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Ati nur2708 paediatrics final exam
Total Questions : 51
Showing 10 questions, Sign in for more11-month-old infant reportedly fell down a flight of stairs from the porch
to the sidewalk.
CT scan shows small subdural hematoma.
Admit for close observation.
Admission:
Axillary temperature 37.1° C (98.8° F)
Apical heart rate 104/min
Respiratory rate 26/min
Oxygen saturation 98% on room air
4 hr later.
Axillary temperature 38.2° C (100.8° F)
Apical heart rate 124/min
Respiratory rate 22/min
Oxygen saturation 96% on room air
Admission note: Infant alert and fussy in guardian's arms. Moves all extremities. Edema and ecchymosis noted on left side of scalp. Anterior fontanel level and soft. Pupils equal and react briskly to light.
4 hr later. Infant sleeping in guardian's arms. Guardian reports they are unable to wake the infant to feed them. Infant slept through vital sign assessment.
A nurse is caring for an infant in the emergency department.
This 11-year-old was diagnosed 2 years ago with tonic-clonic seizure disorder. Three months ago, neurologist changed the child's antiepileptic medications to include Phenytoin due to increasing number of seizures per guardian.
The child has a 1-year history of mild exercise induced asthma for which they were prescribed a rescue inhaler of albuterol prn.
1030:
Complete Blood Count:
WBC count 8,500/mm3 (5,000 to 10,000/mm)
RBC count 4.2 (4.0 to 5.5)
Hemoglobin 11 g/dL (10 g/dL to 15.5 g/dL)
Hematocrit 40% (32% to 44%)
Platelet count 216,000/mm3 (150,000 to 400,000/mm3)
Phenytoin Level: 6 mcg/mL (10 to 20 mcg/mL)
Liver Enzymes:
Alanine aminotransferase (ALT) 32units/L (4 to 36 units/L)
Alkaline phosphatase (ALP) 240units/L (60 to 300 units/L)
Aspartate aminotransferase (AST) 44units/L (10 to 50 units/L)
Albumin 4.1 g/dL (4 to 5.9 g/dL)
Total protein 6.5 (6.2 to 8g/dL)
Direct bilirubin 0.3 mg/dL (0.1 to 0.3 mg/dL)
Indirect bilirubin 0.8 mg/dL (0.2 to 0.8 mg/dL)
0900:
Temperature 36.8° C (98.2° F)
Heart rate 80/min
Respiratory rate 22/min
Blood pressure 116/78 mm Hg
SaO2 is 94% on room air
0900:
The 11-year-old child is being seen today in the provider's office. The child and guardian report that the child has a harsh non-productive cough that is worse when they are outside playing with their friends and during the night. The child reports noticing this cough getting worse during their youth camp stay about 1 month ago and at times feels short of breath during these coughing episodes. The guardian also reports that the child has had 3 seizures over the past week. The last one was yesterday morning. It was a tonic-clonic and lasted about 2 minutes. No intervention was needed. These are the first seizure activity the child has had since being given the phenytoin.
Child is alert and oriented. Afebrile. Mucus membranes are moist. Respirations are easy and regular. Upon auscultation a slight end expiratory wheeze is noted bilaterally in the bases of the lung. Abdomen is soft and nondistended. No tenderness or masses noted upon palpation.
Noted a dry, hyperpigmented, patchy, areas of skin in the antecubital area of both arms. Child reports they are very itchy. Scratch marks and dried blood is noted in these areas.
0930:
Venous blood drawn and sent to lab per provider's prescription.
The client is at risk for developing
Explanation
Stevens-Johnson syndrome: This is a serious skin reaction that can be triggered by medications such as phenytoin. The child has reported itchy, hyperpigmented patches with scratch marks and dried blood, which raises concern for a drug-induced skin reaction.
Skin rash: The presence of a skin rash, particularly one that is itchy and may be associated with recent medication changes, warrants close monitoring for potential development of Stevens-Johnson syndrome.
The nurse is teaching a group of parents about signs of depression in adolescents. Which statement by a parent indicates the need for further education?
A home health nurse is developing a plan of care for a child who has hemiplegic cerebral palsy. Which of the following goals is the priority for the nurse to include in the plan of care?
A nurse is caring for an adolescent who has spina bifida and is paralyzed from the waist down. Which of the following statements by the client should indicate to the nurse a need for further teaching?
A nurse is teaching a school-age child who has type 1 diabetes mellitus and their parents about management during an illness. Which of the following instructions should the nurse include? (Select All that Apply.)
A nurse is caring for an adolescent client who has a newly applied fiberglass cast for a fractured tibia. Which of the following is the priority action for the nurse to take?
An adolescent client has just been diagnosed with systemic lupus erythematosus (SLE). Following client education about the disease, which statement by the client demonstrates understanding of SLE?
A nurse is caring for a child who has a suspected diagnosis of bacterial meningitis. Which of the following actions is the nurse's priority?
A nurse in the emergency department is caring for a 10-year old child who has extensive partial and full-thickness burns of the head, neck, and chest. While planning the client's care, the nurse should identify which of the following risks as the priority for assessment and intervention?
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