1. What is pediculosis capitis? 2. What will be your next steps in A.P.’s care? 3. What should be included in the educational plans for A.P. and her parents? 4. The parents take A.P. home to treat her. Which statement by A.P.’s mother would help make A.P. the most comfortable during this treatment period? Explain. a. “Here is the shampoo. Be sure to scrub your head for several minutes.” b. “We can pretend you are at the beauty parlor! Lean back while I wash your hair.” c. “I sure hope this works. I never thought this would happen!” d. “It might be best to go ahead and cut your hair. It will grow back quickly.” 5. Why would head lice occur in school-aged children? 6. What possible complications can occur as a result of failing to treat head lice? 7. What should your nursing actions include regarding A.P.’s classmates? 1. What are the most common presenting symptoms of a brain tumor? 2. Outline a plan of care for Z.O., describing at least two nursing interventions that would be appropriate for managing fluid status, providing preoperative teaching, facilitating family coping, and preparing Z.O. and his family for surgery. 5. Outline a plan of care that addresses common risks secondary to chemotherapy, describing at least two nursing interventions that would be appropriate for managing risks for infection, bleeding, dehydration, altered growth and nutrition, altered skin integrity, and body image. 6. The nursing assistive personnel (NAP) is in the room caring for Z.O. Which of these safety observations would you need to address? Explain your answer. On Day 10 after initiation of chemotherapy, you receive the following laboratory results: 7. Which of the lab results would you be concerned about, and why? 8. Discuss some of the emotional issues Z.O.’s parents will experience during the immediate postoperative period. 9. Z.O. has a 5-year-old sister. She has been afraid of visiting at the hospital because her “brother might die.” Discuss a preschooler’s concept of death and strategies to help cope with the illness of a sibling. 10. Postoperatively, Z.O. completed his initial course of chemotherapy. Now, 4 months later, he is experiencing new symptoms, including behavior changes and regression in speech and mobility. His tumor has recurred. The physician suggests hospice care to Z.O.’s parents. List some of the goals of hospice care for this patient and family. 1. Discuss additional health problems for which these patients are at risk and who on the craniofacial team would address each issue: 2. S.G. weighs 6.5 kg. Plot this finding on the Centers for Disease Control and Prevention (CDC) growth chart (see http://www.cdc.gov/growthcharts/data/set1clinical/cj41l018.pdf).Which of these statements best summarizes your findings? a. S.G. falls below the 5th percentile. b. S.G.’s weight is at or near the 25th percentile. c. S.G.’s weight is at or near the 75th percentile. 3. What information regarding her health history will you obtain from her mother? (Select all that apply and explain your rationale.) 4. Choose the labs/tests that you expect to be obtained preoperatively, and discuss the rationale for your choices. 5. What will you include in your preoperative teaching to S.G.’s parents? 6. Determine S.G.’s daily fluid maintenance requirements. How can her parents ensure this intake and determine adequate hydration status? 7. Mr. and Mrs. G. are advised that S.G. will return 6 months later for the palatoplasty. They are concerned about the delay between surgeries. What will your response be? S.G. returns to your unit 6 months later for her cleft palate repair (palatoplasty). 8. Which of these nursing interventions are appropriate as you plan her care? (Select all that apply, and explain why or why not.) a. Position patient side-lying or on abdomen postoperatively. b. Use elbow restraints as needed. c. Clear fluids; advance as tolerated. Patient may use a straw. d. Administer pain medications as ordered. 9. S.G. has a normal recovery and is being discharged. When giving her parents discharge instructions, what will you advise them concerning diet and signs and symptoms to report? 1. What additional information will you need to obtain from Mr. and Mrs. B.? 2. What would you include in your physical assessment of S.B.? 3. The emergency physician orders a complete blood count (CBC), complete metabolic profile (CMP), urinalysis (UA), blood pH, and x-rays. The physician suspects dehydration and metabolic alkalosis secondary to hypertrophic pyloric stenosis. Which of these lab findings would you expect with metabolic alkalosis? a. Na: 128 mEq/L, K: 2.6 mEq/L, Cl: 90 mEq/L, HCO3: 28 mEq/L b. Na: 130 mEq/L, K: 5.7 mEq/L, Cl: 94 mEq/L, HCO3: 22 mEq/L c. Na: 130 mEq/L, K: 3.9 mEq/L, Cl: 98 mEq/L, HCO3: 17 mEq/L d. Na: 148 mEq/L K: 4.1 mEq/L, Cl: 108 mEq/L, HCO3: 13 mEq/L 4. What is the underlying cause of S.B.’s diagnosis of metabolic alkalosis? 5. Which of these clinical manifestations might you find with metabolic alkalosis? (Select all that apply.) 6. What additional assessment findings might reflect the consequences of frequent prolonged vomiting in the infant? 7. S.B.’s parents are concerned that their living situation contributed to S.B.’s diagnosis. How would you respond to their concerns? 8. Mr. and Mrs. B. have questions about the necessity of surgery and question what is going to be done next. What are your responsibilities as you respond to Mr. and Mrs. B.’s concerns? 9. Which of these preoperative orders would you question? 10. Which of these interventions can be delegated to nursing assistive personnel (NAP)? (Select all that apply.) 1. What information should you receive from the post-anesthesia care unit (PACU) nurse? 2. How will you use this information in planning your immediate assessment and care of K.B.? 3. Prioritize the following orders from the most important (1) to the least important (9), and be prepared to explain the priorities you assigned. b. Neurologic checks every 2 hours c. Turn, cough, and deep breathe and incentive spirometer (IS) every 2 hours while awake d. Ice pack and elevate right lower extremity and right upper extremity e. Neurovascular checks every 1 hour g. IV fluids D5½NS at 100 mL/hr h. Morphine sulfate 5 mg IV every 4-6 hours prn 8. Which of these findings are early signs of compartment syndrome? (Select all that apply.) 9. You page the orthopedic surgeon. Use SBAR (situation, background, assessment, recommendation) to address patient status. 10. K.B.’s cast is split and her foot pulses are restored. K.B. and her parents are extremely anxious. What education and support will be provided to K.B. and her parents? 11. Recognizing her developmental and cognitive stage, which of these statements are appropriate as you explain her care on discharge? a. Adolescents are capable of thinking in concrete terms only. b. Adolescents are preoccupied with the immediate situation rather than future events. c. Adolescents can anticipate future implications of current decisions. d. Family acceptance is more important than peer acceptance. 12. The multidisciplinary team is made aware of K.B.’s progress in discharge rounds. How will you use the following disciplines? 1. What additional data should be obtained from J.R. and his parents? 2. Describe the pathophysiology of cystic fibrosis (CF). Be sure to address the multisystem component of this disorder. 3. Why is J.R. at risk for developing pulmonary infections? 4. What are the common microorganisms that cause respiratory infections in children with cystic fibrosis? 5. You review the drugs that have been ordered to treat J.R.’s suspected infection. What will you do before administering these drugs? 6. Use a nursing drug reference book to find the safe dosage ranges for the previously mentioned antibiotics, and calculate the dosage of each antibiotic J.R. will receive with the previous orders. Are the prescribed doses within the safe ranges? (Show all work.) 7. What factor will affect the selection of antibiotics and dosages? 8. You are reviewing the physician orders for respiratory care. Which of these nursing interventions would you expect to perform, and why? a. Administer aerosolized albuterol (a bronchodilator). b. Administer chest physiotherapy (CPT) before administering the bronchodilator. c. Monitor continuous pulse oximetry. d. Administer aerosolized Pulmozyme (dornase alfa) after administration of bronchodilator. e. Administer nebulized NS (normal saline). f. Administer antibiotic via JET nebulizer. 9. J.R.’s weight is below the 5th percentile. He has been on a high-calorie, high-protein diet at home; however, he reports that he hasn’t been hungry and really hasn’t been eating much. Describe the link between malnutrition and cystic fibrosis. 10. Which of these actions can be delegated to the nursing assistive personnel (NAP)? a. Charting daily weights and intake and output b. Instructing the parents on correct administration of normal saline nebulizers. c. Administering pancreatic enzymes from home supply with each snack. 11. Which of these strategies are appropriate to manage the GI dysfunction that patients with CF often experience? (Select all that apply.) a. Administer fat-soluble vitamins daily. b. Administer pancreatic enzymes with meals and snacks. d. Encourage a high-protein diet. e. Breastfeeding is contraindicated in infants with CF. 12. What clinical sign assists in determining the effective dosage of pancreatic enzymes? 13. Discuss the common GI disorders that children with CF might be prone to. 14. How can you foster his development while he is hospitalized? 15. J.R. is an adolescent and asks you, “Will I be able to have children when I grow up?” Your best response would be: a. “You should discuss this with your parents. I will let them know you asked.” b. “Most males have a significant chance of being sterile and you won’t need to consider use of contraception.” c. “Although nearly 95% of males are sterile, you can discuss this with your physician and family.” d. “CF does not affect the male reproductive system; however, it does affect the female reproductive tract.”
Pediatric Disorders
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Pediatric Disorders
