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Sunday, August 3, 2008

Free Nclex Review Questions 5 (Nclex Exams)

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In ventricular septal defects, some defects may close spontaneously. If spontaneous closure does not occur, moderate or large defects require surgical closure before school age. If pulmonary hypertension is present, closure is necessary by age 1 year. Open-heart surgery is done for closure.

The MMR vaccine is contraindicated for children who have had an anaphylactic reaction to eggs or neomycin. Immunosuppression from corticosteroids, a low-grade fever, and TB skin testing are not contraindications for the MMR vaccine.

Activity guidelines for children with hemophilia are categorized into those that are usually safe, those that are riskier and should be discouraged, and those in which the risks outweigh the benefits and are not recommended for children with hemophilia. Archery, badminton, fishing, golf, hiking, Ping-Pong, swimming, and walking are usually considered safe for those with hemophilia.

The primary clinical manifestations of von Willebrand’s disease are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract. Prolonged bleeding after trauma and surgery, including tooth extraction, may be the first evidence of abnormal hemostasis in those with mild disease. In female clients, menorrhagia and profuse postpartum bleeding may occur. Bleeding associated with von Willebrand’s disease may be severe and lead to anemia and shock, but unlike the situation in hemophilia, deep bleeding into joints and muscles is rare.

Desmopressin acetate (DDAVP) is prescribed via intranasal route for a child with von willebrand's disease and parents should be instructed to monitor intake and output and to avoid overhydration, but fluids should not be restricted. The medication should be refrigerated, but freezing should be avoided. Side effects include facial flushing, nasal congestion, increased blood pressure, nausea, abdominal cramps, decreased urination, and vulval pain. Signs and symptoms of water intoxication include headache, drowsiness, confusion, weight gain, seizures, and coma.

Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn’t clot as it should. This is due to a low number of blood cells called platelets

The laboratory manifestations of Idiopathic thrombocytopenic purpura (ITP) include the presence of a low platelet count of usually less than 50,000 cells/mm3. Thrombocytopenia is the only laboratory abnormality expected with ITP. If significant blood loss has occurred, evidence of anemia will be found in the complete blood cell count (CBC). If a bone marrow examination is performed, the results with ITP show a normal or increased number of megakaryocytes, the precursors of platelets. Also, with ITP, the bone marrow examination rules out aplastic anemia, leukemia, the presence of malignant tumors, and other bone marrow disorders.

In leukemia, bone marrow examination would indicate an increase number of immature white blood cells

Infant after a sugrgical procedure for insertion of a ventricular peritoneal shunt. If a shunt is malfunctioning, the fluid from the ventricle part of the brain will not be diverted to the peritoneal cavity. The cerebrospinal fluid will build up in the cranial area and result in intracranial pressure, which then causes the infant to cry. The cry is high-pitched. The infant should not have pressure placed on the shunt side. Skin breakdown and possible complications to the apparatus could result. This type of shunt affects the gastrointestinal system but not the genitourinary system.

Infants who weigh up to 20 pounds should be restrained in a car seat in a semireclined, rear-facing position to allow the seat and infant's spine to bear the forces of impact should a collision occur. The infant should never face forward or ride in the front seat.

To decrease the risk of recurrent otitis media, the mother should be encouraged to breastfeed during infancy and to discontinue bottle-feeding as soon as possible. The infant also is fed in an upright position and should never be given a bottle while in bed. The mother also is instructed not to smoke in the child’s presence, because passive smoke increases the risk of otitis media.

Myringotomy is a surgical procedure in which a tiny incision is created in the eardrum, so as to relieve pressure caused by the excessive buildup of fluid

After a myringotomy with insertion of tympanostomy tubes, The mother should be assured that if the tympanostomy tubes fall out, it is not an emergency, but it is best if the physician or health care clinic is notified. The size and appearance of the tympanostomy tubes should be described to the mother after surgery so she will be familiar with the appearance.

After tonsillectomy, suction equipment should be available, but suctioning is not performed unless an airway obstruction occurs. Clear cool liquids are encouraged. Milk and milk products are restricted initially because they coat the throat, causing the child to clear the throat, increasing the risk of bleeding.

A pelvic sling is a traction device consisting of a hammock-like belt wherein the sling cradles the pelvis in its boundaries. It is used for the treatment of one or more pelvic fractures.

Getting out of bed in the morning is often a difficult task for a child with JRA because of the early morning stiffness that occurs. A warm morning bath is helpful, but this may be impractical for busy families. A warm bath at bedtime may provide comfort and assists in aiding sleep but will not prevent the morning stiffness. The nurse should suggest that the child use a sleeping bag at night to stay warm, use an electric blanket with a timer that turns on 1 hour before the child awakens, or sleep in a water bed to ease the stiffness.

Indoor swimming is frequently recommended as an ideal sport for children with asthma because the air is humidified. Exhaling underwater prolongs exhalation and increases end-expiratory pressure. With adequate treatment, however, a child with asthma can participate in most physical activities.

Nose drops are most helpful when administered 15 minutes before feeding and at bedtime. The parents are instructed to instill two nose drops and wait 5 minutes before instilling more drops, if prescribed, to increase effectiveness. Parents should be cautioned against using nose drops for more than 3 days. The vasoconstrictive effect of the decongestant nose drops can cause rebound congestion. Cough suppressants are not recommended because they impair removal of secretions, thus increasing the risk of secondary infection.

Children should wear long pants, long-sleeved shirts, and hats when in wooded or grassy areas. Ticks should be removed with tweezers and should be removed as close to the skin as possible. Repellants should be used with caution and should not be applied to the hands to avoid contact of the repellant with the child’s eyes and mouth. Pets should be kept free of ticks during tick season. If a tick falls off a pet, it can travel and make contact with an individual and attach to the individual’s skin.

In children with mild or moderate diarrhea older than 2 years, the mother should be instructed to give foods high in starch, such as breads, crackers, rice, mashed potatoes, and noodles, because these are easily absorbed during periods of diarrhea. Clear liquids are encouraged, and milk and milk products should be eliminated except for active culture yogurt, which containslactobacillus organisms. Raw fruits and vegetables, beans, spices, and any other foods that cause loose stools should be avoided.

The purpose of Crutchfield tongs is to stabilize fractures or displaced vertebra in cervical and thoracic areas. Tongs are inserted on the sides of the scalp through drill holes. Traction pull is always along the axis of the spine. The nurse should check the tongs every 8 hours and prn for displacement and looseness. The child can be repositioned by log-rolling or turned as a unit when repositioning. Neurological status should be checked frequently in the first 24 hours because spinal cord injury frequently accompanies this type of injury. Pin care is done every shift.

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Fans can be directed toward the cast to facilitate drying. Ice can be applied to the casted area, and the casted extremity should be elevated with pillows to prevent swelling. The fingers of the casted extremity should be the same color and temperature as on the other extremity. When assisting with bathing and showering, the mother should be instructed to cover the cast to keep the cast dry.

Rheumatic fever characteristically is first seen 2 to 6 weeks after an untreated or partially treated group A b-hemolytic streptococcal infection of the respiratory tract. Initially on assessment, the nurse determines whether any family member has had a sore throat or unexplained fever within the past few weeks

When the child is receiving chemotherapy, the nurse should avoid taking rectal temperatures. Oral temperatures also are avoided if mouth ulcers are present. Axially temperatures should be done to prevent alterations in skin integrity. Meticulous mouth care should be performed, but the nurse should avoid alcohol-based mouthwash and should use a soft-bristled toothbrush. The nurse should assess the mouth and anus each shift for ulcers, erythema, or breakdown. Bland, nonirritating foods and liquids should be provided to the child. Fresh fruits and vegetables should be avoided because they can harbor organisms. Chemotherapy can cause neutropenia, and the child should be maintained on a low-bacteria diet if the white blood cell count is low.

Impetigo is a bacterial skin infection characterized by blisters that may itch.

If impetigo is caused by B-hemolytic streptococci, the child should be observed for periorbital edema or blood in the urine, which may signal the development of acute glomerulonephritis.

With a fungal infection of the foot, the client should be instructed to wash the feet daily and keep them dry. Nonventilated athletic shoes should be allowed to dry thoroughly between wearing. If socks are needed, the child should wear heavy cotton socks and change the socks at least twice a day. The heavy cotton socks will absorb sweat and keep the feet dry. The child should avoid wearing socks, if possible, and wear sandals as much as possible. Talcum powder or antifungal powder applied twice daily may help keep the feet dry.

Antilice sprays are unnecessary and should never be used on a child. Combs and brushes should be boiled or soaked in antilice shampoo or water hotter than 140° F for 15 minutes. Bedding and linens should be washed with hot water and dried on a hot setting. Items that cannot be washed should be dry-cleaned or sealed in plastic bags and placed in a warm place for a period of 3 weeks. Thorough home cleaning is necessary to remove any remaining lice or nits. Parents should vacuum floors, play areas, and furniture to remove any hairs that may carry live nits.

The suctioning procedure for pediatric clients varies from that which is used in adults. Suctioning in infants and children requires the use of a smaller suction catheter and lower suction settings than in the adult. Suction settings for preterm infants is 40 to 60 mm Hg. The settings for an infant or child are 60 to 100 mm Hg.

Applying suctioning when inserting the catheter can cause trauma to tissues and should not be done. Intermittent suctioning is applied when withdrawing the catheter.

Oxaprozin (Daypro) is a nonsteroidal antiinflammatory medication that is used to treat acute and chronic osteoarthritis and rheumatoid arthritis.

Enuresis refers to a condition in which the child is unable to control bladder function, although he or she has reached an age at which control of voiding is expected. Children who have never been dry at night for prolonged periods are said to have primary nocturnal enuresis.

The vastus lateralis muscle is the best choice for intramuscular injections for all age groups and should always be used in children younger than 3 years. The ventrogluteal muscle is safe for children older than 18 months because it is free of major blood vessels and nerves. The dorsogluteal muscle develops with walking, so it should not be used until the child has been walking for at least 1 year. The deltoid muscle is not used in children because the small muscle mass cannot hold large volumes of medication or medications that must be injected deep into the muscle mass.

Intradermal injections are placed just below the outer layer of the skin in the epidermis. The sites most often used are the inner aspect of the forearm and the upper back. The needle is small (25 to 27 gauge) and short (1/2 to 5/8 inch). The volume also is small, usually 0.1 mL. The needle is inserted at a 15-degree angle, and the medication is injected to form a wheal.

Breast milk or formula provides all the nutrients required for growth for the first 6 months. Whole milk is not recommended for the first year. Cereals and baby food are not recommended before 4 to 6 months because they are difficult to digest and may lead to allergies. Frequency of feeding is individual, the average being every 4 to 6 hours by age 6 months.

Congenital hypothyroidism may have a number of causes and can be either permanent or transient. Congenital hypothyroidism may be caused by an embryonic defect in the development or placement of the thyroid gland or inborn errors of thyroid hormone synthesis, secretion, or utilization. Genetic counseling may be needed because an inborn error of thyroid hormone synthesis is an autosomal recessive trait. Transient primary hypothyroidism is often caused by a maternal ingestion of medication during pregnancy such as iodides for asthma, antithyroid medications, or maternal antibodies.

An infant that has adjusted to drug withdrawal is calm and quiet and interacts with caregivers or the parents. If the infant remains distressed when exposed to light or noise, or if the infant is not exhibiting weight gain appropriately, drug withdrawal is not complete.

Prednisone dosage needs to be maintained at the prescribed levels, and dosage adjustments are made only by the physician. To prevent withdrawal syndrome, doses are gradually reduced and are never abruptly stopped or started.

Fluid restrictions are needed to prevent fluid overload and complications of cerebral edema and increased ICP. Sitting up will decrease fluid retention in cerebral tissue and promote drainage. Keeping the child awake will assist in the accurate evaluation of cerebral edema that may be present and will detect early development of ICP. Pupil checks are part of a neurological examination. The parent can explain the pupil checks to the child. Preparing the child for this procedure will decrease anxiety about this testing.

The diagnosis of bacterial endocarditis is established primarily on the basis of a positive blood culture of the positive organisms and visualization of a vegetation on echocardiographic studies. Other laboratory tests that may help to confirm the diagnosis are an elevated sedimentation rate and C-reactive protein level. An ECG and EEG are not helpful in the diagnosis of bacterial endocarditis. Changes in the white blood cell count can occur in a variety of conditions and are not specific to bacterial endocarditis.

Measures that will decrease the workload on the heart include limiting the time the child is allowed to bottle-feed or nurse, elevating the head of the bed, allowing uninterrupted rest periods, and providing oxygen during stressful periods.

Platelets are necessary for the clotting of blood. Therefore a decreased number would promote bleeding tendencies. Decreased erythrocytes may indicate that the bone marrow function is decreased. A decreased white blood cell count is not necessarily related to bleeding. Decreased eosinophils indicate a decrease in an allergic reaction.

The glycosylated hemoglobin measures the glucose molecules that attach to the hemoglobin A molecules and remain there for the life of the red blood cell, which is approximately 120 days. This is not reversible and cannot be altered by human intervention. Daily glucose logs are useful if they are kept regularly and accurately. However, they reflect the blood glucose only at the time the test was done. A fasting blood glucose is time limited in its scope, as is the dietary history.



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