PEDDIATRIA A A A
The nurse planning teaching for the parents of a child newly diagnosed with hemophilia will include information about which long-term complication? 1.Heart valve injury [33%] 2.Intellectual disability [3%] 3.Joint destruction [54%] 4.Recurrent pneumonia [8%]
Explanation: Hemophilia is a bleeding disorder caused by a deficiency in coagulation proteins. Clients with classic hemophilia, or hemophilia A, lack factor VIII. Clients with hemophilia B (Christmas disease) lack factor IX. When injured, clients with hemophilia should be monitored closely for external as well as internal bleeding. The most frequent sites of bleeding are the joints (80%), especially the knee. Hemarthrosis can occur with minimal or no trauma, with episodes beginning during toddlerhood when the child is active
and ambulatory. Over time, chronic swelling and deformity can occur.
(Option 1) Heart valve injury is common with rheumatic heart disease not hemophilia.
(Option 2) Intellectual disability in children is commonly seen with fetal alcohol syndrome,
Down syndrome, hypothyroidism, and lead poisoning. In rare cases, hemophilia can cause life-threatening intracranial bleeding. However, isolated intellectual disability is not seen.
(Option 4) Recurrent pneumonia is commonly seen with cystic fibrosis not hemophilia.
Educational objective:
Clients with hemophilia are at risk for permanent joint destruction due to frequent bleeds into the joint spaces. Assisting clients with decreasing the incidence of bleeding episodes and prompt treatment when bleeding occurs can help minimize joint destruction.
A A A
The clinic nurse supervises a graduate nurse who is teaching the parents of a 2-year-old with acute diarrhea about home management. The nurse would need to intervene when the graduate nurse provides which instruction? 1."Do not administer antidiarrheal medications to your child." [26%] 2."Follow the bananas, rice, applesauce, and toast diet for the next few days." [32%] 3."Record the number of wet diapers and return to the clinic if you notice a decrease." [28%] 4."Use a skin barrier cream such as zinc oxide in the diaper area until diarrhea subsides." [12%]
Explanation: During bouts of acute diarrhea and dehydration, treatment focuses on maintaining adequate fluid and electrolyte balance. The first-line treatment is oral rehydration therapy, using oral rehydration solutions (ORSs) to increase reabsorption of water and sodium. Even if the diarrhea is accompanied by vomiting, ORS should still be offered in small amounts at frequent intervals. Continuing the child's normal diet (solid foods) is encouraged as it shortens the duration and severity of the diarrhea. The BRAT (bananas, rice, applesauce, and toast) diet is not recommended as it does not provide sufficient protein or energy.
(Option 1) Use of antidiarrheal medications is discouraged as these have little effect in controlling diarrhea and may actually be harmful by prolonging some bacterial infections and causing fatal paralytic ileus in children.
(Option 3) Parents should be taught to monitor their child for signs of dehydration by checking the amount of fluid intake, number of wet diapers, presence of sunken eyes, and the condition of the mucous membranes.
(Option 4) Protecting the perineal skin from breakdown during bouts of diarrhea can be accomplished by using skin barrier creams (eg, petrolatum or zinc oxide).
Educational objective:
When a child is experiencing acute diarrhea, the priority is to monitor for dehydration. Treatment is accomplished with oral rehydration solutions and early reintroduction of the child's normal diet (usual foods).
A A A
The mother of a 6-year-old child with cystic fibrosis (CF) has received instruction on the use of pancreatic enzymes. Which statement made by the mother indicates a need for further teaching? 1."I need to monitor the total amount of this medication that I give to my child every day." [6%] 2."I should give this medication with or just before my child has a meal or snack." [10%] 3."It is okay for my child to chew this medication." [61%] 4."It is okay to open the capsule and sprinkle the medicine on a tablespoon of applesauce." [21%]
Explanation: In CF, unusually thick mucus obstructs the pancreatic ducts, preventing pancreatic enzymes (amylase, trypsin, and lipase) from reaching the small intestine. The result is malabsorption of carbohydrates, fats, and proteins; the inability to absorb fat-
soluble vitamins (A, D, E, and K) is of particular concern. Gastrointestinal signs and symptoms of CF include flatulence, abdominal cramping, ongoing diarrhea, and/or steatorrhea.
Nutritional therapy includes the administration pancreatic enzyme supplements with or just before every meal or snack (Option 2). These enzymes are enteric-coated beads designed to dissolve only in an alkaline environment similar to that of the small intestine. They must not be mixed with a substance that would cause them to dissolve prior to reaching the jejunum. Capsule contents may be sprinkled on applesauce, yogurt, or acidic, soft, room-temperature foods with pH <4.5. Capsules should be swallowed whole and not crushed or chewed; chewing the capsules could cause irritation of the oral mucosa. Excessive intake of pancreatic enzymes can result in fibrosing colonopathy (Option 1).
(Option 4) This is a true statement; some children have difficulty taking a whole capsule. Capsule contents can be sprinkled in acidic substances such as applesauce. Capsules should not be taken with milk as they can cause it to curdle.
Educational objective:
Pancreatic enzyme supplements are used to aid the absorption of carbohydrates, fats, and proteins in a child with CF. They are taken with or just before every meal (not as needed); should be swallowed whole or sprinkled on an acidic food; and should not be crushed or chewed. They should not be taken with milk. Excessive intake could result in fibrosing colonopathy.
A A A
An 8-month-old infant is scheduled for a balloon angioplasty of a congenital pulmonic stenosis in the cardiac catheterization laboratory. Which finding should the nurse report to
the health care provider (HCP) that could possibly delay the procedure? 1.Auscultation of a loud heart murmur [8%] 2.Infant has been NPO for 4 hours [9%] 3.Infant has polycythemia [52%] 4.Infant has severe diaper rash [29%]
Explanation: The presence of severe diaper rash should be reported to the HCP . This could potentially delay the procedure if the rash is in the groin area where access is planned for arterial cannulation. Candida, yeast, or bacteria may be present on the rash and could be introduced into the bloodstream with the arterial stick.
(Option 1) A loud heart murmur can be an expected finding in a child with pulmonic stenosis.
(Option 2) Children are allowed nothing by mouth for 4-6 hours or longer before the procedure. Younger children and infants may have a shorter period of NPO status and should be feed right up to the time recommended by the HCP .
(Option 3) Infants and children with polycythemia may need IV fluids to prevent dehydration and hypoglycemia. Polycythemia will not cause a delay in the procedure.
Educational objective:
The nurse should report the presence of severe diaper rash to the HCP in an infant who has an interventional catheterization procedure planned. If the rash is near the groin area, the procedure may be delayed due to possible contamination at the insertion site.
A A A
When monitoring an infant with a left-to-right-sided heart shunt, which findings would the nurse expect during the physical assessment? Select all that apply. 1.Clubbing of fingertips 2.Cyanosis when crying 3.Diaphoresis during feedings 4.Heart murmur 5.Poor weight gain
Explanation: Congenital heart defects that cause blood to shunt from the higher pressure left side of the heart to the lower pressure right side (eg, patent ductus arteriosus, atrial septal defect, ventricular septal defect) increase pulmonary blood flow.
Left-to-right shunting results in pulmonary congestion, causing increased work of breathing and decreased lung compliance. Compensatory mechanisms (eg, tachycardia,
