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Study Guide EXAM #2- Pediatrics EXAM is on CHPT 6, 8, 9 & 14 Slides and Book Chapter When conducting a pediatric assessment, know the distinguishing “oral eruptions” associated with Rubeola, Chicken pox, Roseola Infantum and Rubella. Rubeola Fever, coryza, cough, red eruptions with white center on the buccal mucosa = kolpik spots and the child has rubeola chicken pox sores in mouth, last about a day and can turn into ulcers, yellow or gray in color roseola infantum erythematous maculae on the soft palate, also known as Nagayama spots rubella Painless red spots may appear on the back of the roof of the mouth and throat (Forchheimer spots) _ Varicella (Chickenpox), etiology, treatment, transmission and prevention. not a true transmission of chickenpox = children w/chickenpox are infectious only during the period when skin lesions are present. m Coping mechanisms for heart failure (i.e., Is there increased sympathetic activity, Ventricular Hypertrophy or Ventricular Dilation associated with Heart Failure?) What do you usually see?? not coping HF = ventricular septal defect _ Tuberculin Testing, Tuberculous and who this test should be administered to. who should not have tuberculin skin testing = 2yr old who was infected with RSV at 3 months and asymptomatic = a child with the diagnosis of pulmonic Stenosis what symptoms are displayed, anatomical obstructions and what type of murmurs are associated with this diagnosis.
m stenosis = obstructed right ventricular outflow casing right ventricle hypertrophy, systolic murmur, cyanosis, and symptoms of HF Understand the etiology, treatment, diagnosis and treatment regimen for Lyme disease. lyme disease = amoxicillin PO Understand Blood transfusions in the pediatric patient and treatment of complications. .old with adverse reaction to blood = immediately stop transfusion, notify provider, obtain vital signs, and infuse normal saline Understand the anatomy and physiology of Patent Ductus Arteriosus. “ ductus arteriosus =blood flow from RE side of the heart to the L side of the heart and creates a loud, harsh murmur mfi?!\b- \IV{_, Know what Tetralogy of Fallot is, what are the symptoms and what is a TET spell. Hypercyanosis blue spells
- old turned blue = cyanotic spell related to tetralogy of fallot Know Tricuspid Atresia. Anatomy and what is happening. with deoxygenated blood Describe and know the presenting symptoms of Hypoplastic left heart syndrome. ventricle and hypoplasia of aortic arch Know the difference between Foreign body aspiration, cystic Fibrosis, croup and Asthma. What symptoms do each present with? ° “ persistent asthma medicine = inhaled corticosteroid e 2yr old with unilateral wheezing = foreign body aspiration Understand the management of an infant with suspected heart disease and reported cyanosis.
- disease and reported cyanotic spell = prompt referral to cardiologist Understand 5" disease, symptoms, causes, treatment and contraindications and or effects of the disease. . appropriate to be assigned to a nurse who is pregnant = 3yr old who has 5th disease receiving supportive care with tylenol _ is Coarctation of the Aorta, anatomy, symptoms & Complications (Listen to the narration with this slide)
a.Acyclovir (Zovirax) b.Varicella globulin
c.Diphenhydramine hydrochloride (Benadryl)
d.VCZ immune globulin (VariZIG)
ANS: D
VariZIG is given to high-risk children to prevent the development of chickenpox. Acyclovir decreases the severity, not the development, of chickenpox. Varicella globulin is not effective because it is not the immune globulin. Diphenhydramine may help pruritus but not the actual chickenpox. 3.A nurse is assessing a child and notes Koplik spots. In which of these communicable diseases are Koplik spots present?
a.Rubella
b.Measles (rubeola) c.Chickenpox (varicella) d.Exanthema subitum (roseola)
ANS: B
Koplik spots are small irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Rubella occurs with rash on the face, which rapidly spreads downward. Varicella appears with highly pruritic macules, followed by papules and vesicles. Roseola is seen with rose-pink macules on the trunk, spreading to face and extremities.
- Which is a common childhood communicable disease that may cause severe defects in the fetus when it occurs in its congenital form? a.Erythema infectiosum
b.Roseola
c.Rubeola
d.Rubella
ANS: D
Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not
dangerous to the fetus. 5.An infant that is born with a large ventricular septal defect may present with which of the following? [SATA] a. Tachypnea and labored respirations b. Heart murmur as only manifestation c. Trouble feeding and growing at a normal rate d. Symptoms that may not present until several weeks after birth a,cd Infants born with VSD of a large size may breathe faster and harder than normal, have trouble feeding and growing at a normal rate, and may not develop symptoms until several weeks after birth. Over time these symptoms may cause permanent damage to the lung blood vessels. 6.TRUE or FALSE: The signs and symptoms of a ventricular septal defect are most commonly detected in a baby following birth. False
The answer is FALSE. Signs and symptoms of a ventricular septal defect are NOT
commonly found in a baby after birth, but rather a little later on. VSD signs and symptoms most likely start to present around 1-3 months after birth. WHY? In utero, the baby has the same pressure on the right and left side of the heart. However, after birth the lungs start to work and this pressure changes gradually over the next 2-3 weeks. The pressure in the right side will decrease compared to the left side. Therefore, when a large VSD is present the pressure changes will cause blood to begin shunting from the LEFT ventricle to the RIGHT ventricle (hence increasing lung blood flow which leads to pulmonary hypertension and eventually heart failure). Therefore, at about 1-3 months of life the infant will be presenting with heart failure, growth problems, and respiratory issues. 7.After speaking with the mother of the infant in the previous question, who may have a ventricular septal defect, you auscultate heart sounds. If a ventricular septal defect was present, you may hear a harsh murmur that is A. Located at the lower left sternal border and starts at S1 and extends into S2. B. Located at the upper left sternal border and is continuous during systole.
C. An 18-month-old whose mother is infected with HIV. D. A 3-month-old whose family recently emigrated from Cambodia to the United States 1 month ago
A
11.Which of the following is not a coping mechanism associated with heart failure? A.Ventricular Septal Defect B. Increased Sympathetic Activity
C. Ventricular Dilation
D. Ventricular Hypertrophy
A.
12.You are examining a child who has fever, coryza, cough, conjunctivitis, malaise and anorexia. During the oral examination, you observe red eruptions with white centers on the buccal mucosa. What are these eruptions called and what disease does this child have? A. These eruptions are called Koplik Spots and the child has Rubeola. B. These eruptions are called Rubeola Spots and the child has Rubeola. C. These eruptions are called papules and the child has chicken pox. D. These eruptions are called erythema marginatum and the child has Roseola infantum. A. These eruptions are called Koplik Spots and the child has Rubeola. 13.You are assessing a child who is admitted to the cardiac unit. Upon assessing the child, you notice that he has pulmonic stenosis. Which of the following physical exam would point you to the direction of the child's diagnosis as being pulmonic stenosis? A. Your patient has obstructed right ventricular outflow causing right ventricular hypertrophy, a Systolic murmur, Cyanosis and symptoms of heart failure. B. Your patient has obstructed right ventricular outflow causing left ventricular hypertrophy, a Systolic murmur, Cyanosis and symptoms of heart failure. C. Your patient has obstructed left ventricular outflow causing left ventricular hypertrophy, a Systolic murmur, Cyanosis and symptoms of heart failure.
D. Your patient has obstructed right ventricular outflow causing right ventricular hypertrophy, a diastolic murmur, Cyanosis and symptoms of heart failure
A.
14.Which of the following is NOT true regarding transmission of chickenpox? A. Susceptible individuals can contract chickenpox from patients with varicella zoster (shingles).
B. Varicella-Zoster immune globulin (VZIG) should be administered to susceptible
immunocompromised individuals who are exposed to a patient with varicella zoster infection. C. Children with chickenpox are infectious only during the period of time when skin lesions are present. D. Children with chickenpox are no longer infectious once crusting of skin lesions has occurred. C. Children with chickenpox are infectious only during the period of time when skin lesions are present. 15.You are assessing a patient who is diagnosed with Patent Ductus Arteriosus. Which of the following statements is not true regarding Patent Ductus Arteriosus? A. In this condition, blood flows from the right side of the heart to the left side of the heart and creates a loud harsh murmur. B. Patent Ductus Arteriosus can be managed by administering Indomethacin which is a prostaglandin Inhibitor.^ C\O®€5^ ?oB C. Causes increased workload to the left side of the heart because blood is shunted from the aorta through the ductus arteriosus to the pulmonary artery and the lungs D. It occurs when a conduit between pulmonary artery and aorta fails to close.
A
- You are administering blood to a five-year-old in the PACU and notice that the child is having an adverse reaction to the blood. What actions will you take to care for this child? A. Continue with the infusion but increase the frequency monitoring by obtaining more frequent vital signs.
A. It consists of aortic stenosis, mitral stenosis, absent left ventricle and hyperplasia of aortic arch. B. It consists of pulmonic stenosis, mitral stenosis, absent left ventricle and hypoplasia of aortic arch. C. It consists of aortic regurgitation, mitral stenosis, absent left ventricle and hyperplasia
of aortic arch.
D. It consists of aortic stenosis, mitral stenosis, absent left ventricle and hypoplasia of aortic arch.
D
20.You are caring for a two-year-old who present with unilateral wheezing. This is suggestive finding that is associated with which of the following conditions? A. Asthma B. Cystic Fibrosis C. Foreign body aspiration D. Croup C. Foreign body aspiration
- You are caring for a 2 year old child diagnosed with Lyme disease on the inpatient ward. Based on the patient's diagnosis, which of the following antibiotics will you plan to administer? A. Ceftriaxone IV B. Doxycycline po C. Amoxicillin po D. Clindamycin IV C. Amoxicillin po 22.You are the charge nurse on a busy pediatric ward. Upon making patient assignments, which of the following patient is not appropriate to be assigned to a nurse who is pregnant? A. A three-year-old who has fifth disease receiving supportive care with Tylenol. B. A one-year-old that has the flu that has just received his Tamiflu dose. C. A five-year-old with Kawasaki disease getting IVIG.
D. A seven-year-old with poliomyelitis who has just received immunizations. a. A three-year-old who has fifth disease receiving supportive care with Tylenol. 23.A nine-month-old is bought to the Emergency Room and you are the ER nurse that is conducting your assessment on the child. Upon assessment the child has Spasms of paroxysmal coughing followed by stridor on inspiration. The cough has the classic high pitch ending in an inspiratory "whoop". What do you suspect this child has and do you anticipate being used in treatment of this disease? A. This child has Pertusis and you can anticipate this child to be treated with Clindamycin for the next 10 days. B. This child has diphtheria and you can expect this child to be treated with penicillin for the next 14 days. C. This child has Pertusis and you can anticipate this child to be treated with Azithromycin for the next 14 days. D. This child has tetanus and you can expect this child to be treated with a tetanus toxoid injection. C. This child has Pertusis and you can anticipate this child to be treated with Azithromycin for the next 14 days. 24.1n a child who has mild persistent asthma appropriate daily medication should include:
A. An inhaled corticosteroid
B. A short acting beta 2-agonist C. A cough suppressant D. An oral systemic corticosteroid A. An inhaled corticosteroid 25.You are assessing a child who is admitted to the cardiac unit. Upon assessing the child, you notice has elevated blood pressure in his arms and decreased blood pressure in his legs. Which of the following conditions does this child have and what else can you expect this child to display? A. This child has coarcation of the aorta and you can also expect him to be have bounding pulses of his lower extremities.
B. Administering aspirin to prevent clots. 29.A 9-year-old boy presents with a fever of 102° Fahrenheit and is complaining of leg pain. His mother reports that he had an upper respiratory infection with a sore throat approximately 2 weeks ago, which subsided without therapy. On physical exam, he has tender swollen knees bilaterally. His heart rate is 120 beats per minute and a blowing systolic murmur is heard at the apex. No murmur was noted at the previous well child visit. A. Kawasaki disease B. Thalassemia C. Rheumatic Fever D. Leukemia C. Rheumatic Fever
