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‫كلية التمريض‬
‫ األول‬:‫الدراسي‬
‫ تمريض حاالت حرجة أطفال‬:‫المادة‬
Critical Pediatric Nursing
‫ الثالثة‬: ‫الفرقة‬
‫ ساعات‬3 :
‫رحاب هانىء القزاز‬.‫د‬
‫ نبيله حسن على عبدالال‬.‫د‬.:‫المادة‬
QI: Choose the correct answer: Only one choice (25 marks)
1. Congenital anomalies of the genitourinary system includes
a. Hiatus Hernia
b. Chalasia of the Esophagus
c. Hydrocele
d. Wilm’s Tumor
2. which of the following disease in children needs bone marrow transplantion
Aplastic anemia
All of the above
3. Very low birth weight (VLBW):-
Less than 1500gm.
Less than1000gm.
More than 1500.
4. Choanal atresia is defined as…………..
a. A life threatening birth defect in which the nasal passage does not
properly develop during prenatal life.
b. an abnormality in which the middle portion of the esophagus is absent
c. hypertrophy of muscle surrounding pylorus that to narrowing of
pyloric canal
d. a & b
5. Which is not a cause of neonatal jaundice in the first 24 hours?
a. Rhesus incomparability
b. ABO incompatibility
c. Congenital infections
d. Physiological jaundice
6. Which is not true of hyaline membrane disease?
a. It is also caused respiratory distress syndrome
b. it tends to occur in those <30 weeks gestation
c. associated respiratory difficulty may not appear until days 4 or 5
d. treatment involves surfactant down ETT
7. Most common cause of seizure in newborn is
a. Hypoxia induced ischemic encephalopathy
b. Hypocalcemia
‫كلية التمريض‬
c. Metabolic abnormality
d. Sepsis
8. Which is the following manifestation would cause the nurse to suspect renal
a. Pyelonephritis
b. An upper respiratory tract infection
c. Followed to skin infection
d. Antigen-antibody reaction secondary to an infection
9. The primary cause of heart failure in the first 3 years of life is
a. Congenital H.D
b. Poor feeding.
c. Anorexia.
d. Meningitis
10. Common Signs of Digoxin Toxicity are the following except:
a. Anorexia
b. Bradycardia
d. Dysrhythmia
11. Which of the following instructions would the nurse focuses on for the child
epispadias and hypospadias:
The child should not be circumcised before repair of the defect
Avoid restraints in abdomen or chest
Do nothing because this is a normal finding for this child
Perform an intensive neurological examination.
12. Which of the following are defects associated with Tetralogy of Fallot.
a. Coarctation of aorta, aortic valve Stenosis, mitral valve Stenosis, and patent
duct arteriosus.
b. Ventricular septal defect, overriding aorta, Pulmonic Stenosis, and right
ventricular hypertrophy.
c. Tricuspid valve atresia, atrial septal defect, and hypoplastic right ventricle
d. Aorta exits from the right ventricle, pulmonary artery exits from the left
ventricle, and two no communicating circulations
13. A nurse is called to the birthing room to assist with the assessment of anew
born who was born at 32 weeks of gestation. The newborn’s birth weight is
1,100 g. His Apgar scores are 3 at 1 min and 7 at 5 min. He is experiencing
nasal flaring, grunting, and intercostal retractions. Which of the following
are characteristics that the nurse may see at this birth?
a. Lanugo
b. Long hair
c. Long nails
d. Plump face
14. All of the following are true about renal failure except:a. Provide diet low in protein ,sodium ,and potassium
b. Shave abdomen in peritoneal dialysis
c. Instruct about the need for medical evaluation & tissue culture of sore
‫كلية التمريض‬
d. Wash the site of shunt with sterile water
15. A nurse is caring for an infant who has a high bilirubin level and isreceiving
phototherapy. Which of the following findings in the newborn is the highest priority?
a. Conjunctivitis
b. Bronze skin discoloration
c. Sunken fontanels
d. Maculopapular skin rash
16. While assessing a child with Coarctation of aorta, the nurse would expect to find
which of the following
a. Absent or diminished femoral pulse
b. Cyanosis at birth.
c. Squatting posture.
d. Cyanotic episodes.
17. Which of the following instructions would the nurse include in a care plan that
focuses on the management of congestive heart failure:
Avoid restraints in abdomen or chest
Observe cyanosis, dyspnea,Orthopnea
Position and humidified O2
All of the above
18. A nurse is caring for an infant who is preterm and has respiratory distress syndrome.
Which of the following assessment findings will assist the nurse in evaluating the
efficacy of synthetic surfactant?
a. Oxygen saturation
b. Body temperature
c. Bilirubin levels
d. Heart rate
19. Which one of the following conditions is a complication of severe neonatal
a. Glucose-6-phosphate dehydrogenase deficiency.
b. Gastrointestinal problems.
c. Bruising
d. Kernicterus
20. Which one of the following is the major contributor to the development of
physiological jaundice?
a. Breast feeding
b. Decreased hepatic bilirubin execration
c. Immature hepatic enzyme
d. Increased bilirubin production
21. Incidence of respiratory distress syndrome increases with all of the following Except
a. Prematurity
b. Female gender
c. Male gender
d. Cesarean section delivery
22. Tonic seizure may be
a. focal
b. generalized
‫كلية التمريض‬
c. both of the above
d. none of the above
23. Narrowing or stenosis of preputial opening of foreksin is a symptom of
a. Hydrocele
b. Inguinal Hernia
c. Phimosis
d. Chalasia of the Esophagus
24. Poly cystic kidney is defined as ………………………………
a. Wilm’s Tumor (Ebryoma)
b. Epispadias
c. The infant has enlarged kidneys filled with cysts at birth
d. Abnormal fluid loss
25. Which of the following cytogenetic abnormality is associated with
leukemia ?
Monosomy 5
Trisomy 18
monosomy 7
Trisomy 21
QII: read the following sentences and write true or false in front of
each sentence (5 marks):
1. Hypospadias: is opening located behind glands penis or
anywhere along ventral (lower) surface of penile shaft
2. Newborn usually needs less analgesic to obtain relative
comfort after surgical procedures
3. Diaphragmatic Hernia is protrusion of abdominal viscera
through a defect in diaphragm into the chest cavity
4. Reduce the workload of the heart by uninterrupted rest and
decrease excessive crying
5. Edema in the legs, ankles, feet and abdomen are the most
obvious signs of the patent ducts arteriosus
6. Atrial septal defect is due to decrease in pulmonary blood flow wrong
7. Chest electrodes in incubator should be changed every 3 days.
8. The lamp 0f phototherapy should be 5-8cm over incubator
9. Post term is any baby born before 32 weeks of gestational age
10. In pathological jaundice the rate of bilirubin rise more than
10mg/dl /day
‫كلية التمريض‬
QIII: read the following situation and answer the questions (30 marks):
Problem (1)
A 10 month old boy was brought into the accident and emergency department with a six hour
history of vomiting and irritability that began after his first feed of the day. The vomiting was
stained green. During this period the child passed a large amount of diarrhea with no specific
characteristics. He was also noted to have crying episodes that lasted approximately 20
minutes and involved the child bending his legs over his trunk. There was no history of fever,
9 months of age and had been weaned at five months. He had always been healthy and had
normal development.
Answer the following questions:
1. Determine the problem and define it. (2degree)
2. Explain the nursing assessment of the problem. (4degree)
3. Identify Post-Operative Care for this child. (5degree)
1. Intussusception :
Intussusception is a condition in which one portion of the intestine into or folds itself
inside another portion. The term comes from two Latin words, intus, which means "inside"
and suscipere, which means "to receive.”
2. Nursing assessment of the problem
 History taking
 Physical examination
 Clinical manifestation
a. Vomiting and irritability that began after first feed of the day.
b. The vomiting was stained green.
c. Passed a large amount of diarrhea with no specific characteristics.
d. Crying episodes and involved the child bending legs over the trunk
 Diagnostic evaluation
3. Post-Operative Care for this child
1. After return from the operating room, the child’s general condition must be closely
a) Vital signs, especially temperature.
b) Airway must be kept patent newborn babies must be kept in warm cot or
2. Unit the child is responsive and alert; he should be kept on his side (for secretion and
vomitus to get out from mouth).
3. Observe conditions and placement of dressing. Check and mark any apparent
drainage from wound.
4. Intravenous fluids should be checked
5. The child should be carefully handled and should be protected from harming himself
by use of appropriate restraints.
6. Any urinary catheter should be connected to drainage bag and stabilized properly to
7. Observe conditions and placement of dressing. Check and mark any apparent
drainage from wound.
‫كلية التمريض‬
8. Intravenous fluids should be checked
9. The child should be carefully handled and should be protected from harming himself
by use of appropriate restraints.
10. Any urinary catheter should be connected to drainage bag and stabilized properly to
Problem (2)
A 2 year old white female, Lila, is rushed by her parents into the local Children’s Hospital
Emergency Room. The toddler is acutely ill, pale, listless, bruised and having difficulty
breathing. The Emergency Room team responds immediately performing a comprehensive
physical assessment. The attending physician suspects leukemia. Lila’s parents are anxious. A
preliminary diagnosis of childhood cancer is difficult for the family and healthcare workers to
consider. Will the little girl survive? This question is on everyone’s mind. The Emergency
Room staffs works quickly with the pediatric hematologist oncologist to treat and diagnose
the ill child. The patient’s preliminary blood work is consistent with Acute Lymphoblastic
Leukemia, (ALL). Lila will be admitted to the pediatric oncology unit for observation and
further assessment
Answer the following questions:
1. Define the problem in this situation (2degree)
It is a malignant disease in hematopoietic cells in bone marrow .
- Giving rise to uncontrolled clonal proliferation of cells.
With arrest of maturation at different stages.
With subsequent bone marrow failure.
2. Explain the Nursing assessment of the problem (3degree)
1-Physical examination
2-History taking
3-Clinical manifestation .2
‫كلية التمريض‬
It is according the pathological effect
Bone marrow 1-Decrease RDCs:
dysfunction anemia
2-decrease platelets
3-Invasion of bone
marro (bone weakness)
Liver, spleen -enlargement
Lymph gland -fibrosis
dyspnea exertion
*Pain in joint
&abdominal pain
Bone marrow
*Increase intracranial
7-stiff neck
Anorexia Weight loss
Prolonged fever
Muscle wasting
‫كلية التمريض‬
6. Discuss nursing management of the problem (4degree)
1-High risk for infection related to depressed body defense
1-Private room
2-Hand washing is necessary
3-Screen all visitors and staff for infection
4-Use aseptic technique
5-Complete diet
High risk for injury (hemorrhage) related to interference with cell proliferation
1-Use all measures to prevent infection
2-Stop bleeding
3-Limiting activity
4-Avoid accidental injury
5-Administer platelets as prescribed
Altered nutrition less than body requirement Related to loss of appetite
1-Improve quality of food selection
2-Encourage parents to relax on eating .
3-Sever small snakes
4-Allow child to be involved in food preparation
Altered mucous membranes related to
administration of chemotherapeutic agent.
** intervention
1-Inspect mouth daily for oral ulcer ,avoid oral
2-Oral hygiene as soon as possible
3-Use soft sponge tooth brush
4-Moist soft diet and encourage fluids
5-Avoid juices containing lemon
Pain related to diagnosis and treatment
1-Avoid excessive noise or light
2-Use gentle ,minimal physical manipulation
3-Use heat or cold on painful areas
4-Change position frequently
5-Avoid pressure on bony prominences
6-Administer analgesics
‫كلية التمريض‬
Problem No (3)
A newborn boy was admitted to the neonatal intensive care unit (NICU) of this hospital
because of respiratory distress. The patient was born at a gestational age of 29 weeks at
another hospital by cesarean section for breech presentation, premature labor, and rupture of
membranes of approximately 2 hours’ duration. He weighed 1275 g and appeared vigorous,
with spontaneous respirations; the 1-minute and 5-minute Apgar scores were 7 and 9,
respectively. Shortly thereafter, subcostal retractions developed.
Answer the following questions
1. Classify the baby according to gestational age and size in this
situation (3degree)
Classification according to size:
Very low birth weight (VLBW): infants is less than 1500g
Classification according to gestational age:
Premature (preterm): infant born before completion of 37 weeks of gestation
2. Determine criteria for evaluating respiratory distress syndrome?
1. Tachypnea (80 to 120 breaths/min).
2. Dyspnea.
3. Substernal retraction.
4. Fine inspiratory crackles.
5. Audible expiratory grunt.
6. Flaring of the nares.
7. Cyanosis or pallor.
As the disease progress
 Flaccidity.
 Unresponsiveness
‫كلية التمريض‬
 Apnea.
 Diminished breath sounds
 Shock like state.
 Diminished cardiac output and bradycardia.
 Low systemic blood pressure.
3- Design nursing care plan for this case? (4 degree)
1-Infective breathing pattern related to surfactant deficiency, alveolar instability, and
pulmonary immaturity.
2- Impaired gas exchange related to immature
alveolar structure and inability to maintain lung expansion.
3-Ineffective airway clearance related to obstruction or inappropriate positioning of
endotracheal tube.
4- Risk for injury related to acid-base imbalance, oxygen levels, carbon dioxide levels from
mechanical ventilation.
Best wishes