Exam 4 Flashcards
(233 cards)
1
Q
In what weeks of fetal development do congenital abnormalities most often occur?
1) Week 1-5
2) Weeks 4-7
3) Weeks 10-15
2) Weeks 1-3
A
2) Weeks 4-7
2
Q
Within fetal circulation, what is the main structure that provides gas exchange?
1) Umbilical vein
2) Umbilical artery
3) Placenta
4) Foramen ovale
A
3) Placenta
3
Q
What structure carries oxygen rich blood and nutrients to the fetus? Where does it branch into?
A
- The umbilical vein
- It branches into the liver or to the ductus venosus
4
Q
What structure allows passage of blood to divert from the umbilical vein past the liver? Where does the blood mix into?
A
- The ductus venosus allows oxygen rich blood to divert past the liver
- The blood mixes into the inferior vena cava
5
Q
The foramen ovale allows blood to move from the ____ ____ to the ____ ____
A
right atrium -> left atrium
6
Q
The foramen ovale helps perfuse which fetal structure?
A
The brain
7
Q
Why does blood move from the right to left atrium via the foramen ovale? Why is this helpful?
A
- It moves from the right to left atrium because pulmonary pressures are very high due to hypoxic vasoconstriction creating high right ventricle pressure and high right atrium pressures, higher than the left side of the heart.
- It is helpful because more oxygen rich blood shunts to the left side of the heart to be sent for systemic circulation instead of pulmonary
8
Q
Why does hypoxic vasoconstriction occur in developing fetuses?
A
Because they are not breathing at this point (there’s no gas exchange to oxygenate the blood), so the body vasoconstricts the pulmonary arteries and capillaries to shunt blood to oxygen rich areas.
9
Q
What structure accepts blood from the pulmonary arteries and moves it to the aorta? Why does this occur?
A
- The ductus ateriosus
- Blood moves through the ductus ateriosus for the same reason it moves through the foramen ovale, high pressure in the pulmonary circuit
10
Q
What structures does the ductus ateriosus perfuse?
A
The lower limbs
11
Q
What does the umbilical artery do and why does it carry blood to this location in utero? How many are there?
A
- It carries oxygen poor blood back to the placenta because the placenta has low resistance/pressure
- There are two umbilical arteries
12
Q
What are two major changes in circulation when a fetus becomes a newborn that cause subsequent changes in circulation?
A
1) There is no more placenta (causes decreased prostaglandins)
2) The lungs take in oxygen
13
Q
What causes Wharton’s Jelly to contract? What does this contraction cause?
A
- Temperature drop causes Wharton’s Jelly to contract around umbilical arteries/veins
- It causes blood flow to stop at this point creating high resistance at this point and cutting off blood flow to the umbilica vein/arteries, and ductus venosus
14
Q
What causes hypoxic vasoconstriction to be released in newborns? What does this cause?
A
- The first breaths of the newborn allowing oxygen to enter the lungs and perfuse the capillaries releasing the hypoxic vasoconstriction
- This causes a drop in the pulmonary circuit resistance/pressure
15
Q
What causes the foramen ovale to close?
A
- Pressures dropping on the right side of the heart cause it to close (no more high pulmonary pressures d/t oxygen entering lungs)
16
Q
Why do the ductus ateriosus and umbilical arteries close in newborns?
A
- It closes because both have muscles that detect oxygen and prostaglandins
- The increase in oxygen from the lungs and the decrease in prostaglandins from the placenta causes the muscles to clamp down closing them
17
Q
What is the most common congenital condition?
A
- Congenital heart disease
18
Q
Which sex has higher mortality from congenital heart defects?
A
- Males
19
Q
Which demographic group has a higher prevalence of congenital heart defects?
1) Hispanic newborns
2) Black newborns
3) Indigenous newborns
4) Non-hispanic white newborns
A
4) Non-hispanic white newborns have the higest rates of congenital heart disease in both children and adults
20
Q
Among black infants with parents on public health insurance, what is the risk of death from congenital heart defects from the neonatal period to the post-natal period? Why is it this way in the post-natal period?
A
- Prenatally: 40% less risk of death on public health insurance than private
- Post-natally: 70% higher risk of death with public health insurance than private
- Hypothesized that the increase is due to the presentation of congenital heart defects and issues with access to appropriate care
21
Q
True or false: There are currently more adults living with congential heart defects than children
A
True: There are more adults living with a congenital heart defect than children
22
Q
Which pulses (where) are palpated in infants?
A
1) Brachial
2) Femoral
3) Pedal
23
Q
What percentage of fetuses have no risk factors predisposing them to congenital heart disease?
1) 70%
2) 50%
3) 25%
4) 5%
A
1) 70%
- Most babies born with CHD do not have risk factors
24
Q
Which has higher pressures, the atria or ventricles?
A
The ventricles
25
Which has higher pressures, the left or right side of the heart?
The left side, you need to pump out oxygenated blood more
26
What are the heart pressures of the right atrium, left atrium, right ventricle, and left ventricle?
**1)** Right atrium: 0-6 mmHg (think a nickel or 5)
**2)** Left atrium: 6-12 mmHg (think a dime or 10)
**3)** Right ventricle: 15-30/0-6 mmHg (think a quarter or 25 over a nickle)
**4)** Left ventricle: 100-140/6-12 mmHg (think a dollar or 100 over a dime)
- **Note:** the diastolic pressure of the ventricles is the actual pressure of the atria
27
What is the oxygen saturation (%) of the right and left sides of the heart?
**Right:** 74% spO2
**Left:** 98% spO2
28
What does the pulse oximeter measure?
1) Venous oxygen saturation
2) Arterial oxygen saturation
**2)** Arterial oxygen saturation
29
Describe the path or route of conduction in the heart?
Starts at the **sinoatrial node (SA)**, or the pacemaker of the hear -> then moves across the atria and to the **atrioventricular node (AV)** -> then down to the **Bundle of His** -> to the **left and right bundle branches** in the ventricular septum -> and finally down to the rest of the heart via the **Purkinje fibers**
30
When are the coronary arteries perfused?
During diastole
31
Name the primary cardiac arteries:
**1)** Left coronary artery
**2)** Right coronary artery
**3)** Circumflex artery
**4)** Anterior interventricular artery
32
Name the primary cardiac veins:
**1)** Great cardiac vein
**2)** Posterior cardiac vein
**3)** Middle cardiac vein
33
What are the acyanotic cardiac defects with increased pulmonary vascularity? Which way do they shunt? Why is pulmonary vascularity increased?
**1)** Ventral septal defect (VSD)
**2)** Patent ductus ateriosus (PDA)
**3)** Atrial septal defect (ASD)
**4)** Atrioventricular septal defect (AVSD)
**- Shunting:** They shunt left to right because pressures are higher in the left side of the heart
**- Vascularity:** Pulmonary vascularity is increased because more blood (i.e. pressure) is flowing from left to right and into the pulmonary circuit
34
When does the ductus arteriosus being to constrict?
1) 10-20 minutes after birth
2) 1-4 hours after birth
3) 30-60 minutes after birth
4) 10-15 hours after birth
**4)** 10-15 hours after birth the ductus ateriosus begins to constrict
35
What triggers the constriction of the ductus arteriosus?
1) Birth
2) Placental removal
3) Respiration
4) Peripheral vascular resistance drops
**5) Rise in PaO2**
**6) Fall in prostaglandins**
36
When does the ductus arteriosus close?
After 2-4 weeks
37
Patent ductus arteriosus (PDA): what problem does it causes, what causes it, what inverventions can be used to manage premature infants with PDA
**Problem:** PDA allows blood to be pushed back to the pulmonary artery from the aorta due to increased pressure in the aorta reducing total O2 that flows to the rest of the body (left to right shunt)
**Causes:**
**1)** prematurity
**2)** hypoxia
**Premature management:** fluid restriction, diuretics, digoxin, indomethacin
38
How does indomethacin close a patent ductus arteriosus?
- Indomethacin is a NSAID -> inhibits prostaglandin synthesis
39
Atrial septal defect (ASD): what is it, what problem does it cause, how are small ASDs treated?
**What is it:** a hole in the wall separating the atria
**Problem:** creates a left to right shunt d/t high pressure from the LA -> RA *causing increased workload on the right side of the heart*
**Small ASD:** does not require therapy, left alone
40
Ventricular Septal Defect (VSD): what is it, what problem does it cause
**What is it:** a hole between the ventricles (the size and pressures in lungs determines symptoms)
**Problem:** left to right shunt in the ventricles *increases the workload on the right side of the heart*
41
What are the cyanotic cardiac defects with increased pulmonary vascularity?
**1) D-Transposition of the great arteries**
**2) Total anomalous pulmonary venous return**
**3) Truncus arteriosus**
**4) Single Ventricle Physiology**
**- Note:** These are admixture lesions (oxygenated and deoxygenated blood flow together)
42
D-Transposition of the Great Arteries: what is the problem (blood flow), what does the patient require to survive, what are the options for survival
**Problem:**
**1)** The aorta extends from the right ventricle so blood going to the body has no chance to be oxygenated
**2)** The pulmonary artery extends from the left ventricle and pumps oxygenated blood right back to the lungs, cannot get to the body
**Survival:** patient requires blood mixing to survive
**Options:**
**1)** Make an atrial septal defect prior to surgery via balloon atrial septostomy (catheter and pull balloon through atrial septum to make a hole)
**2)** If they have a patent foramen ovale, keep it open with prostaglandins (opposite of indomethacin) before surgery
43
Total Anomalous Pulmonary Venous Return (TAPVR): what is the problem, how is it repaired, what are the post-op considerations?
**Problem:** the *pulmonary veins do not connect back to the left atrium* causing O2 poor blood to go to the body; pulmonary veins usually connect to superior vena cava -> *overcirculation of the right side of the heart* and lungs (ASD usually present)
**Repair:** cut the pulmonary veins and connect to posterior wall of left atrium
**Post-operative considerations:**
**1)** Pulmonary hypertension
**2)** Low cardiac output
44
Truncus arteriosus: what is the problem
**Problem:** there is only a single trunk for pulmonary, systemic, and coronary blood flow/circulation; *most goes to the lungs* -> poor flow to the body + coronary arteries
45
Single Ventricle Physiology: What is hypoplastic left heart syndrome?
**Hypoplastic left heart syndrome:** left ventricle is small or not existent, mitral (bicuspid) valve is closed or atretic; *blood flow to the body is via PDA* (**right to left shunt**), aorta is reduced in size
46
Single Ventricle Physiology: What is double inlet left ventricle?
**Double inlet left ventricle:** position of the great vessels reversed, both atria connected to left ventricle, small right ventricle present, ventricular septal defect
47
Single Ventricle Physiology: What is double inlet right ventricle
**Double inlet right ventricle:** both atria empty into right ventricle, small left ventricle present, ventricular septal defect
48
What is pre-operative management for Single Ventricle Physiology?
**1)** Prostaglandins to keep PDA open
**2)** Atrial septostomy if needed
**3)** Maintain adequate pulmonary blood flow while ensuring optimal perfusion goal Qp:Qs=1 (same flow to lungs as body)
- Ionotropic support
- Intubation if necessary, permissive hypercapnia
**4)** Treat metabolic acidosis
**5)** Goal O2 sats = 70-80% on as low as FiO2 as possible
49
What are the acyanotic cardiac defects with normal pulmonary vascularity?
What part of the heart do they increase workload on?
What kind of lesions are they? Is there shunting?
**1)** Pulmonary stenosis
**2)** Aortic stenosis
**3) Coarctation of the aorta**
**-Workload:** increases workload on left ventricle
**-Lesions:** These are obstructive lesions (prevent proper blood flow). **no shunting**
50
Coarctation of the Aorta: what is it, what is the problem, what happens to the left ventricle and pressures, how does it present, what is the main goal in treatment?
**What is it:** aorta is very narrow
**Problem:** there is increased resistance to blood flow to the rest of the body d/t the narrowing
**Left ventricle:** ends up with higher pressure to maintain flow
**Pressures:** proximal to the narrowing the pressure is high, distal to the narrowing the pressure is low -> collateral pathways develop to circumvent the problem
**Presentation:**
**1)** cardiac collapse at birth
**2)** as a teenager (severe hypertension)
**Treatment goal:** prevent end organ damage
51
What are the cyantoic cardiac defects with *decreased* pulmonary vascularity?
**1) Tetrology of fallot**
**2)** Tricuspid atresia
**3)** Ebstein's malformation
**- Note:** These are obstructions of pulmonary blood flow with septal defects
52
Tetrology of Fallot: what are the four characteristics
**Characteristics:**
**1)** Pulmonary steonsis or atresia
**2)** Right ventricular hypertrophy
**3)** Overriding aorta
**4)** Ventral septal defect (VSD)
53
What are the signs and symptoms of Tetrology of Fallot?
**Signs and symptomts:**
**1)** Cyanotic (blue lips, mucosa, hands, and feet)
**2)** Dyspnea
**3)** Increased respiratory rate
**4)** Fatigue
**5)** Lethargy
**6)** Difficulty gaining weight
54
"Tet" spells: what is it, causes
**What is it:** increased right ventricular outlfow tract (RVOT) resistance with decreased systemic vascular resistance creating **right to left shunting** precipitating hypoxemia
**Causes:**
- Increased RVOT resistance:
**1)** Crying (increased negative intra-thoracic pressure during inhalation creating increased venous return shunting blood across the VSD to left side)
**2)** Stooling
**3)** Feeding
**4)** Noxious stimuli
**5)** Stressors
- Decreased SVR
**1)** Fever
**2)** Dehydration
55
What is the only ventricular assist devices approved for pediatric patients?
Berilin VAD
56
What is a ventricular assist device used for? Select all that apply.
1) Bridge to healing
2) Bridge to transplant
3) Destination therapy
**1)** Bridge to healing
**2)** Bridge to transplant
**3)** Destination therapy
- All three
57
What is the number one cause of acquired heart disease in the United States?
1) Coronary Artery Disease (CAD)
2) Rhuematic Heart Disease (RHD)
3) Kawasaki Disease
4) Myocarditis
**3)** Kawasaki Disease
58
Kawasaki Disease: cause and pathophysiology
**- Cause:** unknown
**- Pathophysiology:** an acute, febrile, and systemic vasculitis
59
Is there a specific test for Kawasaki Disease?
What labs might support a Kawasaki diagnosis?
- No specific test
- **Labs:**
**1)** CBC
**2)** CMP
**3)** CRP
**4)** ESR
**5)** Liver function
**6)** Urine test
**7)** Cardiac isoenzymes
60
What might an ECG find in Kawasaki Disease?
**1)** Non-specific ST changes
**2)** Prolonged PR interval
61
What might an echocardiogram look for in Kawasaki Disease?
**1)** Coronary artery aneurysms
**2)** Pericardial effusion
**3)** Ventricular dysfunction
**4)** Vulvular insufficiency
62
What are the diagnostic criteria for Kawasaki Disase?
How many criteria must an individual have?
**Fever for 4-5 days**
**AND**
**Four or more of five criteria:**
**1)** Conjunctivitis without exudate
**2)** Nonspecific skin rash
**3)** Fissured lips and erythema of buccal mucosa, strawberry tongue
**4)** Cervical lymphadenopathy >1.5cm (generally unliteral)
**5)** Palmar erythema and swelling of hands and feet followed by desquamation 2-4 weeks later
63
How is Kawasaki disease treated?
**1)** Anti-inflammatory medication
- High dose aspirin until symptoms stabilize
- 6-8 weeks of low dose aspirin to prevent coronary clots
**2)** IVIG within 10 days of symptom onset to help protect coronary arteries
64
True or false: Even following a repair, a VSD has a high mortality rate.
False
65
Which of the following is NOT part of the tetralogy of fallot?
1) VSD
2) Overriding aorta
3) PDA
4) Right ventricular hypertrophy
5) Pulmonary steonsis/atresia
**3)** PDA
66
IV prostaglandins are used for what during pre-op for transposition of the great arteries?
1) BP maintenance
2) Expediently close the PDA
3) Keep the PDA open
4) Open the ASD
**3)** Keep the PDA open
67
Avoiding strenuous exercise is specifically recommended with which cardiac abnormality?
1) Long QT syndrome
2) VSD
3) PDA
4) Coarctation of the aorta
**1)** Long QT syndrome
68
What position is used to treat a Tet Spell (hypercyanotic spell)?
1) Supine
2) Knees -to-chest
3) Hands and knees
4) Semi-fowlers
**2)** Knees-to-chest
69
Following heart surgery requiring a sternotomy, the RN should instruct the caregivers that the child should NOT be:
1) Picked up under the arms
2) Picked up hand behind head/shoulders and one under buttocks.
3) Engaged in play
**1)**Picked up under the arms
70
True or false: All pediatric heart murmurs are pathologic.
False
71
What four characteristics make up genetically mutated cells (i.e. cancer cells)?
**1)** Lack of differentiation
**2)** Loss of inhibition
**3)** Unregulated growth
**4)** Cellular immortality
72
Which embryonic tissue does most childhood cancer arise from?
1) Endoderm
2) Mesoderm
3) Ectoderm
4) Blastoderm
| this is on the test according to Donna
**2)** Mesoderm (bone marrow, lymph, bone, muscle)
73
What is the most prevalent type of childhood cancer? What are the second two?
**1)** Leukemia (48.3%)
**2)** CNS Tumors (30.6%)
**3)** Lymphoma (29.2%)
74
Leukemia and lymphoma are both disorders of the ____.
blood
75
What is the #1 cause of death in children by disease?
Cancer
76
How much has the survival rate of childhood cancer increased?
1) 50%
2) 25%
3) 85%
4) 70%
**3)** 85%
77
True or false: There as been no decline in new childhood cancer cases (rates) in the past 20 years.
**True:** Childhood cancer rates have only continued to rise
78
Compare and contrast pediatric and adult cancer on the following factor: Prevention
**Pediatric:** there is no prevention
**Adult:** 80% are preventable
79
Compare and contrast pediatric and adult cancer on the following factor: Early Detection
**Pediatric:** usually accidental, no screening
**Adult:** possible with screening
80
Compare and contrast pediatric and adult cancer on the following factor: Stage at diagnosis
**Pediatric:** 80% metastatic at diagnosis
**Adult:** local or regional
81
Compare and contrast pediatric and adult cancer on the following factor: Response
**Pediatric:** very chemosensitive
**Adult:** less chemosensitive
82
Compare and contrast pediatric and adult cancer on the following factor: Treatment effects
**Pediatric:**
**1)** Less acute toxicity -> can tolerate high doses
**2)** Greater long-term effects -> Often secondary lymphoma
**Adults:**
**1)** Greater acute toxicity
**2)** Less long-term effects
83
Why is cancer hard to detect in pediatric patients?
Signs and symptoms are vague!
84
What are signs and symptoms of pediatric cancer?
**1)** Pallor, bruising, bleeding
**2)** Lumps/swelling *without* fever
**3)** Unexplained weight loss
**4)** Eye changes (white pupil, vision loss)
**5)** Abdominal swelling
**6)** Headaches (persistent and severe)
**7)** Limb or bone pain
**8)** Fatigue/lethargy
**9)** Dizziness
85
What percentage of pediatric cancer patients are seen/treated at Children's Oncology Group (COG) institutions?
1) 90%
2) 100%
3) 70%
4) 80%
**1)** 90%
86
What three findings are correlated with contributing to pediatric cancer?
**1)** Maternal medication use with leukemia
**2) Low birthweight and hepatoblastomas (TPN is used as a tx, but it is hard on the liver)**
**3)** Rapid genetic growth pattern with osteosarcoma
87
What routes can be used for pediatric chemotherapy? (select all that apply)
1) Oral
2) Rectal
3) Intravenous (IV)
4) SubQ
5) Intrathecal
**1)** Oral
**3)** Intravenous (IV)
**5)** Intrathecal
88
Why is chemotherapy timing critical in treating pediatric cancer?
Timing is critical because **rapid, quick doses** of chemotherapy must be used
89
Why is combination chemotherapy common in pediatric cancer treatment?
It produces a higher response rate to slow or stop the cancer
90
True or false: Children's organ systems can tolerate higher doses of chemotherapy
True
91
What are short-term effects of chemotherapy?
**1) Bone marrow suppression (neutropenia)**
**2)** Hair loss
**3)** Nausea/vomiting
**4)** Neuropathy
**5) Mucositis (sores in mouth and GI)**
92
What are long-term effects of chemotherapy?
**1)** Cognitive changes
**2)** Cardiac, pulmonary, GI, and renal issues
**3)** Hearing issues
**4)** Fertility and other endocrine issues
**5)** Secondary malignancies -> usually lymphoma
93
What type of cancer is surgery an option for?
**1)** Tumors
**2)** Osteosarcoma (limb salvaging)
94
Why is radiation therapy avoided in children under 3 years old?
**1)** Causes extreme radiation burns to sensitive, growing skin
**2)** Strongly damages developing cells
**3)** Harms fertility permanantely removing the possibility of reproductive choice in the future
**4)** Has a high chance of irreversibly damaging retinal cells leading to blindness
**2)** Strongly damages developing cells
95
How does radiation therapy work?
**Radiation:** delivers targeted dose of high energy particles or waves to destroy cells causing DNA strand breakage preventing replication
96
What is proton beam radiation?
**Proton beam radiation:** delivers a low dose of radiationt o the front of the tumor with the max dose to the entire tumor and has minimal exit radiation
97
What is biotherapy/immune therapy?
**Biotherapy/immuneterapy:** uses the body's own immune system to detect and destroy cancer cells
98
What is monoclonal antibody treatment?
What is the main side effect nurses must manage?
**Monocolonal antibodies:** drugs design to bind to and mark specific targets in the body to cause an immune response and destruction
**Main side effect:** it's very painful -> **pain management** is necessary
99
What is adaptive cell transfer?
**Adaptive cell transfer:** when researchers take T cells out of the body/tumor, boost their natural ability by modifying specific proteins, and reinfuse them to attack the cancer cells
100
What is precision medicine in cancer treatment? What is the benefit?
A type of targeted gene therapy that aims to selectively attack cancer cells or immediate environment while sparing normal tissue
**Benefit:** less side effects
101
What the goal of stem cell transplants? Why is this beneficial?
**Goal:** restore stem cells that have been destroyed by high doses of chemotherapy or radiation
**Benefit:** allows patient to recieve higher doses of treatment as bone marrow is restored by stem cells
102
What is autologus stem cell transplant and allogenic stem cell transplant?
**Autologus:** The patient receives their own stem cells
**Allogenic:** patient receieves stem cel from brother, sister, parent, or unrelated donor match
103
What are nursing considerations in cancer treatment?
**1)** Monitor for signs and symptoms of infection (No WBCs left in chemo)
**2)** Manage pain and symptoms
**3)** Monitor RBC counts and plateles for anemia
104
What is neutropenia? What level of neutrophils is considered severe?
**Neutropenia:** Low number of neutrophils w/ or w/o fever creating high infection risk
**Severe:** < 500mm3
105
What steps should be taken during neutropenia?
**1)** Hand washing
**2)** Avoid ill people/crowds
**3)** Bathe daily and oral care (with soft tooth brush)
**4) Nothing given rectally**
**5)** Awareness of implanted devices (PACs, central lines, etc.)
**6) Culture and antibiotics within 1 hour**
- Possible medical emergency
106
What is thrombocytopenia? What is considered severe thrombocytopenia?
**Thrombocytopenia:** low platelets
**Severe:** < 25k
107
At what platelet range do you transfuse?
1) 10-20 thousand platelets
2) 1-5 thousand platelets
3) 10-15 thousand platelets
4) Below 25 thousand platelets
**1)** 10-20 thousand platelets
108
What four issues should you monitor for in thrombocytopenic patients?
**1)** Bruising
**2)** Bleeding
**3)** Epistaxis
**4)** Heavy menses
109
What medication and what type of sports should invidiauls with thrombocytopenia avoid?
**Medication:** NSAIDs
**Sports:** Any contact sports
110
Anemia: what is it, when do you transfuse, signs and symptoms
**What is it:** low RBCs, hemoglobin, and/or hematocrit
**Transfuse:** if hemoglobin is less than 7-8g/dL
**S/S:** dizzy, fatigue, shortness of breath
111
What interventions can you provide to patients experiencing cancer treatment induced nausea and vomiting?
**1)** Small, frequent meals
**2)** High protein and calorie foods
**3)** Monitor fluids
**4)** Avoid strong odors
**5)** Administer anti-emetics
**6)** Aroma therapy
**7)** Sea bands (for wrist)
**8)** Acupressure
112
What interventions can you provide to patients experiencing cancer treatment induced diarrhea or constipation?
**1)** Mush and push (stool softener with any stimulants)
**2)** Monitor fluids
**3)** Increase dietary fiber
113
What interventions can you provide to patients experiencing cancer treatment induced mucositis?
**1)** 2x/day oral cares
**2)** Manage pain
**3)** Special rinses
114
What interventions can you provide to patients experiencing cancer treatment induced fatigue?
**1)** Yoga
**2)** Physical therapy for rehab or structured activity
**3)** Nutritional support
115
What interventions can you provide to patients experiencing cancer treatment induced neuropathies?
**1)** Typically caused by chemo (Vincristine)
**2)** Footboard in bed to prevent dropfoot
**3)** High top shoes
**4)** PT/OT involvement
**5)** Encourage mobilization
**6)** Medications for pain
116
What interventions can you provide to patients experiencing cancer treatment induced mood and coping difficulties?
**1)** Address body image
**2)** Recognize high symptom burden
**3)** Recognize isolation
**4)** Provide socialization
**5)** Provide space
**6)** Involve psychosocial team
117
What are four important things to know about childhood cancer outcomes today?
**1)** There has been an 80%+ increase in five-year survival rates
**2)** Hodgkin/non-hodgkin lymphoma, Wilm's tumor, and acute lymphoid leukemia have highest survival rates
**3)** Research started in the 70's to improve outcomes today
**4)** Glomas have the poorest outcomes (low survival)
118
What improvements have the Children's Oncology Group made?
**1)** Reduced radiation
**2)** Reduced dose and frequency of chemotherapy needed
**3)** Greater targeted therapy
**4)** Earlier palliative care referrals
119
Pediatric anemia: what is it, causes, signs and symptoms, treatment
**What is it:** low RBCs, hemoglobin, and/or hematocrit
**Causes:** iron deficiency (often d/t drinking milk only without other food), genetic syndromes
**S/S:**
**1)** Tachycardia
**2)** Pallor
**3)** Fatigue
**4)** Muscle weakness
**5)** Shortness of breath
**6)** Dizzy
**Treatment:**
**1)** Transfusions (PRBCs if really bad
**2)** IV iron infusions
**3)** Vitamin C to increase absorption
120
What are four nursing consideration for anemia?
**1)** Constipation/diarrhea
**2)** Nausea/vomiting
**3)** Monitor labs
**4)** Provide rehabilitation
121
What type of genetic inheritance pattern is sickle cell?
Autosomal recessive
122
What is sickle cell disease and what is the primary problem?
**Sickle cell:** abnormal (sickled) hemoglobin, S-shaped RBCs replace normal ones
**Problem:** sickle shape increase viscosity *affecting blood flow to joints and tissues* resulting in a "crisis" or vaso-occlusive event -> **tissue hypoxia causes ischemia and severe pain**
123
True or false: Sickle cell is intermittent, i.e. crises do not always happen
**True:** Sickle cell crises are intermittent
124
What are possible triggers for sickle cell crises?
**1)** Illness
**2)** Infection
**3)** Fever
**4)** Dehydration
125
What populations does sickle cell normally affect?
**1)** African Americans
**2)** Mediterranian variants
**3)** India
**4)** Middle East
126
What are signs and symptoms of sickle cell?
**1)** Shortness of breath, congestion
**2)** Pain, especially in joints, bone, and abdomen
**3)** Jaundice
**4)** Headache +/- vision changes
**5)** Hematuria
127
What are possible long-term consequences of sickel cell?
**1)** Osteomylitis
**2)** Retinal detachment
**3)** Renal failure
**4)** Cirrhosis, hepatomegaly
**5)** Skeletal deformities, necrosis
128
Why can a delay in treamtent of sickle cell be fatal?
**1)** Severe dehydration
**2)** Shock
**3)** Stroke
**4)** Acute chest
129
What is the primary treatment or priority in sickle cell?
1) Fluids and high fowlers
2) Pain medication and oxygen therapy
3) RBC infusion and hydroxyurea
4) Pain medication and fluids
**4)** Pain medication and fluids
130
Aside from pain management and fluids, how else can sickle cell be treated?
**1)** CBC to monitor hemoglobin, increased WBC, bilirubin, and reticulocytes
**2)** Antibiotics
**3)** Hdyroxyurea (to prevent crises)
**4)** O2 if anemic with s/s of hypoxia
**5)** RBC or exchange transfusion if crisis
**6)** Stem cell transplant
131
What are nursing considerations for sickle cell?
**1)** Pain management
**2)** Treat and prevent infection
**3)** Monitor fluids and electrolytes
**4)** Monitor for acute chest syndrome (chest pain, cough, SoB)
**5)** Monitor for cerebrovascular attack (seizure, changes in speech or behavior, headache)
**6)** Mobilization
132
What is hemophilia? When is it often identified?
**Hemophilia:** deficiencies in clotting factors increasing the risk of internal or external hemorrhage
**Identified:** often identified in toddlers (falls) or infants (circumcision) d/t bleeding
133
What is hemophilia A?
What percentage of cases is it?
What type of genetic inheritance is it, what does this mean?
**Hemophilia A:** deficiency in factor VIII (8)
**Percentage:** 80% of all cases
**Genetic inheritance:** x-linked recessive, it means males only have this disorder
134
What is hemophilia B?
What type of genetic inheritance is it, what does this mean?
**Hemophilia B:** deficiency in factor IX (9)
**Genetic inheritance:** x-linked recessive, it means males only have this disorder
135
What is Von Willebrand's disease and what does it cause?
**VWD:** Lack Von Willebrand factor protein
**Causes:** platelet dysfunction through failure to aggregate
136
What are signs and symptoms of hemophilia?
**1)** Nose bleeds (epistaxis)
**2)** Bruising
**3)** Excessive bleeding
**4)** Joint pain
**5)** Headache, changes in speech, loss of consciousness
**6)** Prolonged aPTT
137
What are two long-term complications of hemophilia?
**1)** Joint deterioration, deformities
**2)** Stroke
138
What are three interventions for hemophilia?
**1)** Assays and DNA testing to determine type or trait
**2)** Administer factor replacement based on type
**3)** DDAVP (desmopressin) for mild type A because it increases factor VIII (8)
139
What are nursing considerations for hemophilia?
**1)** Administer exogenous blood factor and blood products
**2)** Monitor bleeding (urine, stool, intracranial)
**3)** Control bleeding + RICE
**4)** Manage pain
**5)** Educate
**6)** Rehab for strengthening
**7)** Low contact activities
140
When is the best time to start palliative care?
1) At diagnosis or relapse of a problem
2) Toward the end of a terminal illness
3) Once symptoms become unmanageable
4) Only primary provider deems it necessary
**1)** At diagnosis or relpase of a problem
141
Why is treatment continued during palliative care for pediatric patients?
Because we don't have a good timeline for pediatric patients, thus they could deteriorate quickly, the illness could go on for a long time, or they could get better quickly.
142
What are the five aims of palliative care?
**1)** Establish trust
**2)** Review and prioritize goals
**3)** Optimal pain and symptom management
**4)** Extra layer of support
**5)** Provide anticipatory guidance
143
True or false: Children who receive palliative care live longer due to better pain and symptom management
True
144
What is the indication for pediatric palliative care?
For children with potentially life-threatening or life limiting conditions
145
What are important aspects of palliative care?
**1)** Pain and symptom management is fundamental
**2)** Focus on quality of life
**3)** Goals of care are examined
**4)** Curative care continues
**5)** Optimize development and support
**6)** Provide hope
146
What are some conditions that palliative care might be indicated for?
**1)** Neurodegenerative conditions
**2)** Oncology
**3)** Congenital heart disease
**4)** Complications at birth or prematurity
**5)** Genetic disordes
**6)** Complex medical conditions
147
What is hospice?
A shift in hope going from cure to comfort for those at the end of their life.
148
True or false: We cannot always adequately control pain at the end of someone's life.
**False:** We can **always** control pain at the end of a patient's life through palliative sedation
149
True or false: Nurses have a duty to always provide pain relief if a patient is at the end of their life, even at the risk of hastening death.
**True:** The ANA Code of Ethics states that nurses are obligated to provide pain relief at end of life even if it causes death to come more quickly
150
What is esophageal atresia (EA) and tracheoesophageal fistula (TEF)?
**EA:** Esophagus fails to connect leaving a blind pouch at the end (doesn't go to the stomach)
**TEF:** esophagus connects to the trachea creating fistula to the airway causing food and/or gastric secretions to enter the trachea and lungs
151
What diagnostic options are there for esophageal atresia (EA) and tracheoesophageal fistula (TEF)?
What are the signs and symptoms?
**Diagnostics:**
**1)** Ultrasound
**2)** Contrast revealing blind pouch
**3)** Air on abdominal x-ray
**Signs and symptoms:**
**1)** Feeding results in regurgitation and coughing
**2)** Constant saliva
**3)** Gastric distension
152
How is esophageal atresia (EA) and tracheoesophageal fistula (TEF) treated?
One surgery to ligate the fistula and anastamose (reconnect) the esophagus
153
What are nursing considerations for patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF)?
**1)** Cannot be fed orally
**2)** Need IV access for parenteral feeding
**3)** May be associated with other syndromes
**4)** Surgical intervention will be needed (muscle relaxed post-op, NICU/PICU)
154
What is a congenital diaphragmatic hernia? What systems does this impair?
**Congenital diaphragmatic hernia:** hole in the diaphragm allows GI contents to drift up into the upper chest cavity ***impairing lung development***
**Imapairs:** GI and respiratory systems
155
What are nursing considerations for congential diaphragmatic hernia?
**1)** Urgent surgical repair is needed
**2)** Mechanical ventilation is likely
**3)** Underdeveloped lungs
**4)** Chronic issues are likely, especially, if the repair is done post-partum
156
Omphalaceles and gastroschesis: what are they, treatment?
**Omphalacele + Gastroschesis:** placental abnormalities at the umbilicus allowing **GI content out of the body** (gastroschesis is usually to the right of the umbilicus)
**Treatment:** surgery (primary or staged to create a hole to close)
157
What are nursing considerations for omphalaceles and gastroschesis?
**1)** Nutrition, parenteral possible
**2)** May need decompression d/t high abdominal pressures
**3)** Infection risk
**4)** Increased loss of fluids
**5)** Respiratory support
158
Imperforate anus: what is it, treatment, nursing considerations
**What is it:** opening of the anus may be completely missing or misplaced (fistula)
**Tx:** surgery
**Nursing considerations:**
**1)** Parenteral nutrition until surgery complete
**2)** Decompression
**3)** Constipation
**4)** Fluid losses
**5)** Bowel and bladder functions may be altered (may be chronically altered too)
159
True or false: Children are able to manage their thirst
**False:** Children are unable to manage thirst
160
Why do children have faster fluid loss than adults?
They have a larger extra-cellular fluid volume, a large proportion of their body is fluid
161
What are three contributors to fluid loss in children?
**1)** Higher body surface area
**2)** Higher respiratory rate
**3)** Higher metabolic rate
162
What age should be carefully monitored for fluid loss?
1) Children ages 5-10 years old
2) Children under 5 and a half years old
3) Children under 2 years old
4) Children under 1-5 years old
**3)** Children under 2 years old
163
What are causes of diarrhea in pediatric patients?
**1)** Bacterial intestinal infection
**2)** Intestinal obstruction or intussusception
**3)** Malabsorption
**4)** Inflammatory bowel disease
164
What are four diarrhea red flags?
**1)** Blood in stool
**2)** Fever
**3)** Poor growth
**4)** Severe belly pain
165
What are three symptoms of appendicitis?
**1) Always have nausea and vomiting**
**2) RLQ**
**3)** Normal stool
166
What are three symptoms of acute gastritis?
**1) Always diarrhea**
**2) Diffuse abdominal pain, very crampy**
**3)** Nausea and vomiting may be present
167
What are three symptoms of ulcerative colitis?
**1 Pus or blood in stools**
**2) Rectal bleeding**
**3)** Frequent urge to defecate (tenesmus)
168
What are three symptoms of Chron's disease?
**1)** Constipation and/or diarrhea
**2)** Night sweats
**3)** Loss of menstrual cycle
169
What is short bowel syndrome (SBS)?
**SBS:** short bowels leading to the **inability to absorb nutrients** resulting in watery stool; requires *long-term parenteral nutrition with TPN, which harms the liver*
170
What are nursing considerations in short bowel syndrome (SBS)?
**1)** Infection risk
**2)** Altered fluid balance
**3)** Poor weight gain
**4)** Liver failure
**5)** Will likely need a liver/bowel transplant
171
What is the prognosis for short bowel syndrome?
* **Prognosis:** 50% or less survival rate
- Poor prognosis even after transplant
172
Oral thrush: what is it, which populations is it common in, treatment
**What is it:** fungal infection of the mouth via Candida albicans
**Populations:** infants (fall asleep with milk in mouth), diabetics, immune disorders, antibiotic overuse
**Tx:**
**1)** Antifungal lozenge
**2)** Swabs (infants)
**3)** Rinses
173
Hand-Foot-Mouth: what is it, transmission, prevention, signs and symptoms, treatment
**What is it:** infection by the coxsackie virus
**Transmission:** contact; *highly contagious*
**Prevention:** Frequent handwashing
**S/S:**
**1)** Fever
**2)** Sore throat
**3)** Blister in 1-3 days around hands, feet, and mouth
**Treatment:** supportive care only (pain and fever management, fluids, rest)
174
Fifths disease: what is it, transmission, signs and symptoms, treatment
**What is it:** infection with parvovirus
**Transmission:** droplet
**S/S:**
**1)** low-grade fever
**2)** Headache
**3)** Runny nose
**4)** Rash - looks very lacey, like a doily
**Tx:** supportive care (manage pain and fever, fluids, rest)
175
Roseola: what is it, signs and symptoms, treatment
**What is it:** infection with herpes virus
**S/S:**
**1)** Starts with a *very* **high fever**
**2)** Flat rash on trunk and neck
**Tx:**
**1)** Control fever (*febrile seizure risk*)
**2)** Monitor for seizures
**3)** Supportive care
176
Strep rash/scarlet fever: what is it, when does it develop, signs and symptoms, treatment
**What is it:** infection of Group A streptococcus bacteria
**When does it develop:** after untreated strep throat
**S/S:**
**1)** sore throat
**2)** high fever
**3)** Diffuse, bumpy rash
**4)** Red tongue (strawberry)
**Tx:** antibiotics
177
Pink eye (conjunctivitis): what causes it, signs and symptoms, treatment
**Causes:** bacterial (very contagious), viral, clogged duct
**S/S:**
**1)** Redness + swelling
**2)** Photophobia (light sensitivity)
**3)** Drainage *(only with bacterial)*
**Tx:** warm packs, antibiotics (bacterial only)
178
Head lice: what is it, transmission, signs and symptoms, treatment
**What is it:** insect infestation d/t lice
**Transmission:** direct contact with infested object (hat, comb, pillow)
**S/S:**
**1)** Itching
**2)** Lice + eggs (nits)
**3)** Sore on head, neck, shoulders if untreated
**Tx:** difficulty to treat - anti-lice shampoos, etc.
179
What is the least developed system at birth? When does it begin to function more?
**1)** Endocrine
**2)** Functions at 12-18 months
180
Which of the following is not a function of the endocrine system?
1) Stimulates mature immunity
2) Regultes growth and development
3) Metabolism and glandular regulation
4) Enables sexual function and reproduction
**1)** Stimulates mature immunity
181
What does aplastic or underdeveloped thyroid gland cause?
Poor TSH secretion that leads to *irreversible brain damage* if not treated early
182
What are signs and symptoms of aplastic/underdeveloped thyroid gland?
**1)** Low T4
**2)** High TSH
**3)** Large tongue
**4)** Hypotonia (poor muscle tone/weakness)
**5)** Distended abdomen
**6)** Slow reflexes
**7)** Large anterior fontanelle
**8)** Skin mottling
183
What is the treatment and nursing consideration for aplastic/underdeveloped thyroid gland?
**Tx:** lifelong levothyroxine
**Nursing considerations:**
**1)** Newborn screen
**2)** Monitor levels of TSH
**3)** Education
184
Congenital Adrenal Hyperplasia: what is it, signs and symptoms, effects
**What is it:** an autosomal recessive disorder that causes **adrenal insufficiencies** (too little cortisol and/or aldosterone, too much androgens)
**S/S:**
**1)** Dehydration
**2)** Failure to thrive
**3)** Hyponatremia
**4)** Hyperkalemia
**Effects:** ambiguous genitalia in females, salt wasting
185
What is the treatment and nursing considerations for congenital adrenal hyperplasia?
**Tx:** lifelong glucocorticoid treatment
**Nursing considerations:**
**1)** Newborn screen
**2)** Monitor electrolytes
**3)** Adjust glucocorticoid doses as needed
186
Hypothyroidism (Hashimoto's): what is it, causes, treatment, nursing considerations
**What is it:** low thyroid hormones (T3+T4)
**Causes:** autoimmune, goiter
**Tx:** thyroid hormone replacement (levothyroxine)
**Nurisng considerations:**
**1)** Monitor weight (gain)
**2)** Bowel function (constipation)
**3)** Cognitive function
**4)** Growth and development
187
What are signs and symptoms of hypothyroidism?
**1)** Dry, thick skin
**2)** Coarse dull hair
**3)** Fatigue
**4)** Constipation
**5)** Weight gain
**6)** Edema
188
Hyperthyroidism (Grave's): what is it, causes, treatment, nursing considerations
**What is it:** excess thyroid hormones (high T3+T4)
**Causes:** autoimmune (Grave's)
**Tx:** anti-thyroid medication (PTU), ablation
**Nursing considerations:**
**1)** Optimize mobility
**2)** Grwoth and development
189
What is acquired precocious puberty? What is the focus of treatment?
**Onset of puberty before:**
- 8 years old in girls, 10x more likely than boys, 90% idiopathic
- 9 years old in boys, CNS abnromailities more common
**Tx focus:** stopping or revering development of secondary sexual characteristics because growth will be limited if not interrupted - hormone agonists
- Tx is not beneficial in girls older than 8 y/o
190
What are nursing considerations in acquired precocious puberty?
**1)** Monitor for early signs with exams
**2)** Developmental age - appears older than actually are
**3)** Treatment = hormone agonists
**4)** Education
191
Growth hormone deficiency: what is it, which sex is it more common in, nursing considerations
**What is it:** a pituitary dysfunction where the individual lacks growth hormone
**Sex:** more common in boys
**Nursing considerations:**
**1)** Daily SubQ injections of growth hormone
**2)** Self-esteem d/t lack of growth
192
What are the symptoms of growth hormone deficiency?
| Think of them as kind of baby-ish for their age
**1)** Hypoglycemia
**2)** Height below the 5th precentile
**3)** Association with syndromes (like Turner's)
**4)** Cherubic face
**5)** Delayed puberty
**6)** Increase in body fat compared to muscle mass
193
Type 1 diabetes mellitus: what is it, cause, diagnosis peak, what are genetic and environmental contributors, treatment?
**What is it:** the inability of the pancreas to secrete insulin in adequate amounts
**Cause:** autoimmune destruction of the pancreatic beta cells (islets)
**Diagnosis peak:** 12 years old
**Genetic and environment:**
**1)** Infection
**2)** Dietary toxins
**3)** Obesity
**4)** Chemical exposure
**Tx:**
**1)** SubQ insulin
**2)** Diet + exercise
194
What are the signs and symptoms of type 1 diabetes? (Select all that apply)
1) Cracked lips
2) Polydipsia
3) Fatigue
4) Blurred vision
5) Left upper quadrant pain
6) Polyuria
7) Polyphagia
8) Hematuria
9) Severe headache
10) Weight gain
**2)** Polydipsia
**3)** Fatigue
**4)** Blurred vision
**6)** Polyuria
**7)** Polyphagia (often weight loss despite high intake)
195
What are nursing considerations for type 1 diabetes?
**1)** Provide education in the "honeymoon" phase or when children are more receptive to rules and instruction
**2)** Promote developmentally appropriate independence
**3)** Optimize nutrition
**4)** Manage blood glucose
**5)** Site rotation and absorption (highest in stomach, moderate in arm and hip, slow in thigh)
196
Type 2 diabetes: what percentage of diabetes cases, signs and symptoms, possible complications, treatment
**Percentage of DM cases:** 20% (high association with obesity)
**S/S:**
**1)** Fatigue
**2)** Blurred vision
**3)** Frequent urination
**Complications:** hypertension and hyperlipidemia
**Tx:** diet, exercise, and oral agents
197
What are four common long-term consequences of diabetes?
**1)** Peripheral neuropathy
**2)** Retinopathy
**3)** CV disease
**4)** Nephropathy
198
Hypoglycemia: onset speed, signs and symptoms, cause, treatment
**Onset:** rapid
**S/S:**
**1)** Trembling
**2)** Sweaty
**3)** Clammy
**4)** Pale
**5)** Tachycardia
**6)** Irritable
**7)** Slurred speech
**8)** Drunken bhx
**9)** Decreased LoC
**10)** Seizure
**Causes:** too much insulin, too much exercise, poor intake
**Tx:** 15g of fast acting carbs
199
Hyperglycemia: onset speed, signs and symptoms, causes, treatment
**Onset:** slow
**S/S:**
**1)** fatigue
**2)** Increased thirst
**3)** Increased urination
**4)** Blurred vision
**5)** Weight loss
**6)** Emotionally libale
**7)** Headache
**Causes:** excess intake, poor activity, insufficient insulin
**Tx:** insulin, increase activity
200
Diabetic Ketoacidosis (DKA): onset speed, signs and symptoms, cause, treatment
**Onset:** slow
**S/S:**
**1)** Abdominal/chest pain
**2)** Nausea/vomiting
**3)** Acetone/fruity breath
**4)** Decreased urination
**5)** Dry mouth and lips
**6)** Kussmal breathing
**7)** Sunken eyes
**8)** Increased HR/RR
**9)** Lethargy
**10)** Decreased LoC
**Cause:** excess stress, insufficient insulin
**Tx:** IV fluids and IV insulin
201
What are special considerations for insulin?
**1)** Store in a cool, dry place
**2)** Roll, not shake vials
**3)** Monitor expiration dates
**4)** Mix clear (fast) before cloudy (NPH)
**5)** 15-30g of carbs for every 40-60 minutes of exercise
202
What four disorders are externalizing disorders?
**1)** Oppositional defiant disorder
**2)** Conduct disorder
**3)** Autism spectrum disorder
**4)** ADHD
203
List etiology and risk factors for externalizing disorders:
| 6 of them
**1)** Low socioeconomic status (SES)
**2)** Environemental adversity
**3)** Parental mental illness such as substance use, mood disorders, antisocial personality disorder, ADHD
**4)** Poor family functioning
**5)** Child abuse history
**6)** Genetic vulnerability
204
Describe the termperament of children with externalizing disorders:
**1)** Increased anxiety
**2)** Poor adaptability
**3)** Distractable
**4)** High intensity
**5)** Strong-willed
**6)** Poor reaction to new stimuli
**7)** Low sensory threshold
**8)** Negative mood
205
What is oppositional defiant disorder?
A persistent pattern of **rule** breaking, resisting authority, and disobeying
- They often argue, have outbursts, blame others, and behave differently in other settings
206
What is conduct disorder?
A pervasive pattern of **law** breaking, antisocial behavior, aggression, and cruetly toward people and/or animals
- Destroys poperty
- Steals
- Cons/deceives others
- May be present with ADHD
207
ADHD: subtypes, diagnostic criteria, risk factors
**Subtypes:** hyperactive, inattentive, both
**Diagnostic criteria:**
- Inattention - to details, cannot stay on task, trouble organizing
- Hyperactive - excessive compared to age expectations
- Impuslive - blurts, shouts out, interrupts
**Risk factors:**
**1)** Exposure to lead/pesticides
**2)** Low birth weight
**3)** Premature birth
**4)** Brain injury
208
What difficulties are people with ADHD at risk for?
**1)** Accidents
**2)** Job/school failure
**3)** Substance abuse
**4)** Depression/anxiety
**5)** Relationship/familial stress
**6)** Delinquincy
209
How can support for those children with ADHD be provided?
**1)** Help with family relationships
**2)** Help with social skills
**3)** Child care issues
210
Autism Spectrum Disorder: sex prevalence, diagnosis age, risk factors
**Sex:** more common in boys, 4x more
**Dx:** 2-6 y/o
**Risk factors:** older parents, genetics, environmental exposure
211
How does autism manifest?
**1)** Persistent deficits in social communication and interaction
**2)** Restricted, repetitive patterns of behavior, interests, and activities
**3)** Must be present in early developmental period
**4)** May cause significant impairment in functioning
212
What are nursing considerations for those with ADHD and autism?
**1)** Provide short, clear instruction
**2)** Daily routine
**3)** Break tasks into portions
**4)** Get their attention
**5)** Cue transitions
**6)** Manage stimulation
213
What are nursing considerations for children with oppoisitional defiant disorder and conduct disorder?
**1)** Teach collaborative problem-solving
**2)** Set clear rules and consequences
**3)** Nonjudgement attitude
**4)** Work on talking versus acting out
214
What are examples of internalizing disorders?
**1)** Reactive attachment disorder
**2)** Anxiety
**3)** Depression
215
What are risk factors for reactive attachment disorder
**1)** Early trauma
**2)** Removal from caregivers
**3)** Multiple caregivers
**4)** Institutional care
**5)** Neglect
216
What are signs and symptoms of reactive attachment disorder?
| Avoidant and shy
**1)** Lack positive emotions
**2)** Avoid eye contact and touch
**3)** Tantrums/anger
**4)** Limited social interactions
**5)** Withdrawn
217
What are signs and symptoms of disinhibited social engagement disorder?
**1)** Breaks rules
**2)** Attention seeking
**3)** Overly affectionate
**4)** Poor boundaries
**5)** Inappropriate social bhx
218
What are children with reactive attachment disorder at risk for?
**1)** Developmental delays
**2)** Mood disorders (anxiety, depression, PTSD)
**3)** School issues
**4)** Relationships issues
**5)** Risk taking
219
Nursing considerations for those with reactive attachment disorder?
**1)** consistent approach
**2)** Consistent limits
220
What is the most common mental health conditions in children?
1) Depression
2) Autism spectrum disorder
3) Oppositional defiant disorder
4) Concut disorder
5) Anxiety
6) Reactive attachment disorder
7) ADHD
**5)** Anxiety - 25% of 13-18 year olds
221
How many pediatric patients with anxety actually receive treatment?
36.9%
222
What problems do anxiety and mood disorders cause?
**1)** Cognitive changes
**2)** Emotional changes
**3)** Physiological changes
223
What does higher social media use lead to?
**1)** Higher anxiety incidence and symptoms
**2)** Increased perception of social isolation
**3)** Lees deep and empathetic connection
224
Why should you report child maltreatment other than moral or ethical beliefs?
It's a misdemeanor to not report child maltreatment
225
What are three resources someone can call to discuss/report child maltreatment? Why would you call one over another?
**1) CPS:** when immediate safety is **not** a concern but maltreatment is suspected
**2) Law enforcement:** when immediate safety **is a concern**
**3) Child abuse specialist:** to receive advice on management, reporting, and transfer of care
226
Why is there a high rate of screenouts for child maltreatment reports?
**1)** Corporal punishment is legal
**2)** CPS is not primary prevention
**3)** Report may not be clear and/or honest
- Make sure to include the word abuse and explain your rationale
227
True or false: Parents still retain decision-making authority even if their child is placed in a protective hold
True
228
List some signs of abuse that a nurse might encounter with pediatric patients:
**1)** Story is inconsistent with injuries
**2)** Delay between injury and seeking medical attention
**3)** Changing stories
**4)** Physical signs
- Bruises on infants
- Bruises on face, trunk, hands, ears, genitalia, or buttocks
- Patterned bruises/burns
- Fractured ribs, sternum, scapula
- Shaken baby syndrome
229
What is the leading cause of head injury in small children?
**1)** Falls
**2)** Sports injuries
**3)** Bike accidents
**4)** Abusive head injury
**4)** Abusive head injury (95% of serious head injury under 1 year old)
230
What populations is head injury higher in?
**1)** Premature infants
**2)** Twins
**3)** Moms under 18 y/o
**4)** Children in military families
231
Males make up what proportion of head injury perpetrators?
1) 1/3
2) 2/3
3) 3/3 (100%
4) 1/4
**2)** 2/3
232
When is the risk of fatal abuse by head injury highest? How many more times likely is it in this circumstance?
Risk of fatal abuse by head injury is the highest when there is an unrelated male present in the home or caring for the child
50x more likely
233
At what age can you not leave a child at home alone?
1) 7 years old and under
2) 10 years old and under
3) 13 years old and under
4) 9 years old and under
**1)** 7 years old and under (you cannot leave them home alone for any period of time)
