Pediatric Emergency Nursing Quiz #6

1. The adolescent patient has symptoms of meningitis: nuchal rigidity, fever, vomiting, and lethargy. The nurse knows to prepare for the following test:

Blood Culture

Throat and Ear culture

CAT scan

Lumbar puncture

Meningitis is an infection of the meninges, the outer membrane of the brain. Since it is surrounded by cerebrospinal fluid, a lumbar puncture will help to identify the organism involved.

Explanation

Meningitis is an infection of the meninges, the outer membrane of the brain. Since it is surrounded by cerebrospinal fluid, a lumbar puncture will help to identify the organism involved.

2. When administering an I.M. injection to an infant, the nurse should use which site?

Deltoid

Dorsogluteal

Ventrogluteal

Vastus lateralis

The recommended injection site for an infant is the vastus lateralis or rectus femoris muscles. The deltoid is inappropriate. The dorsogluteal and ventrogluteal sites can be used only in toddlers who have been walking for about 1 year.

Explanation

The recommended injection site for an infant is the vastus lateralis or rectus femoris muscles. The deltoid is inappropriate. The dorsogluteal and ventrogluteal sites can be used only in toddlers who have been walking for about 1 year.

3. A child is diagnosed with Wilms' tumor. During assessment, the nurse expects to detect:

Gross hematuria

Dysuria

Nausea and Vomiting

An abdominal mass

The most common sign of Wilms’ tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms’ tumor. Nausea and vomiting are rare in children with Wilms’ tumor.

Explanation

The most common sign of Wilms’ tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms’ tumor. Nausea and vomiting are rare in children with Wilms’ tumor.

4. Which of the following organisms is responsible for the development of Rheumatic fever?

Streptococcal pneumonia

Haemophilus influenza

Group A β-hemolytic streptococcus

Staphylococcus aureus

Group A β-hemolytic streptococcus can cause strep throat, and if untreated, can cause Scarlet fever, which in turn can lead to Rheumatic fever. Rheumatic fever is an inflammatory condition that can affect the heart, joints, skin and brain. It usually occurs 2-4 weeks after the diagnosis of strep throat, impetigo or scarlet fever. It can thicken the heart valves and lead to heart failure, while in the joints causes pain and swelling.

Explanation

Group A β-hemolytic streptococcus can cause strep throat, and if untreated, can cause Scarlet fever, which in turn can lead to Rheumatic fever. Rheumatic fever is an inflammatory condition that can affect the heart, joints, skin and brain. It usually occurs 2-4 weeks after the diagnosis of strep throat, impetigo or scarlet fever. It can thicken the heart valves and lead to heart failure, while in the joints causes pain and swelling.

5. Sunshine, age 13, has had a lumbar puncture to examine the CSF to determine if bacterial infection exists. The best position to keep her in after the procedure is:

Prone for two hours to prevent aspiration, should she vomit.

Semi-flowler's so she can watch TV for 4 hours and be entertained.

Supine for several hours to prevent headache.

On her right side to encourage return of CSF.

Lying flat keeps the patient from having a “spinal headache.” Increasing the fluid intake will assist in replenishing the lost fluid during this time.

Explanation

Lying flat keeps the patient from having a “spinal headache.” Increasing the fluid intake will assist in replenishing the lost fluid during this time.