Peds Exam 2

1. Peds Exam 2

2. Clinical manifestations of increased ICP in children include all of the following except: Headache Vomiting, w/ or w/o nausea Seizures Setting-sun sign This is seen in infants HA, vomiting, seizures & diplopia are seen in children Infants: irritability, poor feeding, vomiting, seizures, high pitched cry, difficult to soothe, fontanelles tense & bulging, scalp veins distended, setting sun sign (eyes open but upper lid falls to level of pupil)This is seen in infants HA, vomiting, seizures & diplopia are seen in children Infants: irritability, poor feeding, vomiting, seizures, high pitched cry, difficult to soothe, fontanelles tense & bulging, scalp veins distended, setting sun sign (eyes open but upper lid falls to level of pupil)

3. FYI: late signs of inc’d ICP Dec’d LOC Dec’d motor response to command Dec’d sensory response to painful stimuli Alterations in pupil size & reactivity Papilledema (optic nerve swelling) Cheyne-Stokes repsirations Decerebrate or decorticate posturing

4. Nurse caring for 8yo w/ dx of basilar skull fracture. Which order would nurse question? Clear liquid intake Maintain patent IV line Daily weight Suction as needed 4. sxn? inc’d ICP & risk puncture of soft tissue @ back of head4. sxn? inc’d ICP & risk puncture of soft tissue @ back of head

5. Nurse monitoring child for bleeding post brain tumor resection. Checks head dressing & notes colorless drainage on back of dressing. Which would be most appropriate intervention? Circle area of drainage & continue to monitor Reinforce dressing Notify physician Document findings & continue to monitor 3. Possibly CSF3. Possibly CSF

6. Post op removal of brain tumor, physician order to maintain child in flat position. Nurse monitoring notes child is restless, pulse rate is elevated & BP has dropped significantly from baseline. Suspects shock. Which would be most appropriate nursing action? Place child in Trendelenburg’s position Elevate head of bed Increase IV fluids Notify physician 4. Cannot be 1 or 2-Need to keep child flat per order & IV fluid change needs order4. Cannot be 1 or 2-Need to keep child flat per order & IV fluid change needs order

7. Lumbar puncture performed on child w/ suspected bacterial meningitis. Which of the following CSF results would verify dx? Cloudy CSF, dec’d protein, dec’d glucose Cloudy CSF, inc’d protein, dec’d glucose Clear CSF, inc’d protein, dec’d glucose Clear CSF, dec’d pressure, elevated protein 2. r/t inc permeability & bacteria using glucose for energy2. r/t inc permeability & bacteria using glucose for energy

8. Which statement regarding meningitis is true? Both viral & bacterial meningitis may have an associated fever Stiff neck is the most common symptom in infants w/ bacterial meningitis Headaches only occur w/ bacterial meningitis Viral meningitis is more easily detected than bacterial meningitis is children 1.1.

9. Which of the following vaccine(s) protects infants from bacterial meningitis (there may be more than one)? IPV (polio) PCV (pneumococcal) DTaP (diptheria, tetanus, pertussis) Hib (haemophilus influenzae type b) 2, 42, 4

10. Which of the following positions is the most effective in preventing a further increase in ICP? Left side lying, head flexed, knees drawn up Trendelenburg position Fowlers position Supine w/ 30o head elevation 4.4.

11. Adolescent discharged w/ prescription for phenytoin (Dilantin). Which of the following by father indicates discharge teaching has been effective? I need to admin her medicine in the morning & evening I will keep the annual appt for f/u on her med I will be sure to encourage good oral care & regular dental visits I can allow her to stop taking the med after 6wks, as long as there are no seizures 3. s/e of Dilantin? gingival hyperplasia3. s/e of Dilantin? gingival hyperplasia

12. Parent of 9yo w/ GH deficiency asks nurse how long son will need to take injections for his growth problem. Which is most appropriate? Injections are usually cont’d until age 10 for girls & 12 for boys Injections need to continue until child reaches the 5th percentile on the growth chart Injections should be cont’d until bone maturation is complete, usually between 14-16yrs The injections will need to be administered throughout the child’s entire life. 33

13. During which of the following periods of growth & dev’t should a nurse anticipate behavioral problems form a child w/ untreated GH deficiency? Infant Preschooler School-age Adolescent 44

14. When providing health teaching to group of adolescents w/ type 1 d.m., a nurse instructs them that a hypoglycemic reaction can occur b/c of: Too much glucose in the body Eating too much junk food Exercising strenuously Not enough insulin in the body 33

15. Nurse caring for child w/ type 1 d.m. who has been taking insulin for 3 mos. Which diagnostic study will provider likely order to determine how well child’s diabetes is being managed? Morning faster blood glucose 2hr oral glucose tolerance test Hb1Ac Diary of child’s daily blood glucoses 33

16. Place the following steps in order when treating hypoglycemia: Recheck blood glucose Treat w/ 15g carbs If still low, give 15g more carbs Stop activity & sit down Recheck blood glucose 4, 2,1,4,54, 2,1,4,5

17. Child brought by parents to ER w/ 1st degree burns to shoulders from sun exposure. Which interventions are indicated? Start IV of NS Apply cool, wet compresses Scrub area w/ soft-bristle brush Admin morphine sulfate for pain relief 22

18. Child experiences 3rd degree burns to both legs after they were immersed in boiling water. Which nursing diagnoses will receive priority during the first 24 hours? Deficient fluid volume Imbalanced nutrition: less than body requirements Impaired breathing pattern Disturbed body image 11

19. Mother of 3yo arrives at clinic & tells nurse that child has been scratching the skin continuously & has developed a rash. Nurse assess & suspects scabies. Nurse bases this suspicion on which finding: Clusters of fluid filled vesicles Fine, threadlike lines Purple-colored lesions Thick, honey colored crusts 22

20. Which of the following orders should a nurse implement first for a child w/ a UTI? Ampicillin 250mg IV q 12hr Blood & urine cultures Sitz bath prn for pain Voiding cystourethrogram (VCUG) 22

21. 3yo being admitted w/ nephrotic syndrome. Best roommate is: 16yo recovering post-op from ruptured appendix 8yo w/ leukemia Another toddler w/ rheumatic fever No roommate because isolation is required 2- non contagious, closer in age2- non contagious, closer in age

22. Admission assessment on 2yo who has been dx’d w/ nephrotic syndrome. Nurse knows that most common characteristic assoc’d w/ it is? Generalized edema Frank bright red blood in urine Inc’d urinary output hypertension 11

23. Parents of child w/ glomerulonephritis concerned about activity restrictions after discharge. Nurse bases response on the fact that urinary findings are near normal. Activity must be limited for 1 mo Child must not play active games Child must remain in bed for 2 wks Activity does not affect course of disease 44

24. Which nursing intervention has highest priority when caring for child w/ acute glomerulonephritis? Assess for dysuria Monitor BP Monitor temp Assess for jaundice 22

25. A child is admitted w/ glomerulonephritis. Nurse should expect to see a recent _______ infection in the history given by the mother. strepstrep

26. Failure to repair hypospadias can lead to testicular cancer later in life. True False 2 cryptorchidism can lead to CA2 cryptorchidism can lead to CA

27. To prevent swelling of casted extremity, elevate the extremity above heart level & apply ice to cast. True False 11

28. Which of the following is an early sign of impaired neurovascular function in a child w/ an arm cast? Cool, cold fingers Pain Inability to detect a pulse distal to cast Inability to move distal extremity 2. Others are late signs2. Others are late signs

29. Choose the most appropriate roommate for a 16yo in a full body cast. 12 yo w/ inguinal hernia repair 9 yo w/ gastroenteritis 6 yo w/ fractured femur 15 yo w/ pneumonia 1. Not infectious & close in age1. Not infectious & close in age

30. When caring for child in Bryant’s traction, nurse should be aware that this traction is: Skin traction to the affected leg Attached to a pin placed in the affected femur Used to allow child to turn from side to side Skin traction & elevates hips slightly from bed 44

31. Nurse detects a positive Ortolani sign in a newborn. What is the nurse assessing? Broadening of perineum Shortening of one leg Audible click on hip manipulation Unilateral droop of hip 3. Used to assess for developmental dysplasia of the hip (congenital hip dysplasi)3. Used to assess for developmental dysplasia of the hip (congenital hip dysplasi)

32. 13mo old dx’d w/ L hip dysplasia & scheduled for surgery & spica cast. Child’s mother questions why a pavlik harness is not being used. Appropriate response is: Pavlik harness is used for children w/ scoliosis, not hip dysplasia Pavlik harness is used for school-age children Your child’s condition is too severe for a pavlik harness Pavlik harness is only used for infants <6mos 44

33. Mother brings 2wk old to clinic for tx following dx of clubfoot made at time of birth. Which statements, indicates need for further teaching? I need to bring my infant back to clinic in 1 mo for a new cast Tx needs to be started as soon as possible I need to come to clinic every week w/ my infant for casting I realize my infant will require follow-up care until full grown 1. Casting will be required more often1. Casting will be required more often

34. Nurse providing instructions to parents of child w/ scoliosis regarding use of a brace. Which statement indicated need for further instructions? I should apply lotion under the brace to prevent skin breakdown I should avoid the use of powder b/c it will cake under the brace I will have my child wear soft fabric clothing under the brace I will encourage my child to perform prescribed exercises 1. Lotion keeps skin soft, want it to toughen up1. Lotion keeps skin soft, want it to toughen up

35. To prevent loss of joint fxn in a child w/ JRA, nurse should teach parents to avoid letting child: Ride a bike Walk to school Do frequent isometric exercises Watch TV for prolonged periods 44

36. Child scheduled for debridement of leg wounds. In what order should nurse perform procedures? Remove dressing Medicate for pain Pour water on dressing to loosen it Assess need for dressing supplies 2,4,3,12,4,3,1

37. Which of the following are manifestations of scabies? (all that apply) Nits present Threadlike rash between fingers & other moist areas Circular rash on extremities Pruritus Eczematous eruption in infants 2, 4, 52, 4, 5

38. Match skin disorder w/ cause Impetigo contagiosa Scabies Lyme disease Cold sore, fever blister ringworm Fungal infection Bacterial infection Viral infection Caused by spirochete Caused by burrowing mite 1 B, 2 E, 3 D, 4 C, 5 A1 B, 2 E, 3 D, 4 C, 5 A

39. Match type of dermatitis w/ it’s description Diaper dermatitis Infantile eczema Acne Seborrheic dermatitis Weeping, red vesicles & papules Comedones & pustules Red, inflamed skin Thick, yellow scaly areas 1 C, 2 A, 3 B, 4 D1 C, 2 A, 3 B, 4 D

40. Which of the following meds can be used for children w/ eczema? (all that apply) Corticosteroids Accutane Peroxide Antihistamines Calamine lotion 1, 4, 5. corticosteroids for inflammation. Antihistamines to prevent scratching. Lotions (Calamine) may be soothing when applied to skin. Accutane & peroxide are meds used for acne1, 4, 5. corticosteroids for inflammation. Antihistamines to prevent scratching. Lotions (Calamine) may be soothing when applied to skin. Accutane & peroxide are meds used for acne

41. Diaper dermatitis can be largely prevented by changing an infant’s diapers frequently & keeping the diaper area clean & dry. True False 1. 1.

42. Eczema usually appears on cheeks of a 4yo child. True False 2. Eczema is most likely to be seen on the antecubital & popliteal fossae of children 2-5. in infants, the cheeks are a common area2. Eczema is most likely to be seen on the antecubital & popliteal fossae of children 2-5. in infants, the cheeks are a common area

43. A complication that may occur w/ acne & most types of dermatits is cellulitis. True False 1. cellulitis, an inflam of connective tissue underlying skin, is usually caused by a secondary bacterial infection1. cellulitis, an inflam of connective tissue underlying skin, is usually caused by a secondary bacterial infection

44. Nurse reviewing sick day mangement w/ parent of a child w/ type 1 diabetes. Which of following should be included in teaching? (all that apply) Monitor blood glucose every 4 hr Discontinue taking insulin until feeling better Drink 8 oz fruit juice every hour Test urine for ketones Call PCP if blood glucose is >250mg/dL 1, 4, 5. 1, 4, 5.

45. Providing health teaching to group of adolescents w/ D.M., nurse teaches them to observe for s/s of hypoglycemia. Which of following should be included? (all that apply) Frequent urination Inc’d energy level Nausea Nervousness & irritability Sweating & pallor Deep, rapid & labored respirations 3, 4, 5. 3, 4, 5.

46. Hypoglycemic rx can occurs b/c of: Too much glucose in body Eating too much junk food Exercising strenuously Not enough insulin in body 33

47. Child w/ type 1 D.M. on insulin for 3 months. Which of the following diagnostic studies will provider order to how well child’s D.M. is being managed? Morning fasting blood glucose 2hr oral glucose tolerance test Hb1Ac Diary of child’s daily blood glucoses 33

48. When teaching child w/ newly dx’d type 1 D.M., priority should be placed on: Wt loss measures Self-monitoring of blood glucose Need to reduce physical activity Elimination of sugar from diet 22

49. During scheduled exam, child’s HbA1c level is 9%. Child has had type 1 D.M. for 1 yr. Which of the following actions should nurse take? Assess signs of infection & child’s intake for past 24hr Explore child’s general dietary patterns for past 3 mos Review parents’ understanding of diabetic foot care Immediately admin child’s rapid acting insulin dose. 22

50. Nurse asks 12yo w/ GH deficiency to draw a pic off herself playing w/ children on a playground. List potential characteristics that might represent positive & negative self-esteem. See next slideSee next slide

51. Nurse asks 12yo w/ GH deficiency to draw a pic off herself playing w/ children on a playground Positive Child playing w/ other children Child smiling Interaction between children True height discrepancy Bright, colorful picture Negative Child standing off to side while other children are playing Drawing indicates teasing &/or ridicule Child appears much smaller than others Dark picture that is scribbled

52. Match diagnostic test w/ findings r/t growth disorders. X-rays of wrist & hand IGF-1 MRI GH stimulation/ suppression test Determines GH level Id’s pituitary gland tumor Determines bone age Measures effect of glucose on GH 1 C, 2 A, 3 B, 4 D1 C, 2 A, 3 B, 4 D

53. 6yo who has been bladder trained w/o enuresis since age 4 has begun having accidents both at night & occasionally during the day. Which of the following should be ruled out as possible causes? (all that apply) Glomerulonephritis UTI New onset D.M. Epispadias Bladder exstrophy 2,3. glomerulonephritis does not lead to enuresis. Epispadias is found in boys only; congenital abnormality of the location of the opening of the urethra. Bladder exstrophy is serous structural defect present at birth; therfore it would not be newly dx’d in this child.2,3. glomerulonephritis does not lead to enuresis. Epispadias is found in boys only; congenital abnormality of the location of the opening of the urethra. Bladder exstrophy is serous structural defect present at birth; therfore it would not be newly dx’d in this child.

54. Match structural GU disorder w/ definition Hypospadias Epispadias Phimosis Bladder exstrophy Cryptorchidism Chordee Hydrocele Ventral curvature of penis Narrowed opening in urinary meatus preventing retraction of foreskin over glans penis Failure of 1 or both testicles to descend into scrotum Collection of fluid in scrotal sac Urethral meatus is located on ventral side of glans penis Eversion of bladder through lower abd wall Urethral meatus located on dorsal side of glans penis 1 E, 2 G, 3 B, 4 F, 5 C, 6 A, 7 D1 E, 2 G, 3 B, 4 F, 5 C, 6 A, 7 D

55. Multiple surgeries will be required for child w/ bladder exstrophy to repair damage to bladder & pelvic area. True False 1. Multiple surgeries over several years1. Multiple surgeries over several years

56. 6yo admitted to acute care w/ dx of possible UTI. Which of following should nurse expect to find? Dysuria, thirst, light colored urine, ammonia odor in urine Dysuria, L sided pain, foul odor to urine, dark color to urine Polyuria, lower abd pain, yellow urine, sweet odor to urine Oliguria, epigastric pain, yellow skin tones, ammonia odor to breath 2. Painful w/ L flank pain, foul odor, dark color are symptoms of UTI. Light colored, ammonia odor are normal. Polyuria & sweet odor indicate D.M. Oliguria, epi pain, yellow skin, ammonia odor to breath are signs of renal fail2. Painful w/ L flank pain, foul odor, dark color are symptoms of UTI. Light colored, ammonia odor are normal. Polyuria & sweet odor indicate D.M. Oliguria, epi pain, yellow skin, ammonia odor to breath are signs of renal fail

57. Nurse preparing discharge teaching for mother of 6yo girl who had severe UTI. Which instructions are beneficial? (all that apply) Avoid bubble baths Change child’s bathing suit immediately after swimming Encourage child to go to BR q6hr Have child wear cotton underpants rather than nylon Observe child wiping back to front after voiding 1, 2, 41, 2, 4

58. Child admitted w/ glomerulonephritis. Which of following indicates need to call PCP? Specific gravity decrease from 1.022 to 1.020 Crackles in bases bilaterally Absence of S3 on auscultation Wt gain of 0.91kg overnight 4. Indicator of fluid retention. Dec specific gravity & absence of S3 not indicators of + change. Presence of crackles does not have enough detail to determine if this is a change for better or worse4. Indicator of fluid retention. Dec specific gravity & absence of S3 not indicators of + change. Presence of crackles does not have enough detail to determine if this is a change for better or worse

59. Child admitted w/ nephrotic syndrome. Which of following classic symptoms should nurse observe for? HTN, hypoNa, hemoconcentration hyperNa, hypoalbuminenia, hyperlipidemia Hematuria, hypoaldosteronemia, hyperNa Hemodilution, hyperalbuminemia, hypoproteinemia 22

60. Parent of child w/ excess fluid vol & weeping skin tells nurse he would like to be more involved in cares. Which should nurse encourage? Admin IV Lasix under supervision of nurse Read to child from bedside chair Reposition child q30min Assist in changing linens as they become wet 4. Child needs parental cuddling, not reading from bedside. Parent does not need to reposition q30min but does need to keep cihld as dry as possible; this will require frequent mvmt of child. Parent should not admin IV meds.4. Child needs parental cuddling, not reading from bedside. Parent does not need to reposition q30min but does need to keep cihld as dry as possible; this will require frequent mvmt of child. Parent should not admin IV meds.

61. Toddler w/ nephrotic syndrome has plt count of 700,000mm3. For which s/s should nurse monitor? Thrombosis Bruising Pulm congestion Cardiac enlargement 1. Toddler at risk fro developing clot that could lead to phlebitis, stroke MI. Normal ct 150,000-400,000. 1. Toddler at risk fro developing clot that could lead to phlebitis, stroke MI. Normal ct 150,000-400,000.

62. 3 yo w/ meningitis is documented as having photophobia. Which of following interventions is most effective in minimizing this symptom? Avoid using the TV Keep volume down on radio Bandage both eyes temporarily Elevate HOB 11

63. Child admitted w/ possible Reye syndrome. Which factors in health history might be supportive of this dx? Recent h/o UTI Recent h/o bacterial otitis media Recent episode of gastroenteritis Recent episode of haemophilus influenzae meningitis 33

64. Which manifestations are indicative of Stage II of Reye syndrome? (all that apply) Coma Fixed pupils Hyperventilation Combativeness Hyperactive deep tendon reflexes 3, 4, 5. the first two are later stages3, 4, 5. the first two are later stages

65. Lack of which is a warning sign of palsy in 3mo old infant? Crawling Sitting up w/o assistance Hold head upright Babbling simple words 33

66. Match type of CP w/ correct description Hemiplegia/ hemiparesis Diplegia/ diparesis Quadriplegia/quadriparesis Dyskinetic/ athetoid ataxic Will cause child to experience difficulty w/ quick or precise mvmts (writing, buttoning) Causes slow & uncontrollable writhing mvmts of hands, feet, arms, &/or legs Delays ability to walk in children (may walk on tips of toes b/c of tight heel tendon) Tightness in certain leg muscles makes legs move like arms of scissor (scissor walking) Will interfere w/ child’s ability to speak (child often hard to understand) 1 C, 2 D, 3 E, 4 B, 5 A1 C, 2 D, 3 E, 4 B, 5 A

67. Child w/ spina bifida should be instructed in intermittent bladder catheterization using clean latex catheter. True False 2. Although child may learn to cath self, it is important to use nonlatex cath due to child’s potential for latex allergy2. Although child may learn to cath self, it is important to use nonlatex cath due to child’s potential for latex allergy

68. Priority nursing dx for child who sits in wheelchair all day is risk for impaired skin integrity. True False 1. d/t dec’d sensation, child w/ paralysis who sits in wheelchair is at very high risk for pressure ulcers.1. d/t dec’d sensation, child w/ paralysis who sits in wheelchair is at very high risk for pressure ulcers.

69. School-age child w/ spina bifida has shunt in place for hydrocephalus. Which s/s are manifestations of inc’d ICP? (all that apply) Fever Hypotension Headache Lethargy Bulging anterior fontanel Seizures Change in school performance 3, 4, 6, 7. temp & hypotension not signs. Ant fontanel should be closed in children>18mos3, 4, 6, 7. temp & hypotension not signs. Ant fontanel should be closed in children>18mos

70. Match each type of seizure below w/ its definition. Tonic-clonic Absence seizure Febrile seizure Complex partial seizure Occurs w/ temp > 38.8 (101.8) Generalized mvmt of all extremities Dec’d consciousness w/ staring, lip smacking, chewing during seizure 5-10sec loss of consciousness that looks like daydreaming 1 B, 2 D, 3 A, 4 C1 B, 2 D, 3 A, 4 C

71. A single seizure lasting >10mins or a series of seizures lasting 20-30mins is called ________. Status epilepticusStatus epilepticus

72. Which vitals is indicative of Cushing’s reflex in a 6yo? Temp 37.2 (99), pulse 100, RR 22, BP 100/70 Temp 37.9 (100.2), pulse 140, RR 26, BP 60/30 Temp 35.6 (96), pulse 50, RR 18, BP 80/50 Temp 37.8 (100), pulse 64, RR 20, BP 140/40 4. Cushings triad- bradycarida, systolic HTN, widening pulse press. Resp not a part of triad although cheyne-stokes often occurs w/ other 3 symptoms. Temp not part of triad4. Cushings triad- bradycarida, systolic HTN, widening pulse press. Resp not a part of triad although cheyne-stokes often occurs w/ other 3 symptoms. Temp not part of triad

73. Child w/ concussion being discharged home w/ parent. Which statement indicates need for further teaching? I will keep him awake all night to make sure there is no change I should call the hospital if I cannot arouse him His pupils should remain equal & get smaller when I shine a light into them I should call the doctor if he starts to vomit 11

74. 6mo old infant admitted to critical care w/ basilar skull fracture. Which findings should nurse expect? (all that apply) Two black eyes Nuchal rigidity Split cranial sutures Bruising of neck posterior to infants ear Nosebleed 1, 4, 5. signs of basilar facture: raccoon eyes, Battle’s sign (bruising neck post to ear), bleeding from nose. Nuchal rigidity is from meningitis. Spil cranial sutures in diastatic skull fracture1, 4, 5. signs of basilar facture: raccoon eyes, Battle’s sign (bruising neck post to ear), bleeding from nose. Nuchal rigidity is from meningitis. Spil cranial sutures in diastatic skull fracture

75. Which are priority assessments for adolescent postop for insertion of Harrington rod secondary to scoliosis? Ability to eat a balanced diet BP & pulse O2 sat Assess for body image disturbance Neurvascular assessment Pain assessment Assess for wound infection 2, 3, 5, 6. 1-will be NPO post op. 4-not a priority until physically stable. 7-not priority immediate postop2, 3, 5, 6. 1-will be NPO post op. 4-not a priority until physically stable. 7-not priority immediate postop

76. 8 yr old R femur fracture after falling off skateboard. After 3 wks traction w/ pin, casted & discharged. Teaching instructions include: (all that apply) Wash cast carefully if it becomes soiled Allow cast to remain uncovered until it dries completely Support wet cast carefully & avoid denting it Make sure nothing is placed inside cast Check leg frequently for signs of swelling 2,3,4,5. 1-cast should never be washed or wetted2,3,4,5. 1-cast should never be washed or wetted

77. Inc’d pain, erythema & fever are 3 signs that compartment syndrome is occurring w/in casted extremity. True False 2. inc’d pain is sign of compartment syndrome. Others include pallor, paresthesia, absent pulses distal to cast. Erythema & fever s/s of infection such as osteomyelitis2. inc’d pain is sign of compartment syndrome. Others include pallor, paresthesia, absent pulses distal to cast. Erythema & fever s/s of infection such as osteomyelitis

78. Adolescent w/ rheumatoid arthritis reports severe pain during PT exercises & states she doesn’t want to go back to PT again. Intervention to solve this problem: Medicate w/ morphine sulfate before PT Use ice packs before PT to dec inflammation Take warm bath or use warm packs before PT Perform passive ROM for adolescent before PT 3. Warm can dec joint pain during exercise. Meds for inflammation (ie NSAIDS) better for RA), ice stiffens joints. Passive ROM not realistic & would not dec pain.3. Warm can dec joint pain during exercise. Meds for inflammation (ie NSAIDS) better for RA), ice stiffens joints. Passive ROM not realistic & would not dec pain.

79. What measures can be taken to dec pain & prevent deformity during sleep for child w/ RA? See next slideSee next slide

80. What measures can be taken to dec pain & prevent deformity during sleep for child w/ RA? Splinting of knees, wrists, hands Sleeping on firm matterss w/o pillows under knees may help dec pain & prevent flexion deformities

81. 5 yo child unable to sit through meals, easily distracted. At night, gets up while family is sleeping & wanders about house. Doing poorly in kindergarten d/t inability to concentrate on work. Which should child be evaluated for? Mental retardation Down syndrome ADHD Autism 33

82. Nurse is discussing w/ parents of 3mo w/ Down syndrome ways to help prevent recurrent resp infections. Which interventions should nurse discuss? (all that apply) Practice frequent handwashing Keep infant in Fowler’s position most of time to prevent choking Use bulb syringe to remove nasal mucus Keep infant’s mouth moist by rinsing frequently w/ water 1, 3, 4. need to change posititons1, 3, 4. need to change posititons

83. Nurse assessing 4yo for autism. Should be alert for: Constant talking & impulsive behavior Poor language & interpersonal skills Frequent resp & UTI’s Constant clinging to parents & wanting to be cuddled 2. 2.

84. 9yo w/ autism continually hits head on desk. During planning w/ teachers, school nurse has devised one outcome for the problem, which states child “will develop self-control measures to prevent behavior”. Nurse should evaluate this outcome to be met when child: Wears his helmet continually to prevent injury Begins cutting his arm instead of banging his head Seeks out a staff member instead of head banging Is placed in seat w/o desk to prevent this unacceptable behavior 33

85. 3mo old FTT being bottle fed. Following techniques nurse should teach mom: (all that apply) Simulate feeding environment in common dining room Maintain eye contact w/ infant during feeding Burp infant frequently during feeding Give infant as much formula as she can hold during each feeding Develop structured feeding routine 2, 3, 5. quiet environment better than DR. Small frequent meals better than large ones2, 3, 5. quiet environment better than DR. Small frequent meals better than large ones

86. Nurse evaluating family in which child abuse has occurred. Which is best indicator that parents are making progress toward resolution of violence? Parents plan weekly outings to park Parents are attending parenting classes Parents report high expectations for their children Parents relate an understanding of normal growth & development 44

87. Nurse assessing family of child brought in for severe injuries. Which behaviors by parents indicates probable abuse? Delay in seeking treatment for child’s injuries Detailed description of events prior to injuries Anxious, concerned attitude Encouraging child to explain injuries 11