ATI PEDIATRICS PROCTORED EXAM; COMPLETE Questions with solutions.

ATI Pediatrics Proctored Exam hand preference Ans- all kids normally show hand preference by 1 year old plaster casts Ans- -heavy -not water resistant -dry in 10-72 hrs fiberglass casts Ans- -light weight -water resistant -dry in 15-20 min types of traction Ans- Skin traction: -Buck -Bryant -Russell Skeletal traction Halo traction -cervical traction care for traction Ans- -assess pin sites -ensure hardware is tight -ensure bed is in correct position -ensure weights do not touch floor Halo: ensure wrench is readily available surgical intervention for scoliosis Ans- -realign (2 rods on either side of spine) -internal fixation -fusion The child is prescribed lanoxin (Digoxin) 75 mcg PO qd. The pharmacy supplies lanoxin (Digoxin) 0.05mg scored tablets. How many tablets will the nurse administer? Record your answer using one decimal place. Ans- 1.5 tablets The physician orders the patient a 10-mL/kg normal saline bolus to infuse over 2 hours. The child weighs 36 kg. Calculate the infusion rate in mL/hr. Ans- 180 mL/hr What happens to the voice during epiglottitis? Ans- it becomes hoarse Leukotreine modifiers Ans- -Blocks leukotriene receptors or synthesis of leukotrienes (Singulair) -Side effects: headache, nausea, abdominal pain, increase infections if over age 55, depression, suicidal, aggression -Generally well tolerated. -Monitor for improvement in symptoms Cromolyn (Intal) and nedocomil (Tilade) Ans- -Anti-inflammatory agents that inhibit release of histamine, leukotrienes, -Prevention or maintenance drugs -Administered by inhalation, onset of action in 2-4 weeks -Side effects: cough, headache, throat irritation, GI upset Long acting beta-adrenergics Ans- -Salmeterol (Serevent) -used twice daily -Added to anti-inflammatory therapy -Not for acute symptoms due to onset of action in 20 minutes with peak in 3-4 hours Lortab Ans- tylenol with hydrocodone dornase alpha Ans- decreases viscosity of secretions (thins mucous) for CF patients tobramycin Ans- aerosolized antibiotics used for CF Norwood procedure Ans- -Treats hypoplastic left heart -3 stages -done shortly after birth -Right ventricle is converted: connects aorta to right ventricle -Between step 1&2 is highest risk for death -bi-directional Glenn operation (stage 2, under 6 mo. old) -superior vena cava redirected to lungs -Fontan operation (1.5-3 yrs old) -inferior vena cava redirected to lungs Heart transplant is another option Biot's respirations Ans- periods of apnea alternating with 2 or 3 shallow breaths Cheyne-Stokes respirations Ans- periods of apnea alternating with periods of hyperventilation What gauge needle should be used when administering an immunization to a toddler? Ans- 24 gauge sodium normal range Ans- 135-145 Recommended play activities for infant, toddler, preschool, and school age children Ans- Infant: play pat-a-cake Toddler: push-pull toy Preschool: play dress-up School age: create a scrapbook protecting against SIDS Ans- -supine to sleep -empty bed: firm mattress only -breastfeeding -use of pacifier while sleeping manifestations of pneumonia in infants Ans- nasal flaring increased WBCs diarrhea abdominal distention steps to take during a tonic-clonic seizure Ans- **FIRST: assist child to side-lying position on the floor then... -apply O2 mask -clear immediate area -loosen restrictive clothing A nurse is preparing to administer ibuprofen f5 mg/kg q6h PRN for temps above 38 degrees F to an infant who weights 17.6 lb. The infant has a temp of 38.4. Available is ibuprofen liquid 100 mg/5 mL. How many mL should the nurse administer to the infant per dose? Round to nearest whole number. Ans- 2 mL What is an indication of IICP in a child with a concussion? Ans- forceful vomiting What is an expected finding of endocarditis? Ans- headache What is an expected finding in a school-age child with glomerulonephritis? Ans- brown colored urine McBurney's point Ans- -lower right abdomen -pain in appendicitis teaching to parents of child with juvenile idiopathic arthritis Ans- -exercise large joints regularly -encourage child to perform independent self-care -provide a firm mattress for sleeping -discourage daytime naps because stiffness can occur quickly Celiac disease expected findings Ans- -steatorrhea -distended abdomen -weight loss What type of vomiting is common with pyloric stenosis? Ans- projectile vomiting management of tinea pedis Ans- -avoid wearing plastic shoes -wear sandals as much as possible What is used to treat scabies lesions? Ans- permethrin 5% cream For what disease should non-washable items be sealed in a plastic bag for 14 days? Ans- pediculosis manifestation of pertussis Ans- dry hacking cough manifestation of acute streptococcal pharyngitis Ans- inflamed throat with exudate manifestation of bacterial conjunctivitis Ans- purulent eye drainage Koplik spots Ans- rubeola (measles securing an infant's car seat Ans- lower anchors and tethers (the LATCH child safety system) when this is available the seatbelt does not have to be used Where should the car seat harness in rear-facing car seat be positioned? Ans- at or just below the infant's shoulders At what angle should an infant's car seat be placed? Ans- 45 degree angle 1. Who should the FACES pain rating scale be used for? 2. Who should the numeric pain rating scale be used for? 3. Who should the CRIES pain assessment scale be used for? 4. Who should the non communicating children's pain checklist be used for? Ans- 1) 3+ yrs old 2) 5+ yrs old 3) infants 4) pediatric clients with cognitive impairments Diabetes insipidus lab values Ans- -dilute urine/low specific gravity -high sodium -normal blood glucose -polyuria (excessive urine output) minimal change nephrotic syndrome management Ans- -dietary fluid restriction -low sodium diet -corticosteroids How often should a child with asthma get pulmonary function tests? Ans- every 12-24 months lumbar puncture nursing care Ans- -apply topical analgesic to the lumbar site 60 min prior to procedure -place in prone position or flat in bed for up to 12 hours to prevent post procedural spinal headache -encourage to drink extra fluids to replace CSF care for a partial-thickness burn Ans- -wash the affected area with mild soap & water -apply antibiotic ointment to the affected area For what type of burn would you insert and NG tube? Ans- a major burn - to empty the contents of the stomach & maintain decompression CF diet Ans- -well-balanced -high in protein & calories -unrestricted fat -ensure adequate fluid intake Can a child with celiac disease eat malt? Ans- no, it has gluten in it What should be done after administering PO suspension digoxin? Ans- brush the child's teeth manifestations of digoxin toxicity Ans- nausea, vomiting, decreased appetite age of controlling impulsive feelings Ans- school age age of understanding right from wrong Ans- preschool begins to express likes and dislikes Ans- toddler positioning to reduce the risk of IICP Ans- head elevated in a midline position indications of brainstem herniation Ans- Cushing's triad: htn, bradycardia, decreased respirations infant care after a cheiloplasty Ans- -clean sutures with sterile water or diluted hydrogen peroxide after each feeding -don't put large objects in the mouth -apply a thin layer of antibiotic ointment on the suture line daily for 3 days and then petroleum jelly for several weeks developmental activities for school age kids, preschoolers, and toddlers Ans- school age - book about adventure preschooler - large piece puzzle toddler - puppets child behaviors suggestive of physical abuse Ans- -reluctance to return home -description of injury is vague and incompatible with the actual wounds -denies discomfort during assessment of injuries -withdrawn behavior and poor relationships with peers sodium polystyrene sulfonate enema Ans- -antidote that exchanges sodium ions for potassium ions in the intestine -treats hyperkalemia adverse effect: diarrhea interventions for lead toxicity Ans- -diet rich in calcium, vitamin C, and iron -chelation therapy for lead levels 45 mcg/dL or greater expected findings following an appendectomy Ans- -absence of peristalsis -WBC 10,000/mm3 Meckel diverticulum Ans- passage of dark red stool with mucus spastic cerebral palsy expected findings Ans- -positive Babinski reflex -ankle clonus -exaggerated stretch reflexes -contractures indications of early septic shock Ans- fever & chills plan of care pre-op for a preschooler with a Wilm's tumor Ans- -avoid palpating the abdomen -auscultate bowel sounds -do not engage in play with other children - increases risk of injury -do not explain about pain till post op so as not to increase anxiety physical findings suggestive of physical abuse Ans- symmetric burns of lower extremities physical findings suggestive of physical neglect Ans- -growth failure -lack of subcutaneous fat physical findings suggestive of sexual abuse Ans- recurrent UTIs indications of SIADH Ans- -low sodium level -high urine specific gravity -decreased urine output -hypoosmolality -overhydration -mental confusion -bounding pulses -increased BP -tachycardia An allergy to neomycin, eggs, or gelatin contraindicates what vaccine? Ans- MMR Steps for discontinuing IV fluids Ans- 1. turn off the IV pump 2. occlude the IV tubing 3. remove the tape securing the catheter 4. apply pressure over the catheter insertion site teaching parents to protect their children from sunburn Ans- -waterproof sunscreen with SPF of at least 15 -avoid liberal application till 6 months of age -dress in tight weave cotton fabric -reapply sunscreen every 2-3 hrs wheezes Ans- high-pitched, musical, whistling-like sounds heard primarily on expiration as air passes through and vibrates narrowed airways crackles Ans- -high-pitched, short, and noncontinuous sounds heard usually at the end of inspiration -occur when air expands deflated alveoli or when the passage of air through small airways is disrupted pleural friction rub Ans- -loud, rough, grating sound heard during inspiration or expiration -occurs when the pleurae are inflamed and the surfaces rub together rhonchi Ans- -low-pitched, continuous sounds that have a snore-like quality and are usually louder during expiration -occur when the larger airways are obstructed When should an infant be able to stand while holding onto furniture? Ans- 10 months When should an infant be able to say 1-2 words? Ans- 10 months When should an infant be able to sit unsupported? Ans- 8 months What should an infant be able to roll a ball to someone else? Ans- 11 months post op care following a cardiac catheterization Ans- -avoid strenuous activities but may attend school the next day -resume regular diet -keep site clean and dry for at least 3 days and do not take a tub bath for those 3 days -remove the pressure dressing the day after the procedure and apply a new adhesive bandage strip daily for at least the next 2 days interventions for a superficial minor burn Ans- -administer a tetanus toxoid if 5+ yrs since prior dose -apply antimicrobial ointment to the burned area to prevent infection -apply a clean-dry dressing of fine mesh gauze and a light gauze dressing that restricts movement to prevent injury to the wound -do NOT apply ice - may impair circulation & increase tissue damage suctioning an infant who has a tracheostomy Ans- -suction only as needed to prevent hypoxia and to maintain patency of the tube -do NOT instill normal saline beforehand -ensure the vacuum pressure is set between 60-100 mm Hg -suction for 5 seconds or less to prevent hypoxia mononucleosis Ans- -caused by Epstein-Barr virus -no known specific txt -monospot to diagnose -acute s/s last approx. 10 days with fatigue lasting up to 4 wks -complications: splenomegaly - restrict activities for 2-3 months to avoid rupturing the spleen intussusception Ans- -bloody stools that are currant jelly-like in appearance -vomiting -lethargy -diarrhea -weight loss -leaking blood and mucus into the intestines VSD Ans- loud, harsh murmur coarctation of the aorta Ans- -weak femoral pulses -elevated BP infant with a hypercyanotic spell r/t Tetralogy of Fallot Ans- -place infant in knee-to-chest position -administer morphine IV to decrease infundibular spasms -administer IV fluids -apply oxygen at 100% via face mask precautions for pertussis Ans- droplet positive pressure airflow Ans- reduces risk of disease transmission to the patient negative pressure airflow Ans- patient with airborne infection (measles, varicella) teething s/s Ans- -pulling on the ears -difficulty sleeping -increased drooling -increased fussiness -cold teething rings -rub infants gums with a cold cloth -eruption of teeth begins with lower central incisors identifies right from left hand Ans- 6 years old uses utensil to spread butter Ans- 6 years old using scissors to cut out a shape Ans- 4 years old drawing a stick figure with 7 body parts Ans- 5 years old diabetes mellitus type 1 teaching the child Ans- -avoid puncturing pads of the fingers -give self shot of regular insulin 30 min before meals -eat snack of 15 g of carbs such as 120 mL (4 oz) of fruit juice or 66 g (1/2 cup) of ice cream to rapidly decrease a mild hypoglycemic reaction -increase fluids when sick recombinant growth hormone Ans- treats hypopituitarism desmopressin Ans- used to treat hyposecretion of ADH luteinizing hormone-releasing hormone Ans- used in txt of precocious puberty to slow prepubertal growth in children and txt of advance prostate cancer in adult clients Levothyroxine Ans- used to treat various hypothyroid conditions strabismus Ans- -crossing of the eyes -disappears at 3-4 months of age care fora school-age child with a tunneled central venous access device Ans- -avoid use of scissors during dressing changes -flush each lumen of the catheter with heparin solution daily when not in use -use a semipermeable transparent dressing to reduce the risk of infection What type of needle should you use when accessing an implanted port? Ans- a non coring angled or straight needle bicycle safety Ans- -able to stand on balls of feet when sitting on bike -ride single file -wear light colored clothing with fluorescent material at night -ride in the direction of the flow of traffic Poor personal hygiene in a toddler is a potential indication of ________________________. Ans- physical neglect CF diet management Ans- -administer pancreatic enzymes within 30 min of meals and snacks -increase pancreatic enzymes if steatorrhea occurs -encourage fluid intake -increase fat content to 40% of total calories priority intervention for a toddler with epiglottitis Ans- prepare the toddler for nasotracheal intubation/tracheostomy vaccine that can prevent epiglottitis Ans- Haemophilus influenzae type B conjugate vaccine (Hib) Kawasaki disease Ans- -increased temp lasting 4 days unresponsive to antipyretics or abx -strawberry tongue -cracked lips -edema of oral mucosa & pharynx -xerophthalmia (reddening of conjunctiva & dry eyes) -tachycardia with a gallop rhythm -cervical lymphadenopathy: on 1 side of the neck, nontender, 1.5 cm in size complications: -coronary artery aneurysms -MI What can phenytoin therapy cause? Ans- gingival hyperplasia Koplik spots Ans- measles (rubeola) hoarseness Ans- diphtheria facial rash Ans- erythema infectiosum (fifth disease), lasts 1-4 days splenomegaly Ans- infectious mononucleosis increase in anterior convexity of the lumbar spine Ans- lordosis increased curvature of the thoracic spine Ans- kyphosis lateral flexion of the neck Ans- indication of torticollis as a result of contracture of the sternocleidomastoid muscle can be... -congenital: result of intrauterine fetal posturing or abnormality of cervical spine -acquired: traumatic lesion to sternocleidomastoid muscle unilateral rib hump Ans- -scoliosis -S or C shaped curvature to thoracic spine resulting in asymmetry of rib, shoulders, hips, or pelvis What should be applied to the affected area on an infant with diaper dermatitis? Ans- zinc oxide Pavlik harness Ans- -wear continuously till hip is stable (6-12 weeks) -parents should not adjust the harness in any way -avoid use of powders/lotions -place diapers under the harness straps What kind of respirations will a child have who has a flail chest? Ans- paradoxic respirations What kind of respirations will a child in DKA have? Ans- deep and rapid manifestations of IICP Ans- -lethargy -decreased activity -decreased attention span -bradycardia (late) -hypertension (late) manifestations of peritonitis (perforated appendix) Ans- -hypoactive bowel sounds -abdominal distention -tachycardia What can increase the risk of perforating the appendix in case of appendicitis? Ans- -enema -laxatives -heat ways to prevent acute asthma attacks Ans- -dehumidifiers -airconditioners -NO cough suppressants -wet mop bare floors weekly -keep child indoors when mowing the yard findings associated with bacterial meningitis Ans- -increased CSF pressure -increased WBC count -increased protein concentration -decreased glucose level Where should a pulse ox monitor be placed on an infant? Ans- the great toe rheumatic fever nursing interventions Ans- -maintain on bed rest -administer salicylates tobramycin side effects Ans- it is an aminoglycoside which can cause mild to moderate hearing loss nursing interventions for a child with heart failure Ans- -small, frequent meals -restrict play activities to minimize energy expenditure -weigh the child daily -maintain the bed in semi-Fowler's position sign of a hemolytic transfusion reaction Ans- flank pain sign of an allergic reaction to a transfusion Ans- laryngeal edema sign of circulatory overload (complication of a blood transfusion) Ans- distended neck veins indication of electrolyte disturbance (complication of a blood transfusion) Ans- muscle weakness When does a child begin referring to himself/herself by the appropriate pronoun start? Ans- 30 months When does a toddler's interest in pictures occur? Ans- 15 months When should a child have control of bowel and bladder functions during the day? Ans- 30 months When should a child be able to scribble spontaneously using a crayon? Ans- 15 months When should a child be able to imitate drawing strokes? Ans- 18 months When can a head-to-toe approach be returned to with children Ans- with preschoolers pneymococcal polysaccharide Ans- administered to children 2-18 years old who have a specific high-risk condition that places them at risk for an infection with Streptococcus pneumococci, which causes meningitis, otitis media, and pneumonia. meningococcal polysaccharide Ans- all incoming college students should receive this vaccine When is the final rotavirus dose administered? Ans- before 8 months of age When is the herpes zoster immunization given? What is it for? Ans- adults over 60 years old to prevent shingles What is the most common food allergy in children? Ans- cow's milk When does the stepping reflex disappear? Ans- 4 weeks When does the Babinski reflex disappear? Ans- 1 year old When does the extrusion reflex disappear? Ans- 4 months When does the Moro reflex disappear? Ans- 3-4 months What is crossed and extended legs when supine a finding associated with? Ans- cerebral palsy What can reduce the absorption and effects of lead? Ans- adequate intake of calcium and iron When is copying a circle achieved? Ans- 4 years When is cutting food using a table knife achieved? Ans- 7 years When does a child begin writing in cursive? Ans- 8-9 years old When can a child print their first and last name clearly? Ans- 5 years What kind of strategy is have a child hold their breath and blow it out slowly? Ans- distraction What kind of strategy is asking the child to describe a pleasurable event? Ans- guided imagery What kind of strategy is rocking the child in long rhythmic movements? Ans- relaxation When should development of sexual characteristics begin to develop in boys? girls? Ans- 9 yrs in boys; 8 yrs in girls To prevent a burn injury, temperature of water heater should not exceed what temperature? Ans- 120 degrees F What position is used when performing a gavage feeding? Ans- semi-recumbent What positions may be used during a lumbar puncture? Ans- -side lying position -flexed sitting position What position is used for a femoral venipuncture? Ans- supine with legs in a frog position When should an infant begin vocalizing vowel sounds? Ans- 7 months When is a crude pincer grasp demonstrated? What else is evident at that time? Ans- 9 months; use of a dominant hand Where is a liquid oral medication administered to an infant? Why? Ans- in the side of the mouth (buccal cavity) to prevent gagging and aspiration Which is gender is a increased risk for hospitalization related stress? Ans- males How long can a PICC line last with proper care? Ans- several weeks Must the client's arm be immobilized if they have a PICC line? Ans- no Where is a PICC line inserted? Ans- the operating room using local anesthetic by trained personnel How is Hirshprung's disease diagnosed? Ans- biopsy on a small amount of tissue from the colon How is pyloric stenosis diagnosed? Ans- an upper GI series nursing interventions post op following a surgical repair of cleft lip and palate Ans- -avoid placing objects in the infant's mouth -gently suction the mouth with a bulb syringe PRN to maintain a patent airway -position the infant upright -clean the incision with sterile saline or sterile water after each feeding and as needed Boston brace Ans- for scoliosis; wear 23 hrs a day manifestation sof tracheomalacia Ans- -barking cough -stridor -wheezing -cyanosis -apnea How many calories should 2 year old toddlers consume daily? Protein? Milk? Vegetables? Ans- -1,000 calories -2 oz protein -no more than 24 oz (3 cups) milk -8 oz (1 cup) vegetables What ages is the Word-Graphic pain rating scale used for? Ans- 4-17 yrs What ages is the Color Tool pain scale used for? Ans- children as young as 4 yrs who know how to recognize colors What ages is the Poker Chip Tool pain scale used for Ans- children as young as 4 yrs old who know how to use numbers What does an ASO titer check for? Ans- a recent strep infection What should alert the nurse that a toddler in acute respiratory distress may have epiglottitis? Ans- drooling How should an infant be fed following a cleft palate repair? Why? Ans- clear liquids in a cup for 7-10 days to prevent trauma/injury to the suture line What are children with hemophilia at risk for? Ans- bleeding What kind of murmur is expected with VSD? Ans- murmur at the left sternal border? What kind of murmur is expected with ASD? Ans- diastolic murmur What is an expected finding in a child who has an atrioventricular canal defect? Ans- cyanosis that increases with crying interventions for an infant with GERD Ans- -give lansoprazole 30 min before feeding -place infant in a seat or at a 30 degree angle for 1 hr after feedings -avoid feedings just before bedtime -at rice cereal to the milk/formula to thicken the feedings and decrease the episodes of vomiting phenytoin Ans- seizure medication lab findings in a child with acute lymphocytic leukemia Ans- -low platelet count -low RBC count -very high WBC count -low Hct level How long can a child use an opened vial of insulin? Ans- 28-30 days stored at room temp or in the fridge What can a child with rheumatic fever take to control inflammation in the joints to decrease joint pain? Ans- aspirin antidote for acetaminophen overdose/poisoning Ans- acetylcysteine treatment for intussusception Ans- barium enema What does an increased Hct level indicate? Ans- dehydration antidote for warfarin Ans- phytonadione oxybutynin Ans- antispasmodic used for clients 6+ yrs old who have neurogenic bladders osteomyelitis Ans- infection in the bone minimal change nephrotic syndrome Ans- kidney disease in which large amounts of protein are lost in urine toddler RR normal range Ans- 24-40 rpm