childhood cancer. The child schould continue to brush his teeth, but he should use a soft toothbrush to minimize trauma. The child still needs appropriate discipline and limits. A lack of consistent parenting may lead to negative behaviors and fear.

400

When reviewing the laboratory results of a child with leukemia, the healthcare provider notes that the child is also anemic. Which statement provides the best rationale for this problem? Please choose from one of the following options. A. The increased number of lymphocytes is destroying the red blood cells at a rapid rate B. Chemotherapy-induced osteoporosis has caused decreased erythropoiesis C. The overproduction of immature white blood cells occurs at the expense of other cells D. The child has a poor appetite and has not been consuming adequate dietary iron

What is C. The overproduction of immature white blood cells occurs at the expense of other cells

500

During the induction phase of chemotherapy for acute lymphoblastic leukemia (ALL) the patient experiences tumor lysis syndrome. Which of the following metabolic disturbances can occur because of tumor lysis syndrome? Please choose from one of the following options. A. Hypercalcemia B. Hypokalemia C. Hyperuricemia D. Hypoglycemia

What is C. Hyperuricemia tumor lysis syndrome occurs when large numbers of neoplastic cells are killed rapidly, leading to the release of intracellular ions and metabolic byproducts into the systemic circulation. Clinically, the syndrome is characterized by rapid development of hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acute renal failure