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PEDS > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Why is a child at risk for shaken baby syndrome?

A

The head is disproportionate and the neck is not supported

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2
Q

What should the nurse do if a client who has a hip spica cast and complains of pain for 1 hour after receiving intravenous opioid analgesics?

A

Complete a neuromuscular assessment

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3
Q

What should the nurse do if a client who has been re-casted for clubfoot has been crying for an Hour?

A

Make sure blood is circulating.

Complete another neuro assessment of the foot

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4
Q

How long should a child with meningitis remain in isolation?

A

24 hours on antibiotics in isolation

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5
Q

What nursing actions are appropriate to prevent skin break down for a client with a spinal cord injury?

A

Turn / reposition Q2

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6
Q

What lab value should the nurse report to the provider before initiating amphotericin B (an anti fungal that can cause kidney damage)

A

BUN > 20 (55 is high)

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7
Q

What is beneficial in reducing the risk of Reye syndrome?

A

Avoid aspirin

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8
Q

What assessment should the nurse include on a child who had acute rheumatic fever?

A

Heart sounds

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9
Q

What should a nurse expect from a child who has heart failure?

A

Orthopnea

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10
Q

What comfort medication can be given to a child who just had cardiac catheterization?

A

Tylenol

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11
Q

What is a normal apical heart rate for a 6 month old ?

A

90-180

(Hold Dig if heart rate is <90)

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12
Q

What supplement can be added to a babies formula to increase calories in an infant with heart failure?

A

Polycose

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13
Q

What data or medical information would clue to the nurse that a child might have rheumatic fever?

A

If anyone else in the family has had strep throat recently

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14
Q

What defect is associated with increased pulmonary blood flow?

A

PDA (congenital)

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15
Q

What should the nurse monitor for a child who has Kawasaki disease?

A

Lymph nodes
Cardiac

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16
Q

What should the nurse expect of a client has arteriosclerosis and increased peripheral vascular resistance?

A

Increase in systolic portion of BP

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17
Q

What manifestations should the nurse monitor first for or are priority for a client with infective endocarditis?

A

Respiratory
Trouble feeding
Fever
Murmur
Weight loss
Hemorrhage under nails

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18
Q

What venous access device should the nurse identify as appropriate for the client with bacterial endocarditis?

A

PICC

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19
Q

What nursing interventions should be included in the care following a cardiac catheterization

A

Monitor the cranial nerves

Prevent bleeding, maintain affected extremity in straight position for 4-6 hours

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20
Q

What does baclofen do in a child with cerebral palsy?

A

Controls muscle spasms

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21
Q

What manifestations would indicate that a shunt revision is necessary due to hydrocephalus?

A

Check LOC

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22
Q

What manifestations should the nurse assess for Cushing’s triad?

A

Widened pulse pressure
Decreased respiratory
Bradycardia

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23
Q

What should the nurse include in the child’s care plan who has an acute head injury ?

A

Elevate HOB
Assess LOC

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24
Q

What should the nurse test for a client with clear drainage coming out of the clients right nostril that was sustained from a nasal skull fracture ?

A

Glucose

25
Q

What cerebrospinal fluid results support the diagnosis of bacterial meningitis

A

Decreased glucose
Increased protein
Cloudy

26
Q

If a child has a fever of 103, what type of isolation should the child be in?

A

Droplet precaution

27
Q

What is the manifestations of a child having hydrocephalus?

A

Distended scalp veins
Bulging fontanel
Vomiting
Irritability

28
Q

What seizure precautions should be implemented by the nurse if the child is experiencing a seizure?

A

Time seizure
Stay with the patient
Protect head
Loosen clothing
Remove furniture

29
Q

What is the nurses priority who has a tonic clinic seizure?

A

Side laying position

30
Q

What type/route temperature on an infant who has myelomeningocele ?

A

Auxiliary

31
Q

What should the nurse include in the plan of care for an infant who has spina bifida?

A

No latex gloves

32
Q

How often should a child who has legg-calve-parthesis and is in a buck extension traction be moved?

A

Q2 hours

33
Q

What plan of care should be included for a client who is postoperative following scoliosis repair?

A

PCA pump for pain management

34
Q

What type of position should a patient be placed in who is postoperative following a ventricularperitoneal shunt replacement ?

A

On the opposite side of the surgical incision

35
Q

What should be included in a plan of care for a child who has hemiplegic cerebral palsy?

A

Maintain activity level in a modified environment

36
Q

What type of position should a client be placed in who is having a seizure?

A

Side lying

37
Q

What action should the nurse take when assessing cranial nerve 3?

A

PERLA, pupil reaction to light

38
Q

What type of assessment should the nurse do on a client who has a newly applied fiberglass cast for a fractured tibia?

A

Neuromuscular assessment

39
Q

What type of assessment should a nurse do on a client with myelomeningocele

A

Protect sac

40
Q

What manifestations are seeing with a client who is hydrocephalus?

A

Dilated scalp things

41
Q

What is unnecessary in the child’s plan of care who has bacterial meningitis?

A

Measuring the head circumference, if they’re older than 18 months

42
Q

What is a manifestation of a client who has increased ICP

A

Cushing’s triad

43
Q

How should a nurse proceed with a child who will be getting a cast?

A

Use a toy to demonstrate

44
Q

What findings should the nurse observe first on a client with a leg cast?

A

Color of the toes, pallor is bad

45
Q

What should the nurse check first in a client who has a cast in place for a fractured tibia?

A

Cap refill

46
Q

What should be a nursing priority for a client who has osteomyelitis?

A

Antibiotics

47
Q

What should the nurse also include in the care plan of a seizure patient following a seizure

A

Side lying

Assess cranial nerves?

48
Q

What is Brudzinski’s sign

A

Passively flex neck and involuntary flex in both legs

49
Q

What medication should the nurse be ready to administer to a client who has a traumatic head injury and is having ICP

A

Mannitol 25%

50
Q

What is the purpose of administering an osmotic diuretics IV to a client with ICP

A

To reduce edema in the brain

51
Q

How should a patient be position who has ICP?

A

Semi Fowler
15 to 30%

52
Q

Which manifestations would be related to having a leaking cerebral aneurysm?

A

Headache
Disoriented
Slurred speech

53
Q

What type of action should the nurse take when caring for a client with increased ICP following a head injury

A

Log roll

Keep their head midline, elevate HOB

54
Q

What should a nurse monitor for an infant following a car crash?

A

Sleepiness
Temperature
Respirations

ICP : bulging, fontanelle, increase head, circumference, high scream, distended veins, irritability, bradycardia, decreased respirations

55
Q

What is the purpose of a halo fixation device?

A

To immobilized keep straight

56
Q

What is the function of cranial nerve three?

A

Oculomotor
Response to light

57
Q

What action should the nurse take first for a client who has a short leg cast to treat at ankle fracture?

A

Notify the PCP if the patient cannot flex their toes

58
Q

What complication might be suspected if the client has a cast that feels warm to the touch?

A

Check for infection / restlessness (possible ICP)???

Compartment syndrome?

*my notes said compartment syndrome, but class told me otherwise

PEDS (6 decks)

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