NURS 221 PEDS Test Prep Questions and Solutions with Rationale

  peds test - 75 topics 2 1. Idiopathic Thrombocytopenia Purpura ○ A hemorrhagic autoimmune disorder that causes excessive destruction of platelets ○ Symptoms → sometimes NO symptoms i. Purpura (easy/excessive bruising) & Petechiae ii. Bleeding from gums/nose/mucus membranes iii. Blood in urine or stool iv. Heavy menstrual flow & low PLT count ○ Causes → immune system attacking its own platelets, viral illness (flu/mumps) ○ Risk Factors → sulfa drugs, systemic lupus erythematosus, pregnancy, viruses ○ Diagnosis → CBC, blood smear, bone marrow exam (platelets are produced in the bone marrow) ○ Labs → Platelets will be below 20,000. Normal range = 150,000-450,000 INR, PT & PTT high ○ Treatment → Acute ITP resolves spontaneously within 6 months i. Corticosteroids ii. Discontinuation of meds known to cause ITP iii. Immunosuppressive agents & IV immune globulin iv. Splenectomy & Chemotherapy agents ○ Nursing Considerations i. Assess activities that increase risk for bleeding ii. Instruct client to avoid aspirin & NSAID’s = high risk drugs for bleeding iii. Taking any sulfa-based meds & any other PLT altering meds? iv. Avoid constipation & using dental floss, use soft- bristled toothbrush v. Instruct children about no contact sports, bike riding, skateboarding, climbing or running vi. Encourage quiet activities vii. Inform HCP if there is head or abdomen trauma ○ Signs of Improvement → PLT count of 100,000- 400,000 → A student nurse presents a conference on hematological disorders in children. The student nurse identifies which information should be included.. presentation about immune thrombocytopenia purpura (ITP)? Immune thrombocytopenia purpura is caused by excessive destruction of platelets. There is discoloration due to petechiae, and the bone marrow is normal. 2. Developmental Dysplasia of the Hip ● Definition → spectrum of conditions where there’s an abnormal relationship between the proximal femur & acetabulum. There are 3 forms: dysplasia, subluxation (mis-alignment of the vertebrae) & dislocation ● Signs & Symptoms ○ Asymmetrical skin folds (gluteal folds) ○ Galeazzi sign (shortening of limb on affected side) ○ Limited hip abduction & hip instability ○ Lordosis (curvature of the lumbar and cervical regions of the human spine) ○ Waddling gait ● Diagnostic Tests → Trendelenburg test (one leg up = opposite hip drops), XRAY, MRI, US ● Treatment ○ Pavlik harness (“overalls”), spica cast (legs) & surgical correction ● Nursing Care ○ Reassure parents that early, prompt treatment will probably result in complete correction 3 ○ Encourage parent to stay with child during his/her first few days in cast/harness ○ Spica Cast Treatment: keep cast dry & change child’s diapers often, turn Q2 & Q4 at night, check color, sensation & motion of child’s legs & feet ○ Give Benadryl if child complains of itching or cool blow dryer - Do NOT scratch with objects ○ Encourage parents to let child sit at a table, floor & play with other kids (socialize) ○ Watch for signs that the child is outgrowing the cast - cyanosis → The nurse cares for the 2-week-old infant diagnosed with developmental dysplasia of the hip (DDH). The nurse notes which finding is consistent diagnosis of DDH? Asymmetry of the gluteal folds. 3. Osteogenesis Imperfecta (Brittle Bone Disease) → inherited syndrome causing fractures & bone deformities, most common osteoporosis syndrome in children → bones become brittle ● Signs & Symptoms ○ Multiple fractures at birth & during childhood causing limb & spinal deformities ○ Mosaic pattern to the bones (puzzle like pieces) ○ Blue sclera of the eye ○ Dental deformities ○ Progressive hearing loss ● Treatment → NONE KNOWN, just focus on preventing & treating fractures ○ Prenatal US to detect disease in utero ○ Growth hormone to stimulate bone growth ○ Calcitonin to aid in bone healing ○ Bisphosphonates to increase bone mass ○ Surgery to correct fractures & place rods to correct deformities ○ Physical Therapy & moderate exercise to increase bone density ● Nursing Care → provide a safe, protective environment to minimize any trauma ○ Educate parents on how to help kids live a productive, safe life ○ Raise side rails up on cribs & beds to reduce falls ○ Remove objects on the floor that could cause tripping ○ Lifting children with care → What special instruction should you give to the parents? Reposition the child carefully 4. Meningitis → inflammation of the meninges due to either a virus or bacteria ● Signs & Symptoms → droplet precautions! ○ High fever, chills, malaise (fatigue) ○ Headache & vomiting ○ Stiff neck (nuchal rigidity) & exaggerated deep tendon reflexes ○ Positive Brudzinski’s sign → flexion of the neck produces flexion of the knees & hips ○ Positive Kernig’s sign → when patient lies with the hip flexed, the leg cannot be completely extended without pain ○ Photophobia ○ Skin lesions → rash to ecchymosis ○ Disorientation, confusion, delirium, deep stupor & coma ○ Seizures & ICP, brain stem herniation & eventual death ● Diagnostic Tests → Lumbar puncture - CSF will be cloudy ● Treatment → Antibiotics: PCNs, Cephalosporins & Vancomycin with Rifampin ○ Dexamethasone as adjunctive therapy with bacterial meningitis 4 ○ Supportive Care if viral ○ Digoxin to control arrhythmias ○ Mannitol to decrease cerebral edema ○ Anticonvulsant to treat seizures, Tylenol for HA & fever ○ Vaccination as prophylaxis for high risk groups - college kids, military, travelers ● Nursing Care → assess patient’s neuro status often! ○ Monitor fluid balance carefully to avoid fluid overload - I’s & O’s! ○ Turn patient often to prevent joint stiffness & neck pain ○ Quiet, comfortable, dark environment ○ Ensure that family members & others in contact are evaluated for post-exposure antibiotic prophylaxis → What should the RN do first with a child diagnosed with meningitis? Place on droplet precautions 5. Language Development → organized into language milestones ● Neonate → cries when upset, makes enjoyment sounds during meals ● 6 weeks → smiles to familiar voices, babbles ● 10 months → vocalizes one or two words ● 12 months → “mama” and “dada” ● 15 months → names common places/objects ● 18 months → scribbles ● 21 months → 300 word vocabulary, obeys easy commands ● 3 years → has 900 word vocabulary, uses sentences ● 4 years → 1500 word vocabulary ● 5 years → 2100 words The nurse monitors a 13-month-old for speech and hearing development. To better understand the child’s speech dev., its most important for nurse to ask the parents which question? Does your child say da, na, ya ya? 6. Retinoblastoma → rare, congenital malignant tumors found in the neural tissue of the retina which can cause blindness. 10% of cases are inherited & 90% arise spontaneously ● Signs & Symptoms ○ Abnormal white pupil (cat’s eye) ○ Strabismus (lazy eye) ● Diagnostic Tests→eye exams, CT, US, LP, liver & bone scans, MRI, bone marrow biopsy ● Treatment ○ Cryosurgery → freezing tumor cells to destroy them ○ Eye prosthesis ○ Photocoagulation to destroy the blood supply to the tumor ○ Radioactive applications sutured to the sclera to destroy the tumor ○ Chemotherapy ● Nursing Care → describe procedures & support parents decisions to remove childs eyes to save his or her life ○ Assess eye for bleeding and infection after surgery ○ Irrigate the empty eye socket with saline solution & apply antibiotic ointment before dressing changes ○ Help parents & child cope with partial or total blindness after surgery 5 Nurse performs an assessment on a 15-month old. The infant’s parents tells nurse that child has started to walk, is eating with a spoon, and builds a two-block tower. During the visit, the parent mentions that the toddler’s right eye sometimes “glows” which response by nurse is best? I will tell the HCP about your observation. 7. Oxygen Safety → NO candles, cigarettes, electric razors, hair dryers, electric blankets, heaters, flammable or oil-based products ● Be sure sign is posted in the room ● Used for patients who will not leave a facial mask or nasal cannula in place (oxygen hood) → Nurse cares for the infant receiving O 2 through an O 2 hood. Which observation requires an intervention by the nurse? Infant’s parent covers the infant with a brightly colored nylon blanket (nylon → static → spark → fire!) 8. Cohorting → (sharing a room) consider the epidemiology and mode of transmission of the infecting organisms. ● Place client with an infection in a private room or in a room with a client with a similar infection ● Private room if client has poor hygiene habits, contaminates the environment, or can’t assist in maintaining infection control precautions (e.g. infants, children, altered mental status client) ● Do not place a client diagnosed with an infectious process with a client who is immunocompromised, has open wounds, or has anticipated prolonged hospitalizations. Standard precaution → first level of precautions. Use to prevent transmission of nosocomial (hospital based) infections. ● Hand washing, use gloves, masks, eye protectors, face shields, gowns, linens, and patient care equipment. Transmission-based precautions → Second level. Used for patients with infectious diseases (known or suspected), which are spread by airborne route, droplets, or direct contact. → A pneumonia positive patient can share a room with what other type of patient? Another PNA+ patient 9. Head Injury: Infant → infant’s head is larger and heavier than other body parts and most likely to be injured; incomplete motor development contributes to falls; Head Injuries: ● Concussion (most common) ● Confusion ● Laceration ● Skull fractures RN Care for concussions, lacerations, and confusion: ● Have caregiver to observe for at least 6 hours for vomiting or change in LOC. ● If child falls asleep, awake every 1-2 hrs and assess for change in LOC ● Do not administer analgesics or sedative during observation period ● Check papillary reaction to light every 4 hours for 48 hours ● Notify health care provider immediately if child vomits more than three times, has papillary change, acts troubled or confused, or has a change in LOC RN care for Lacerations: ● Apply ice pack and pressure until bleeding is controlled ● Clean an open wound and use sterile dressing ● Assess need for stitches 6 Complications: ● Cerebral hemorrhage ● Cerebral edema ● Increased ICP (intracranial pressure) The nurse in the peds clinic assess a 12-month-old infant. The infant fell to the floor from a high chair. It is most important for the nurse to assess for which injury? Head injury 10. Diarrhea in Children → Rotavirus is the most common cause of diarrhea in young children. Signs and Symptoms: ● Frequent stools (i.e, two to ten bowel movements/say) often a green color ● Slight fever ● Abdominal pain ● Anorexia and weight loss (with severe diarrhea) ● Irritability ● Dry mucous membranes and loss of skin turgor ● Increased thirst ● Electrolyte imbalance Treatment: ● Oral rehydration therapy (e.g., Pedialyte, Oralyte, WHO formula) ● IV fluids if necessary ● Antibiotics Nursing Care: ● Tell parents not to use OTC remedies (i.e., loperamide [Imodium], kaolin and pectin [Kaopecate]) to treat diarrhea in children as they are too strong. ● Remind parents to wash their hands after changing diapers or wiping toddlers to prevent the spread of infection. ● Warn parents to call their healthcare providers if fever, abdominal pain, and diarrhea worsen ● Monitor intake and output, vital signs, electrolyte levels, and hydration status in hospitalized patients. ● Record the amount of liquid stool, and note the consistency and appearance of the stool, including the presence of blood or mucus. ● Monitor kidney function so that proper electrolyte replacement therapy is given. ● Follow standard precaution when handling with diarrhea so as not to spread infection. Expected Outcomes: ● Pediatric patient does not experience the untoward complications of dehydration; patient’s mucous membranes are moist, and skin turgor is normal. ● Pediatric patient feels less anxious now that his diarrhea is resolving, and his parents are more involved with care. ● Parents express an understanding of standard precautions in order to stop the spread of the diarrheal infection. Diagnostic Tests: ● Stool culture, to find offending organism ● Hemoglobin screen, to estimate hydration needs ● WBC count to establish the presence of infection ● Electrolyte level, to determine electrolyte needs (Note that K+ supplements are given only if the kidneys are working properly) 7 Nurse instructs the mother of the young child dx with moderate dehydration due to diarrhea. Nurse determines that teaching was successful if mother makes which statement? Offer child 1⁄2 cup of oral rehydration after each diarrheal stool 11. Type 1 Diabetes → (formerly referred to as juvenile diabetes or insulin-dependent diabetes) is a chronic disease characterized by absolute insulin insufficiency. ● Provide extra snacks if child engages in unplanned physical activity; most common cause of hypoglycemia is physical activity without food. Signs and Symptoms: ● 3 cardinal symptoms: polyuria, polydipsia, polyphagia ● Weakness and fatigue ● Iriritability ● Nocturia ● Dehydration ● Weight loss and hunger ● Vision changes ● Frequent skin and urinary tract infections ● Skin changes (cool temp, dry, itchy skin, especially on hands and feet) Treatment: ● Maintain/ restore glucose levels to within accepted range ○ Insulin therapy: must take insulin daily because their absolute insulin deficiency ○ Insulin dosages are based on home blood glucose monitoring ○ Insulin can be administered as one or two injections per day by insulin pump (SubQ) ● Meal planning and exercise to normalize carbohydrate, fat, and protein metabolism, and avert long- term complications while preventing hypoglycemia. Nursing Care: ● Emphasize that adherence to the treatment plan is crucial to bring child’s glucose level within an acceptable range (70-120). Alleviate or prevent DKA or hypoglycemia. ● For child with unstable diabetes who isn’t experiencing DKA, monitor glucose levels several times a day as prescribed till stable. ● Monitor for signs of DKA; suspect DKA and notify the doctor immediately if the child exhibits Kussmaul’s respirations, developes a fruity odor to breath, and shows s/s of severe dehydration ● DKA treatment: fluid and electrolyte replacement, increased insulin therapy, therapy to reduce acidosis, + IV insulin. ● Monitor for s/s of hyper and hypoglycemia ● Make sure child and parent understand that child should base the meal plan on a balanced diet on a balanced diet that incorporates the 6 basic food groups. ● Teach the child and fam about alternate snack ideas to find the child feel more like the peers since concentrated sweets are discouraged. ● Demonstrate blood sugar checks. The pediatric nurse instructs families of children dx with diabetes about the differences between hypoglycemia and hyperglycemia. Which info should the nurse include in the presentation? Hyperglycemia causes fruity breath odor 12. Pyloric Stenosis → Obstruction caused by hyperplasia (increased mass) and hypertrophy (increased size) of pylorus, seen soon after birth. 8 Signs and symptoms: ● Projectile vomiting ○ During or after feedings, despite indication of continued desire to nurse or feed from bottle ○ Vomit may be blood stained but not bile-stained (never reaches the small intestine) ● Weight loss ● Diminished stools ● Palpable olive-shaped tumor in epigastrium ● Peristaltic waves ● Distention of the upper abdomen ● Failure to thrive (poor weight gain) ● Malnutrition and dehydration despite adequate food intake Treatment: ● Pyloromyotomy ● Insertion of NG tube for gastric decompression RN Must: ● Preoperative Care- ○ Remind parents child should be NPO before surgery ○ Provide child age appropriate explanation of all tests, procedures, and surgery ○ Answer all parents questions ○ Monitor VS, I&O, to assess renal function and check for dehydration ○ Record amount of vomitus as well as its frequency, characteristics, and relation to feedings ○ Perform daily weight measurements on same scale to assess growth ○ Assess abdominal and cardiovascular status to detect early signs of compromise ○ Position child, preferably on his right side, to prevent aspiration of vomitus. ○ Correct fluid and electrolyte abnormalities. Monitor for alkalosis and hypokalemia ● Postoperative Care- ○ Feed child small amounts of oral electrolyte solution ○ Then increase amount and concentration of food until normal feeding is achieved ○ Burp child frequently during feedings ○ Provide a pacifier to maintain comfort and satisfy the infant’s sucking reflex ○ Monitor I&O ○ Keep incision area clean to prevent infection; clean with soap and water and keep the diapers content away from the incision ○ Position child on right side, allowing gravity to help flow of fluid through pyloric valve; elevate child’s head after feeding ○ Administer analgesics around the clock for pain management ○ Teach parents proper incision site care, and monitor s/s of infection and dehydration ○ monitor warmth small and frequent feeding of glucose water or electrolyte solution 4-6 hrs, if clear fluids retained then start formula 24 hours postoperative. Expected Outcomes: ● Patient is capable of consuming oral fluids w/o vomiting ● Patient has normal electrolyte balance ● Patient’s incision does not become infected ● Parent’s understand how to care for the surgical incision The nurse admits the infant suspected of having pyloric stenosis. During the nursing history, the nurse expects the parents to make which..? My baby has frequent projectile vomiting 9 13. Iron Supplements → (iron salts) increases availability of iron hemoglobin (HGB) Use: iron deficiency anemia Adverse Effects: ● Nausea ● Constipation ● Black or green stools Nursing Considerations: ● Monitor HGB and HCT ● Dilute liquid preparations in juice but not milk or antacids ● Administer iron dextran using Z-track method Client Education: ● Use straw for liquid preparations to avoid staining teeth ● Food decreases iron absorption but may be necessary to reduce GI effects. The nurse performs a well-baby assessment on the 10-month-old infant. The nurse should intervene if the mother makes which statement? My baby drinks about 40 oz. of cow’s milk each day 14. HIV/AIDS: Children 91% of children with AIDS were infected through perinatal transmission. Signs and Symptoms: lymphadenopathy, hepatosplenomegaly, Candida albicans stomatitis, chronic recurrent diarrhea, failure to thrive, developmental delays Treatment: antiretroviral drugs ● Zidovudine (Retrovir) ● Nucleoside reverse transcriptase inhibitors ● Non-nucleoside transcriptase inhibitors ● Protease inhibitors Combination of anti-AIDS drugs: ● Prophylactic doses of trimethoprim/sulfamethoxazole ● Isoniazid or rifampin ● Methotrexate (Folex) Misc: ● Routine vaccinations (including yearly influenza shot) help avoid common viral illnesses. ● Acyclovir and valacyclovir for chronic herpes outbreaks ● Nutritional supplements to prevent weight loss. Nursing considerations: scrupulous hand washing, instruct child and family about importance of hand-washing, do not allow children to be around persons who are infectious, restrict infected children who bite or do not have control of bodily function, provide high-calorie, high protein meals and snacks, monitor child’s weight and height, encourage child to participate in activities with other children, provide anticipatory guidance to the family because child has potentially fatal disease. The school nurse monitors the kindergarten-aged child dx with HIV. The school nurse should intervene if which finding is observed? The kindergarten teacher reports that the child bit another child 15. Hirschsprung Disease An extremely dilated colon caused by failure of development of the myenteric plexus of the rectosigmoid area of the large intestines. Indications: ◆ Chronic constipation abdominal distension ◆ ribbon-like stools Treatment: 10 ◆ ◆ Surgical (colostomy bag) Nursing considerations: preoperatively include enemas, diet low- fiber, high-calorie, and high protein, TPN (total parenteral nutrition) if needed, measure abdominal girth at level of umbilicus. Postoperatively, reassure parents that colostomy is temporary, provide stoma care. The peds nurse cares for the 4-year old admitted with a dx of hirschsprung disease. The nurse expects to find which s&s: Constipation, abdominal distension, ribbon-like stools 16. Neuroblastoma Malignant hemorrhagic tumor; primarily in infants and children; located in mediastinal and retroperitoneal area; composed of neuroblast cells that create sympathetic system and adrenal medulla. (tumor in the adrenal glands) Nurse cares for 18-month-old dx with stage IV neuroblastoma. During a discussion with the child’s parents, the parents shouts at the... “I have brought my child in for all checkups. The hcp should have found this sooner.” Which response by the nurse is most appropriate? You appear angry that this has happened to your child. 17. Blood Pressure Cuff cuff comes in six standard sizes, ranging from newborn to extra-large adult. Disposable cuffs available. Purpose: ◆ Sizing cuffs appropriately provide accurate readings Implementation: ◆ Correct reading relies on the ability to correct problems of blood pressure measurements regarding cuff sizes and placement. False High reading: ● Cuff to small ○ Ensure that cuff bladder is 20% wider than the circumference of the arm or leg being used for measurement. ● Cuff wrapped too loosely, reducing its effective width Ensure that cuff is tightened ● Cuff deflated too slowly, causing venous congestion in arm or leg Ensure that cuff is never deflated more slowly that 2mm Hg per heartbeat. False Low reading: ● Low-volume sounds inaudible ○ Before reinflating the cuff , instruct the pt. to raise his arm or leg to decrease venous pressure and amplify low-volume sounds ○ After inflating the cuff, instruct pt. to lower arm or leg. Then deflate the cuff and listen. If you still fail to detect low-volume sounds, chart palpated systolic pressure. Falsely elevated reading in pediatric clients: ● Cuff is too narrow ○ Bladder width of BP cuff should be approximately 40% of the arm circumference midway between the olecranon and the acromion. 11 Expected outcomes: ◆ Patient’s blood pressure reading is accurate due to appropriately sized cuff. ◆ Patient’s blood pressure is consistently normal. ◆ Patient understands the importance of maintaining healthy blood pressure, and is conscious of her diet, avoids prolonged stress, and is free from anxiety. ● Normal values: ○ Adults 18 ⇧: 90-140/60-90 ○ Child 5-12: 100-110/56-60 ○ Child 1-4: 90-99/60-65 ○ Newborn: 60-80/40-50 The nursing student cares for clients in the pediatric clinic. The nursing student reports to the nurse that a 12-year-old child has a bp of 150/... which response by the nurse is best? Please show me the bp cuff that you used 18. Glucagon Reverses hypoglycemia by stimulation hepatic production of glucose from glycogen stores to increase blood glucose level. Description of Glucagon ◆ Hormone produced by alpha cells of pancreatic islets ◆ Acts on the liver to promote glycogen breakdown and glucose release ◆ Is not effective if child’s supply of glycogen is depleted ◆ Available in prefilled syringes for immediate use ◆ Administered in the same way as insulin Hypoglycemia ◆ Symptoms occur with a blood glucose level of about 60mg/dL ◆ May result from administration of too much insulin, excessive exercise, or failure to eat enough food. ● Signs and Symptoms: ○ Lethargy, Hunger, Sweating, Pallor, Behavioral problems, Tremors, Seizures, Coma. Nursing Care: ◆ Follow and teach these guidelines to caregivers: ● Schedule blood glucose monitoring for early morning ● Upon recognition of the symptoms of hypoglycemia, provide immediate source of carbohydrates (about 15 grams of a fast-acting carb such as half-glass of orange juice or regular soda). ● If symptoms do not improve and blood glucose level has not risen 15mg/dL in 15 min, provide additional carb. ● If child is unable to cooperate to take oral sugar or is in a coma, administer a specified dose of glucagon subQ. It acts within minutes to restore consciousness. ● After glucagon takes action, provide child with a source of carb. School nurse administers glucagon IM to a child dx with type 1 Diabetes. The child immediately begins to... what action should the nurse take first? Contact the child HCP 1 2 19. Osteomyelitis is an infection of the bone caused by Staphylococcus aureus (MRSA) carried by blood from a soft tissue infection, bone surgery, trauma or a blood-borne infection. It may be chronic or acute. Signs and Symptoms: ◆ Fever, chills, malaise ◆ Septicemia ◆ Pain and swelling over infected area Treatment: ◆ IV antibiotic therapy (PNC, Cephalosporin) around the clock for 3-6 weeks, to control the infection before it gets walled off by new bone growth, forming an involucrum. ◆ Oral antibiotic therapy for 3 months after IV therapy. ◆ Immobilization of the affected area. ◆ Warm soaks, to increase circulation. ◆ Surgery, to expose and remove the abscess (debridement), to irrigate with a sterile saline solution, and to apply antibiotic beads to the wound. ◆ Amputation, to relieve pain and to avoid months in hospital with therapy-resistant chronic osteomyelitis. ◆ High protein diet with sufficient carbohydrates, vitamins and minerals Nursing Care: ◆ Follow strict sterile technique when changing dressings and irrigating wounds. ◆ Administer IV fluids to maintain adequate hydration, and provide a diet high in protein and vitamin C. ◆ Assess vital signs and wound appearance every 4 hours. ◆ Support affected limb with pillows, keeping above body level. ◆ Provide good skin care, turning pt. every two hours watching for signs of pressure ulcers. ◆ Check circulation and drainage every 4 hours for the first 24 hours post op. And report excessive drainage or signs of neurovascular deficits. ◆ Report sudden pain, crepitus, or malposition of the limb, indicating a fracture. ◆ Protect pt. from jerky movements or falls that threaten bone integrity. ◆ Evaluate pt. for pain relief or pain control. ◆ Instruct pt. on how to recognize a recurring infection, encourage them to keep all follow-up appointments, and warn them to seek immediate attention if the infection returns. Expected Outcomes: ◆ Pt. experiences minimal pain with meds. ◆ Pt. does not develop new sites of infection or neurovascular deficits. ◆ Pt. is compliant with oral antibiotic therapy after discharge, and does not report and recurrences of infection. ◆ Pt. returns to normal function after treatment. The nurse cares for the 7-year-old child dx with osteomyelitis of the right arm. Which finding would the nurse expect to observe? Child holds right arm in a semi-flexed position 20. Down Syndrome/Trisomy 21 ● Genetic Disorder/ mental retardation ● Three copies of chromosome 21 instead of 2 ● Most common in mothers over 35 13 ● 3 types: most common- Trisomy 21, Mosaicism & Translocation ● Separated sagittal suture, slanted eyes looking upward and outward, small nose with depressed nasal bridge, muscle weakness ● hypotonia at birth ● Simian crease; single crease along palm of hand → The nurse cares for the infant diagnosed with Down syndrome and the nurse discusses Down syndrome with the parents.The nurse thinks further instruction is required if the infant’s mother makes what statement? There is a greater risk of having a child with ds if the mother is under the age of 35. 21. Car Seat Safety ● Rear facing seats should be used until 2 years of age ● Front facing used until 4 years of age or 40 pounds ● Booster seat 4 years until 12 years or height 4'9" ● Seat belt should be used Question: The nurse instructs parents about car safety for infants. It is most important for the nurse to include which piece of info in the presentation? Answer: Infant should be in a rear-facing car seat. 22. Constipation in School-Aged Children ● typically due to fear of using school bathrooms ● Nursing considerations: encourage regular toiling, encourage high fiber diet, and exercise Question: The nurse in the peds clinic counsels the mother of a 6-year old who has developed new-onset constipation. Which is the most common reason new-onset constipation in a 6-year old? Answer: Beginning school 23. Nephrotic Syndrome