a.i. Therapeutic levels of theophylline is 10-10 mcg/dl, so the child's level is w/in the therapeutic rage.
a.i A trial of HCG may aid in testicular descent, but does not replace surgical repair for true undescended testes. (cryptorchidism: may be found in the inguinal canal due to exaggerated creamasteric reflex
a.i. Celiac disease causes an intolerance to the protein gluten found in oats, rye, wheat, and barley. The child should avoid any produces containing these indredients to avoid symptoms such as diarrhea.
a.i. The best approach for a toddler is to ignor the attention-seeking behavior. The parents should be somewhat nearby, w/in view of the child but should avoid reinforcing the behavior in any way. Tantrums can sometimes be avoided by talking to the child before the situation occurs
a.i. Elbow restraints prevent children from bending their arms and brining their hands to the oral surgical site, (A) restrains the hands but the child can bend and bring their head to their ands. (B) is used during procedures (mummy). (D)-jacket, restrains the body torso and is not appropriate
a.i. Needs of a sibling will be better met with facture information and contact w/ the ill child, so siblings visitation should be encouraged (D). Parents are experts on their children and should determine when their children are old enough to visit. (A) in the hospital/ Separation fr. a family & home (B) may intensify fear & anxiety (suggest that the child visit a grandmother until the sibling returns home. Children may have difficulty expressing questions (C) ask the mother if the child asks when the sibling will be discharged, so the support of parents & other caregivers are needed to help alleviate their fears.
a.i. Outcome of learning is best demonstrated when the client not only verbalizes an understand, but can also provide a return demonstration
a.i. The child is exhibiting signs of a reaction to the blood transfusion. The blood transfusion should be stopped immediately and the healthcare provider notified ©. After the transfusion is discontinused, IV access should be maintained. (A) w/ fluids that do not introduce any more cellular products. (B & D) place the child @ risk for further blood reactions
a.i. Ototoxicity diminishes hear acuity and causes symptoms of tinnitus and vertigo in older children who can express subjective symptoms, so assessing the infant's reation to loud noises (A) helps to determine an infant's risk for hearing deficit r/t to a hx of the mother taking ototoxic drug, such as aspirin, while pregnancy (B,C,D are not assoc w/ the exposure to aspirin in utero
a.i. Pepto Bismol contains aspirin and there is the potential of Reye's syndrome (B). (a) is a common effect of peptobismol and does not warrant discontinuation. Pepto Bismol can be used by children (C). Pepto Bismol does not cause rebound hyperacidity (D) complication of antacids containing calcium
a.i. Nystatin (mycostatin) (A) is an antifungal drug that is effective in treating thrush, an oral fungal infection
a.i. Familizaring the child and mother w/ the department will help decrease anxiety of the child and mother (who may have more anxiety than the child). Three is a difficult age to undergo a procedure that requires cooperation. Restraints and possible sedation may be required
a.i. The most important principle in dealing w/ a poisoning is to treat the child first, not the poison. Initiate immediate life support measures w/ assessment of VS (B), in particular, respirations. Inserting an airway or initiating mechanical ventilation may be necessary. Assessment and identification of the poison should occur prior to A. (C & D after assessing the airway.)
a.i. Children aged 3-6 are in Erickson's initiative vs. guilt stage, which is characterized by vigorous, intrusive behavior, enterprise, and strong imagination. At this age, children develop a conscience and must learn to retain a sense of initiative w/o impinging on the rights of others
a.i. Elbow restraints prevent arm flexion and scratching of involved area, but do not inhibit use of the nads for play activities. Others can be removed easily
a.i. Photosensitivity is a common side effect of tetracycline HCL (AchromycinV) therapy. Severe sunburn can occur w/ minimal sun exposure and clients should be instructed to avoid sunlight and to use sunscreen
a.i. The child must be monitored for S/S of hypontremia, which creates secondary central nervous system alterations such as changes in LOC, seizure coma.
a.i. A small, superficial laceration to the skin should be washed gently w/ mild soap and water for several minutes, followed by thorough rinsing.
a.i. A heart rate of 60 is much lower than normal for a 6-month old and warrants immediate intervention. The normal heart rate for a 6 month old is 80-150 when awake, and a rate of 70 while sleeping is considered w/in normal limits.
a.i. A 4 year old can readily identify w/ simple picures to show the nurse how he/she is feeling. Could be used to validate what the child is telling the nurse via the "faces" pain scale, but it is best to elicit the child's assessment of his/her pain level (C-assess for changes in the child's vs), may not accurately reflect the effectiveness of pain medication as they can also be affected by other variables, such as fear
a.i. Tetrology of fallot, a cyanotic heart defect, causes clubbing of fingers and toes due to tissue hypoxia
a.i. Communicating through play w/ a doll or other toy gives time for the child to feel comfortable w/ a stranger
a.i. Prevention of abdominial palpation minimizes the risk of rupturing the encapsulated tumor and subsequent metastasis.
a.i. The only reliable way to prevent poisoning in young children is to make them inaccessible
a.i. C- 4yr old children are aggressive in their behavior and enjoy "tale telling"
a.i. Is the most common assoc w/ defect in children w/ Down Syndrome
a.i. Developmentally a 5 yr old has the cognitive and psychomotor skills to use a glucometer and to read the number (it is especially helpful if the nurse presents this activity as a game
a.i. Assessing the client's physiological state upon admission is priority, and nervousness, apprehension, hyperexcitability, and palpitations are signs of hyperthyroidism, but assessing loss (even w/ a hearty appetite) (A) occurs in those w/ hyperthyroidism, but assessing the client's neurological state has a higher priority. Hormone replacement is not administered to a client who is already producing too much thyroid
a.i. After the completion of the initial tetanus immunization schedule, the recommended booster for an adolescent or adult if every 10 years or less if a traumatic injury occurs that is contaminated by dirt, feces, soil, or saliva, such as puncture or crushing injuries, avulsions, wounds fr. missiles, burns or frostbite. The adolescent's injury is considered a contaminated wound requiring prophylactic therapy, so the tetanus toxoid booster should be administered
a.i. Removing restraints one at a time (B) is safer than removing all of them at once. The child needs to exercise and should not be kept in restraints at all times
a.i. The student has just completed football practice, and increased muscle activity increases body heat production. A temp of 100F is NORMAL for this student @ this time. The student should attend class
a.i. School aged children strive for independence and productivity (ericksons industry vs. inferiority) & enjoy individual & group activites r/t real life situation, such as playing follow the leader
a.i. Includes the "3 Cs" of esophageal atresia caused by the overflow of secretions into the trachea.
a.i. Russell's skin traction is used for fractures of the femur in young children and adolescents whose growth plates remain open and is applied to the lower leg using moleskin and elastic wrap bandages, which can compress the perineal nerve and arteries that supply the foot. Assessment of adequate circulation, movement, & sensation of the toes and skin distal to the application is make to identify compromised blood flow, so cyanosis should be reported immediately
a.i. Reguardless of a client's age, adequate renal function must be present before adding potassium ot IV fluids, is important in determining the need for fluid replacement
a.i. Intercostals retractions result fr. respiratory effort to draw air into restricted airways
a.i. Drawing pictures is a valuable fr. non verbal communication. As the nurse & child look at the drawings, a verbal story can be told that projects the child's thinking
a.i. The current VS readings and the decreased peripheral pulse volume indicate that the child is experiencing fluid volume deficit due to the polyuria, so the priority action is to restore fluid volume
a.i. Body image and peer acceptance are key concerns for the adolescent © allows for social interaction w/o face to face contact, thus protecting his self image while also promoting social interaction
a.i. Tetracyclines cause enamel hypoplasia & tooth discoloration in children under 8 yrs of age
a.i. A- a child's height & weight, C- Body surface area of child, F- nomogram determined mathematical constant
a.i. Visual changes leading to blindness an occur in children w/ JRA/ Regular eye exams can help to prevent this complication
a.i. A child's head & neck are proportionately larger to their body than and adult's. The standard "Rule of nines" is inaccurate for determining burned body surface areas w/ children, and must be modified for use with children. Specially designed charts for children and are commonly used to determine body surface are involvement
a.i. A description of the vomiting episodes will assist the nurse in determining the reason for the symptoms, which may be helpful in developing a plan of care for this infant/
a.i. The baby is @ 35% which is must more than room air (21%) and at this time the baby should not be moved fr. under the hood. The nurse should offer the parents an alternative such as to stroke and reassure the infant.
a.i. Discipline should be a positive and necessary component of childrearing that is started in infancy & should teach socially acceptable behavior, help children protect themselves fr. danger, and channel undesireable behavior into constructive activity. Misbehavior may result fr. inconsistent rules or messages, so parental attention should be clear, reasonable, and consistent.
a.i. The respiratory rate should be take first in infants, since touching them or performing unpleasant procedures usually makes the cry, elevating the heart rate and making respirations difficult to count. Rectal temp is the most invasive procedure, and is most likey to precipitate crying, so should be done last
a.i. All of these interventions evaluate fluid status in infants (weight diapers, checking skin turgor, oserving mucous membranes for moisture checking for fluid status)
a.i. A tympanic membrane sensor approximates core temps because the hypothalamus and eardrum are perfused by the same circulation. Typmpanic readings obtained using proper technique correlated moderately to strongly w/ oral temperatures in recent research studies
a.i. s/s of diabetes or hyperglycemia need to be reported. Those receiving growth hormone should be monitored to detect elevated blood sugars and glucose intolerance
a.i. Sublingual procardia lowers blood pressure very quickly, and this should be done first
a.i. A tympanic membrane sensor is an excellent site because botht he eardrum and hypothalamus (temperature-regulating center) are perfused by the same circulation. The sensor is unaffected by cerumen and the presence of suppurative or unsuppurative otitis media does not effect measurement. RULE OF THUMB: for managementsterile procedures should be assigned to licensed personnel. Management skill will tested on the NCLEX. An RN is not required to do: rectal temp
a.i. Postrural drainage for a child w/ cystic fibrosis is most effective when performed after nebulization and before meals or at least 1 hour after eating to prevent nausea & vomiting. Postural drainage uses gravity to promote mucous removal after nebulization (which open airways).. Pulmonary toileting or respiratory treatment should be given 3-4 times daily, not esisodically
a.i. A- Cyanosis indicates impaired circulation to fingers and should be reported immediately. Although the actions described may be indicated, they are implemented rather excessively & might tend to frighten the parents. It is not necessary to check the child's ability to move his fingers hourly for 2 days.
B- Increase the infant's intake per feeding by 1-2 ounces per week
d. allow the infant to rest and reefed on demand or every 2 hrs
E. use a softer nipple or increase the size of the nipple opening
Rationale: Correct responses are A,B,D, E. neonates who have VSD may fatigue quickly during feeding and ingest inadequate amounts. They should be monitored for weight gain and at least 6 wet diapers per day. A one month old should ingest 2-4 ounces of formula per feeding and progress to about 30 ounces per day by 4 months of age. Due to fatigue, the infant should rest, but feed at least every 2 hours to ensure adequate intake. A softer (preemie) nipple or a larger slit in the nipple helps to reduce the sucking effort and energy expenditure, thus allowing the infant to ingest more w/ less effort. Antibiotoic prophylaxis is recommended for infants w/ VSDs, but should not be mixed in a bottle of formula because it is difficult to ensure tha the total dose is consumed
a.i. More information is needed to interpret these finding, the tympanic membrane is normally pearly gray, not bulging, and moves when the client blows against resistance or a small puff of air is blown into the ear canal. Since this child's findings are not completely normal, further assessment of hx and related s/s is indicated for accurate interpretation of the finding.
a.i. Two year old children are egocentric and unable to share w/ other children and behaviors of a preschooler.
a.i. The prescribed medication is 4ml dosage and is measured w/ the most accuracy using a syringe, so if the parent uses teaspoon which is equiavelnt to 5ml, further teaching is indicated
a.i. Washing the hair & skin w/ soap & hot water removes oil debris fr. the skin and helps prevent & treat acne. Oily skin especially bothersome during adolescence when hormones cause enlargement of sebaceous glands and increased glandular secretions which predispose the teenager to acne is contraindicated. Cosmetics "medicated" or not should be used sparingly to avoid further blocking sebaceous gland ducts. Might be indicated at a later time, if healthcare recommendations are not successful.
a.i. Hirschsprung's disease is a mechanical obstruction caused by inadequate motility in a part of the intestines. The condition results fr. failure of ganglion cells to migrate craniocaudally along the GI tract during gestation. The lack of peristalsis in the affected bowel segment causes constripation and smaller diameter, brown colored stools
a.i. @ 6 months of age the anterior fontanel should be open, and it should not be closed until approx 18 months
a.i. Between approximately 15 & 24 months of age, a child's speech is only ½ understandable
a.i. Projectile vomiting, which contributes to metabolic alkalosis is the classic sign of pyloric stenosis
a.i. The most definitive measure of improved nutrition is an infant is obtaining the child's daily weight
a.i. Menstruation is an expected secondary sex characteristic that occurs with pubescence and typically occurs by age 18, so A should prompt further investigation to determine the cause of this primary amenorrhea. Children receive tetanus as part of the DPT childhood immunization series, and a booster is not typically given until age 16.
a.i. At 6 months of age, the routine immunizations should HEP B, DTaP, Hib, PCV (pneumococcal) , IPV (inactivated poliovirus) and influenza. The influenza vaccine should be given at a separate site fr. any other injection.
Cleft Lip and Cleft Palate- HESIPage 11.A Complication Occurs"Push, push, push!" Mario urges while holding Isabella's hand and watching as hisfirst-born child makes an entrance into the world. As the infant is delivered, the entire room becomes quiet and Isabella sees a look of concern on her husband's face. The baby boy is crying loudly, but the upper lip appears to be missing, and his face looks deformed. The infant is quickly placed under the radiant warmer and dried. His 1 minute Apgar score is 8. Isabella is frightened, and she has not seen her newborn son yet. "What is wrong with my baby? What is going on?" she cries.2.1.ID: 6975144170Which action should the labor and delivery nurse take?A.Explain that she has a healthy baby boy with a great cry.Her son may be healthy and have a great cry, but he has a facial abnormality that will require repair.B.Wait for the obstetrician to tell Isabella what is happening.The nurse should implement another action without waiting for the obstetrician to talk to Isabella.C.Answer Isabella's questions and allow her to see her son. CorrectThe nurse should answer Isabella's questions and allow her to see her son since he is crying and not in immediate danger. This will allow for bonding between the mother and her baby. The nurse should stay with the couple in case they have any questions or need emotional support.D.Take the infant to the neonatal intensive care unit immediately.Since the infant is not in any respiratory or cardiovascular distress, there is noneed to admit him into the neonatal ICU.CorrectAwarded 1.0 points out of 1.0 possible points.3.The labor and delivery nurse knows that many infants with a cleft lip also have a cleft palate.4.2.ID: 6975144172Which assessment technique will determine if the infant has a cleft palate?The palate is the roof of the mouth, and palpating this area with the finger willdetermine if the palate is open (cleft) or closed (not cleft).