Download Simulation Skills Laboratory Activities

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Simulation Skills Laboratory Activities
Week 1: Pediatric Physical Assessment
Activity 1: Demonstrate a complete head to toe physical assessment on Sim-Baby.
Document your findings on attached physical assessment form (adapted: short care plan).
Activity 2: Complete the following:
Ref: Study Guide for Nursing Care of Children; Prinicples and Practice. (2 nd ed). Rosner & Kiehne. 2002.
Answer the following as either true or false.
1. It is appropriate to auscultate the heart, lungs, and abdomen while an infant is
sleeping. _________
2. Stranger anxiety makes the physical examination of an older infant more difficult.
___________
3. Parents should not be present during a young child’s physical
examination._________
4. In all age groups, invasive procedures should be saved until the end of the
examination._______________
5. Adolescents should be allowed to participate in deciding who will be present
during the physical examination.____________
6. Axillary temperatures are preferable to rectal temperatures because they are less
invasive._________
7. The apical impulse is palpated to determine the position of the heart.__________
8. All irregular heart rhythms in children require immediate attention._________
9. The respiratory rate in infants can be counted by observing the movements of the
abdomen.______________
10. A blood pressure cuff that covers three-quarters of the distance between the
child’s antecubital fossa and shoulder will give a falsely low reading._________
11. Breathing is diaphragmatic in a school-age child.__________
12. Prior to auscultating breath sounds, have a toddler sit on the parents lap.________
13. Normal breath sounds are called adventitious.________
14. The apical pulse is also called the point of maximal impulse (PMI).__________
15. Auscultation of the heart is best done by listening with the bell of the stethoscope
only.____________
16. Splitting of the S2 heart sound is a normal finding in children.____________
17. Functional heart murmurs require immediate intervention.______________
18. For adolescents, the physical examination proceeds from head to toe.__________
Fill in the blanks.
19. Chest circumference is measured at the _________________________.
20. On a child, the nurse assesses skin turgor on the _____________.
21. Unusual hair loss is called_____________.
22. Excessive hair growth is called _________________.
23. When a child has head lice, nits are found in the _______________.
24. Capillary refill should be within __________ seconds in a healthy child.
PHYSICAL ASSESSMENT
Date: __________
Time: __________
Client Name:_________________ Client Diagnosis:____________________
(Please highlight abnormal findings)
Current vital signs, Ht/Wt/ HC and percentiles:
General Survey:
Skin:
Head:
Eyes/Vision:
Ears/Hearing:
Nose:
Mouth:
Neck:
Heart:
Thorax/Lungs/Breasts:
Abdomen:
Genitalia:
Spine/ Back/ Extremities/MS:
Neurologic/Glasgow/Reflexes:
Psychosocial:
Pain (include which scale was used for rating):
Azh/09
Week 2: Pediatric Medication Administration & National Patient Safety Guidelines
Activity 1: Review the National Patient Safety Guidelines
Activity 2: Medication Calculations
1. You are administering Aldactone/ spironolactone to a 3 year old child diagnosed
with CHF who weighs 33 pounds. The child has a history of edema and
hypertension.

What is the recommended weight based children’s dose (use your med
book)?

What is the safe dose range for this child?

What would be the top 3 nursing considerations?
2. You are admitting a 4 year old child with sepsis weighing 45 pounds who is
febrile. The doctor has not ordered any antipyretics and you need to call him for
an order. You decide to ask for both Tylenol and Motrin.

What is the recommended weight based children’s dose (use med book)?
Tylenol:
Motrin:

What is the safe dose range for this child?
Tylenol:
Motrin:

What would be the top 3 nursing considerations?
3. You are caring for a 9 year old weighing 88 pounds who has an abscess that
cultures positive for MRSA. The doctor has ordered Vancomycin IV every 8
hours.

What is the recommended weight based children’s dose (use your med
book)?

What is the safe dose range for this child?

What would be the top 5 nursing considerations when administering this
medication?

What is the recommended dilution for this medication IV?

Which IV fluids are compatible with this medication?
4. You are administering prednisone to a 6 year old child with Status Asthmaticus
who weighs 62 pounds. The doctor ordered Solumedrol 40 mg IV every 6 hours.
The child is also taking INH and Rifampin for TB.

What is the recommended weight based children’s dose for Solumedrol?
(use your med book)

What is the safe dose range for this child?

What would be the top 3 nursing considerations for solumedrol?

Can this child safely take his TB medications while receiving his asthma
medications?
5. You are caring for a 10 month old child with pneumonia who has a harsh, choky
cough. The doctor is ruling out pertussis and has ordered erythromycin po. The
child weighs 17 pounds. The child is also receiving nebulized albuterol every 4
hours and prn.

What is the recommended weight based children’s dose for erythromycin?
(use your med book)

What is the safe dose range for this child?

What would be the top 3 nursing considerations for this medication?

If ordered IV – how would you give it?

What is the recommended weight based children’s dose for albuterol?
(use your med book)

What are 3 of the most common side effects of albuterol?

In addition to universal precautions, what addition types of isolation
precautions are indicated for this patient?
6. A nurse should routinely ask a colleague to double-check a medication calculation and the
actual medication before administering which of the following medications?
Select all that apply.
a.
b.
c.
d.
e.
Antibiotics
Insulin
Anticonvulsants
Anticoagulants
Narcotics
azh/09
Week 3: Pediatric Fluid and Electrolytes
Activity 1: Pediatric IV starts on Sim- Baby. Work with instructor in groups of 1-2.
Activity 2: Discuss the use of IV burretrols
Activity 3: Complete the following.
24 hour Fluid Calculations. Show all Calculations.
Calculate the 24 hour fluid requirements for each of the following patients:
1. Three year old weighing 36 pounds.
2. One year old weighing 19 pounds.
3. Five year old weighing 53 pounds.
4. Ten year old weighing 41 kg.
5. Infant weighing 9#6oz.
6. You are admitting a 2 year patient weighing 25 pounds with a history of diarrhea
and vomiting for 3 days. The doctor has ordered IV fluids at 1.5 maintenance for
the first 24 hours.
What is the total volume of fluid the child should receive in 24 hours?
What will the rate be per hour?
7. The doctor has ordered a fluid bolus of NS 20 ml/kg over 2 hours on a child who
weighs 44 pounds.
What is the total volume of the fluid bolus?
How many ml’s will you give per hour?
8. You are caring for a 21 kg child with MRSA and renal failure. The child is on
fluid restrictions of 1500 ml per day. The child is receiving D5E48 @ 10 ml/hr;
Vancomycin 40 mg/kg/day divided into 3 doses given every 8 hours that is
diluted with D5W to equal 5 mg/ml and given over 60 minutes.

How many ml of fluid per day is the child receiving in IVF and IV
medications?

What is the maximum volume of po fluid the child safely take per day
without surpassing his fluid restriction?
NCLEX QUESTIONS:
1.Which of the following is the most appropriate statement for the nurse to make to a 5-year-old
child who is to have a venipuncture?
a. “You must hold still or I’ll have someone hold you down. This is not going to
hurt.”
b. “This will hurt like a pinch. I’ll get someone to help hold your arm still so it will
be over fast and hurt less.”
c. “Be a big boy and hold still. This will be over in just a second.”
d. “I’m sending your mother out so she won’t be scared. You are big, so hold still and
this will be over soon.
2.The nurse is preparing for the admission of an infant who will need several procedures
performed. In which of the following situations is informed consent required? Select all
that apply.
a. Catheterized urine collection
b. IV line insertion
c. Oxygen administration
d. Lumbar puncture
e. CT scan with contrast
3.Which of the following nursing diagnoses is appropriate for a 5-year-old child in isolation
because of immunosuppression?
a. Spiritual distress
b. Social isolation
c. Diversional activity deficit
d. Sleep disturbance
4.Which nursing action is most appropriate when treating a child who has a fever of 102.5?
a. Use alcohol in the bath water to lower the child’s temperature rapidly.
b. Administer an aspirin.
c. Administer an antipyretic such as acetaminophen..
d. Bathe the child for 45 to 60 minutes.
5.Which action is appropriate when the nurse is bathing a small child?
a. Test the water on the inside of the wrist or elbow for comfort.
b. Allow children older than 2 years to bathe themselves.
c. Check that the water temperature does not exceed 120F.
d. Step out of the room to give the child privacy while bathing.
6.What is the maximum safe volume that a neonate can receive in an intramuscular injection?
a. 0.25 milliliter
b. 0.5 milliliter
c. 1 milliliter
d. 1.5 milliliters
e. None of the above
7.Which muscle would the nurse select to give a 6-month-old infant an intramuscular injection?
a. Deltoid
b. Ventrogluteal
c. Dorsogluteal
d. Vastus lateralis
Azh/jan10
Week 4: Genitourinary System and Immune System
Activity 1: Catheterization of pediatric patients using Sim-Baby, 1-2 students per group.
Activity 2: Case Study – answer the following questions.
CASE STUDY –
REF: R. Belkengren, MD & S. Sapala, EdD, CPNP
Pediatric Management Problems, Pediatric Nursing
May-June, 1997/vol.23/No.3
(modified from original format and study)
Case:
Al, age 9 years old, is sent home from school by his teacher because he is disrupting
the class by constantly coughing. Ms. Beta, Al’s grandmother and legal guardian,
recently registered Al in the nearby ambulatory HMO clinic. A review of the health
history forms for medication or significant illness is negative. Al said he got a cold and
started coughing this morning on the way to school, and during gym (physical education)
class his chest was hurting.
FAMILY/SOCIAL HISTORY
Al, and his brother, age 12 years old, recently moved to California to live with their
grandmother. Their mother died in an automobile accident 3 months ago.
PAST MEDICAL HISTORY
Ms. Beta was unable to add any additional information regarding past medical
illnesses. She gave Al a dose of Tylenol this morning because he felt warm.
PHYSICAL EXAMINATION
Vital Signs- Wt: 45 lbs Ht: 51 inches
Temp. 100 (ax), BP 100/64; HR 92; RR 28.
General Appearance: pale, coughing, anxious, able to answer questions, but short of
breath with speaking.
Eyes: Conjunctiva clear, no discharge, no icterus
Ears: TM’s intact, light reflex present, no injection
Nose: Rhinorrhea (mild), clear in color
Throat: no injection, no exudate, + gag reflex
Lungs: bilateral wheezing, prolonged expiratory phase, using abdominal muscles to
breathe, no nasal flaring, O2 sats 89%.
Heart: S1S2 normal, no murmur, rate 92 and regular.
Abdomen: no organomegaly, normal bowel sounds, no tenderness.
Additional data: unable to use peak flow meter, unable to blow hard enough.
What is your assessment?
1. Highlight data from above (subjective and objective data) that is not within
“normal” parameters.
2.
What medical diagnosis should be considered for this child?
3.
What 5 things should be included in the doctor’s admission orders?
4.
What are the top 3 nursing diagnosis you would consider for this child?
5.
Which nursing interventions should be a priority for this child, why?
6.
What are his percentiles on the growth chart for HT and WT? Based on this
information, what teaching should be included in your plan of care?
NCLEX QUESTIONS: Alternate Format
7.
You are caring for a child weighing 44 pounds who is hospitalized with vomiting
and severe dehydration. The doctor has ordered parenteral rehydration therapy to restore
circulation. The order is for sodium chloride (0.9%) solution in a 20ml/kg bolus. How
much will you give? (Show all calculations!)
8. You are the nurse caring for a child with celiac disease. Which of the following food choices
by a parent indicates understanding of teaching? Select all that apply.
a.
b.
c.
d.
e.
Oatmeal
Steamed Rice
Corn on the cob
Baked chicken
Peanutbutter and jelly sandwhich on wheat bread
9. A child with secondary enuresis who complains of dysuria or urgency should be evaluated for
which of the following conditions? Select all that apply.
a.
b.
c.
d.
e.
Hypocalciuria
Nephrotic syndrome
Glomerulonephritis
Urinary tract infection
Diabetes mellitus
10.Which of the following suggestions is appropriate to teach a mother who has a preschool child
who refuses to take the medications for HIV infection?
a. Mix medications with chocolate syrup or follow with chocolate candy.
b. Mix the medications with milk or an essential food.
c. Skip the dose of medication if the child protests too much.
d. Mix the medication in a syringe, hold the child down firmly, and administer the
medication.
11.Which of the following is the primary nursing concern for a hospitalized child with HIV
infection?
a. Maintaining growth and development
b. Eating foods that the family brings to the child
c. Consideration of parental limitations and weaknesses
d. Resting for 2 to 3 hours twice a day
12.What would the nurse include in a teaching plan for a mother of a toddler who will be taking
prednisone for several months?
a. The medication should be taken between meals.
b. The medication needs to be discontinued because of the risks associated with longterm usage.
c. The medication should not be stopped abruptly.
d. The medication may lower blood glucose so the mother needs to observe for signs
of hypoglycemia.
Azh/jan10
Week 5 – Respiratory and Cardiac Systems
Activity 1: Pediatric Simulation. Break into 2-3 groups. Each group will work together
through the simulation case.
Activity 2: NCLEX questions related to the respiratory and cardiac systems.
Ref: Instructor’s Electronic Resource to accompany Nursing Care of Children: Principles and Practice (2 nd ed).
James, Ashwill, and Droske, 2002.
RESPIRATORY
1. Which of the following changes in the respiratory system occur postnatally?
1. Respirations are stimulated by hypoxemia.
2. It takes up to 48 hours for most of the alveoli to expand.
3. Surfactant in the lungs interferes with lung expansion.
4. Pulmonary blood flow decreases after birth.
2. What information would the nurse teach families about reducing exposure to pollens and dust?
1. Replace wood and tile floors with wall-to-wall carpeting.
2. Do not use an air conditioner. Open windows for ventilation.
3. Put dust-proof covers on pillows and mattresses.
4. Keep humidity in the house above 60 percent.
3. A child has had cold symptoms for over 2 weeks, a headache, and a cough that increases during sleep. The nurse recognizes these
symptoms are characteristic of which respiratory condition?
1. Allergic rhinitis
2. Bronchitis
3. Asthma
4. Sinusitis
4. The child with chronic otitis media with effusion should be evaluated for which of the following problems?
1. Brain abscess
2. Meningitis
3. Hearing loss
4. Perforation of the tympanic membrane
5. The nurse would expect a child with an acute otitis media infection to receive which of the following treatments?
1. If asymptomatic, no treatment necessary
2. An oral antibiotic, such as amoxicillin, several times a day for 7 days
3. A sulfonamide orally once a day at bedtime
4. Myringotomy with tympanoplasty tubes
6. Which statement made by a parent indicates understanding about treatment of streptococcal pharnygitis?
1. “I guess my child will need to have his tonsils removed.”
2. “A couple of days of rest and some ibuprofen will take care of this.”
3. “I should give the penicillin 3 times a day for 10 days.”
4. “I am giving my child prednisone to decrease the swelling of the tonsils.”
7. Which of the following symptoms is characteristic of laryngomalacia?
1. Stridor
2. High-pitched cry
3. Nasal congestion
4. Irritability
8. The nurse would assess a child who has had a tonsillectomy for which of the following signs?
1. Frequent swallowing
2. Inspiratory stridor
3. Rhonchi
4. Elevated white blood cell count
9. Which of the following is a distinguishing manifestation of spasmodic croup?
1. It has a gradual onset.
2. It has a sudden onset, usually at night.
3. It is bacterial in nature.
4. The child complains of a sore throat prior to onset.
10. Which of the following interventions for treating croup at home should be taught to parents?
1. Have a decongestant available to give the child when an attack occurs.
2. Have the child sleep in a dry room.
3. Sit with the child in the bathroom with the shower on when an attack occurs.
4. Give the child a prophylactic bronchodilator at bedtime.
11. The nurse is planning care for a three year old child with epiglottitis. Prioritize the
following nursing concerns in the management of a child with epiglottitis. Use the
numbers 1,2,3,4,5. Prioritize from highest priority (1) to lowest priority (number 5).
___ Adequate hydration
___ Maintain a patent airway
___ Decrease anxiety
___ Ensure adequate rest
Ensure safety
CARDIAC
1. Which of the following statements about fetal circulation is correct?
1. Oxygen is carried to the fetus by the umbilical arteries.
2. Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale.
3. Pulmonary vascular resistance is high because the lungs are filled with fluid.
4. Blood flows from the ductus arteriosus to the pulmonary artery.
2. Which of the following postoperative interventions would be questioned for a child following a cardiac catheterization?
1. Continue intravenous I(V) fluids until the infant is tolerating oral fluids.
2. Check the dressing for bleeding.
3. Assess peripheral circulation on the affected extremity.
4. Keep the affected leg flexed and elevated.
3. Which of the following information would be included in the nurse’s discharge instructions for a child who underwent a cardiac
catheterization earlier in the day?
1. Inspect the catheter insertion site for bleeding or drainage.
2. The child may soak in the tub beginning tomorrow.
3. Contact sports can be resumed in 1 month.
4. The child can return to school after a follow-up visit with the cardiologist.
4. Which of the following is done first in a cardiac assessment?
1. Percussion
2. Palpation
3. Auscultation
4. History and inspection
5. In which of the following situations is there a risk that a newborn will have a congenital heart defect (CHD)?
1. Trisomy 21 detected on amniocentesis
2. Family history of myocardial infarction
3. Father has type 1 diabetes mellitus
4. Older sibling born with Turner’s syndrome
6. Before giving a dose of digoxin (Lanoxin), the nurse checked an infant’s apical heart rate and it was 114 beats per minute.
What should the nurse do next?
1. Administer the dose as ordered.
2. Hold the medication until the next dose.
3. Wait and recheck the apical heart rate in 30 minutes.
4. Notify the physician about the infant’s heart rate.
7. Which of the following interventions would be included in the plan of care for an infant with the nursing diagnosis: Fluid Volume
Excess related to congestive heart failure?
1. Weigh the infant every day on the same scale at the same time.
2. Notify the physician when weight gain exceeds more than 20 g/day.
3. Put the infant in a car seat to minimize movement.
4. Administer digoxin (Lanoxin) as ordered by the physician.
8. The nurse assessing a premature newborn auscultates a continuous machinery-like murmur. This finding is associated with
which congenital heart defect?
1. Pulmonary stenosis
2. Patent ductus arteriosus
3. Ventricular septal defect
4. Coarctation of the aorta
9. Which of the following is an expected assessment finding in a child with coarctation of the aorta?
1. Orthostatic hypotension
2. Systolic hypertension in the lower extremities
3. Blood pressure higher on left side of the body
4. Disparity in blood pressure between the upper and lower extremities
10. Which of the following is a compensatory response to chronic hypoxia?
1. Polycythemia
2. Pulmonary hypotension
3. Dehydration
4. Anemia
11. Which statement made by a parent indicates understanding of activity restrictions for a child following cardiac surgery?
1. “My child needs to get extra rest for a few weeks.”
2. “My son is really looking forward to riding his bike next week.”
3. “I’m so glad we can attend services as a family this coming Sunday.”
4. “I am going to keep my child out of day care for 6 weeks.”
Azh/dec09
Week 6 – Caring for Children Undergoing Procedures
Activity 1: View movie on Pediatric Conscious Sedation. Discussion to follow.
Activity 2: Review forms and policies from Memorial and KMC related to conscious
sedation.
1. What are the pre-sedation requirements for a child who will be undergoing
conscious sedation?
2. What are the intra-sedation nursing activities and considerations for a child
undergoing conscious sedation?
3. What are the post-sedation nursing activities and considerations for a child who
has completed conscious sedation?
4. Name three medications that would be considered “conscious sedation”.
5. What is the reversal agent for opiods? How much would you give to a 7 year old?
NCLEX QUESTIONS:
6. Which of the following medications are the most effective choices for treating pain associated
with inflammation in children? Select all that apply.
a.
b.
c.
d.
e.
Morphine
Acetaminophen (tylenol)
Ibuprofen (advil)
Toradol (ketorolac)
Aspirin
7. A child who is hospitalized has just received a dose of IV morphine for pain and has an
anaphylactic reaction. Which of the following does the nurse identify as serious features
of anaphlaxis? Select all that apply.
a.
b.
c.
d.
8.
Itching of the skin
Cyanosis
Hypertension
Wheezing
The nurse is aware when assessing a child for pain that:
a. neonates do not feel pain.
b. pain is an individualized experience.
c. children do not remember pain.
d. a child must cry to express pain.
9.When pain is assessed in a 4 month old infant, it would be inappropriate to assess for which of
the following?
a. Facial expressions of pain
b. Localization of pain
c. Crying
d. Thrashing of extremities
10.The nurse caring for the child in pain knows that distraction:
a. can give total pain relief to the child.
b. is effective when the child is in severe pain.
c. is the best method for pain relief.
d. must be developmentally appropriate to refocus attention.
Azh/jan10
Week 7 - Hematologic, Shock, Endocrine function in children
Divide total group into 3 small groups. Groups will rotate through 3 stations: work on
Sim Baby; observe work on Sim Baby; working on questions in activity 2 (below). At
the end of lab debriefing with all 3 groups should take place with discussion on how each
group worked on Sim Baby.
Activity 1: Sim Baby
Activity 2: Observing work on Sim Baby
Activity 3: Read and complete the following.
Ref: Study Guide for Whaley & Wong’s Nursing Care of Infants and Children (6 th ed.). Wong, Hockenberry-Eaton,
Wilson, Winkelstein, Ahmann, Divito-Thomas.
Case Study #1
Mary, Age 9, has sickle cell anemia. She is admitted to the hospital with knee and back
pain and is diagnosed with sickle cell vaso-occlusive crisis.
1. In developing a plan of care for Mary, you understand that her pain is r/t what?
2. Describe the nursing interventions that you will include in your plan of care to
control pain during this vaso-occlusive crisis.
3. You are developing an educational plan about sickle cell anemia for Mary and her
parents. What will you include in your teaching plan that will help prevent
recurrence of crisis?
4. Based on Mary’s age, what stages of growth and development has she entered?
Piaget
Erikson
Freud
5. Evaluation of Mary’s progress in the hospital is best based on which of the
following observations?
a. Mary’s verbalization that she no longer has pain or needs pain medication
b. Mary’s ability to perform active range-of-motion exercises.
c. Mary’s desire to drink the required level of fluids for hydration.
d. Mary’s verbalization of how to prevent future sickle cell crisis.
Case study #2:
Rebecca Bennett is an 8 year old who has recently been diagnosed with diabetes mellitus.
She is hospitalized with diabetic ketoacidosis and she is beginning to learn about the
disease process. Her parents are with her continuously. She has an identical twin sister
who is staying with her maternal grandparents.
Which of the following nursing diagnosis is MOST likely to become a priority after the
first few days of Rebecca’s hospitalization?
a. Fluid volume deficit related to uncontrolled diabetes
b. fluid volume excess related to hormonal disturbances
c. impaired home maintenance management related to lack of knowledge
d. impaired respiratory function related to fluid imbalance
In preparing the family for discharge, what should the nurse prepare to teach?
1.
2.
3.
4.
5.
What are the peak, onset, and duration for each of the following? (use your med book and
reference)
Regular Insulin:
NPH Insulin:
Lente/ long acting insulin:
NCLEX Questions:
1. You are the nurse caring for a child with type 1 diabetes. Which complaint would
alert the nurse to the presence of a possible hypoglycemic reaction?
a. hot, dry skin
b. muscle cramps
c. anorexia
d. tremors
2. You are the nurse caring for a child with type 1 diabetes. Which complaint would
alert the nurse to the presence of hyperglycemia?
a. hypertension
b. diaphoresis
c. polyuria
d. increased pulse rate
3. A hospitalized chld with type 1 diabetes received NPH and Regualr insulin two
hours ago (at 7:30am). The child calls the nurse and reports that he is feeling
hungry, shaky, and weak. The child ate breakfast at 8 am and is due to eat lunch
at noon. List in order or priority the actions that the nurse would take.
______ give the child ½ cup of fruit juice to drink
______ check the child’s blood glucose level
______ take the child’s vital signs
______ give the child a small snack of carbohydrate and protein
______ document the child’s complaints, actions taken, and outcome.
NCLEX QUESTIONS: Multiple Response
1. A preschooler is diagnosed with helminthes. The child’s mother is very upset and wants to
know how her child could have contracted this illness. After obtaining a detailed history,
the nurse identifies which of the following as possible transmission modes?
Select all that apply.
a. Playing in the backyard sandbox
b. Not washing hands prior to eating
c. Placing hands in the mouth and nail biting
d. Skin-to-skin contact with other children
e. Scratches from a neighborhood cat.
2. The mother of an HIV positive infant who is 2 months old, questions the nurse about
which childhood immunizations her child will be able to receive. Which of the following
immunizations would an HIV positive child be able to receive? Select all that apply.
a. Hepatitis B
b. DTaP
c. MMR
d. IPV
e. HIB
3.
The nurse is caring for a child with aplastic anemia. Which of the following nursing
diagnoses would be appropriate? Select all that apply.
a. Acute pain related to vaso-occlusion
b. Risk for Infection related to inadequate secondary defenses or immunosuppression
c. Ineffective Protection related to thrombocytopenia
d. Ineffective Tissue Perfusion related to anemia
4. The nurse is caring for a child with iron deficiency anemia. Which of the following would she
expect to find when reviewing the results of the complete blood count (CBC)?
Select all that apply.
a. Low hemoglobin levels
b. Elevated Red Blood Cell (RBC) levels
c. Elevated mean cell volume levels (MCV)
d. Low reticulocyte count
e. Decreased mean cell volume levels (MCV)
5. Which of the following nursing interventions would be appropriate for a child with
type 1 diabetes, insulin-dependent diabetes mellitus (IDDM) is experiencing deficient
fluid volume related to abnormal fluid losses, diuresis and emesis? Select all that apply.
a.
b.
c.
d.
e.
Initiate IV access
Begin IV fluid replacement with Normal Saline
Begin IV flid replacement with D5 ½ NS
Weigh on arrival to the unit and then every other day
Maintain strict intake and output monitoring
6. The nurse is caring for a child hospitalized with sepsis. She enters the room to find the child’s
condition rapidly deteriorating. The child is pale, oxygenation saturation is at 87% and
dropping, the child is obtunded, and oozing blood from the site of a previous
venipuncture. Which of the following would she expect to find when reviewing the
results of the laboratory testing? Select all that apply.
a.
b.
c.
d.
e.
Low platelet count
Elevated Red Blood Cell (RBC) levels
Elevated D-dimer (fibrin degradation products)
Low reticulocyte count
Prolonged PT
Azh/dec09
Week 8- MOVIE WEEK!!
Activity 1: Movies
Activities: Movies & Questions, discussion to follow.
1. Never Shake a Baby!
2. Child Abuse: Identification
3. Reporting Advocacy – Why Report? (vol.1)
4. Reporting Process (vol.2)
5. Reporting Aftermath: Myths & Challenges (vol.3)
Questions r/t movies:
Child Abuse: Identification
1. What are 2 reasons children don’t report that they are being abused?
2. Who are mandated reporters?
3. List the 4 categories of child abuse:
4. In the movie a 5 year old child starved to death –why wasn’t this death prevented?
Reporting Advocacy- Why Report? (vol.1)
1. Define the following types of abuse:
Physical abuse
Sexual abuse
Neglect
2. List the “BIG 3” reasons leading to child abuse:
3. Mandated reporters must submit a written report within _____hours after calling in a
verbal report of child abuse.
Reporting Process (vol.2)
Explain the process for reporting suspected child abuse:
Reporting Aftermath, Myths, and Challenges (vol.3)
Discuss common myths or fears associated with reporting child abuse:
NCLEX QUESTIONS: Alternate Format
1. A 12 year old child is admitted to the burn unit with injuries sustained when her step-father
punished her for reportedly swearing at him. She has partial-thickness burns on 10% of
her body and full-thickness burns on 10 % of her body. Areas involved include her hands,
arms and head. Which of the following nursing assessments and care holds the highest
priority in the initial care for this child’s burn injury? Prioritize the following nursing
concerns in the management for this child. Use the numbers 1,2,3,4,5. Prioritize from
highest priority (number 1) to lowest priority (number 5).
a.
b.
c.
d.
e.
Insertion of a nasogastric tube into the stomach to supply adequate nutrition
Comforting her mother, who is emotionally distraught
Establishing and maintaining the child’s airway
Establishing and maintaining intravenous access
Insertion of a catheter to monitor hourly urine output
Activity 3: Case Study – Discussion
You are the nurse caring for a 3 month old admitted yesterday with intermittent
vomiting for 2 weeks. His height is in the 25%, weight in the 10%, and head
circumference in the 75% percentile. The child is pale and lethargic. You observe the
mother while she is feeding the infant, she props the baby’s bottle in the crib, talks on her
cell phone, and watches TV during the feeding, occasionally glancing at the infant. Upon
assessing the head you note that the head circumference has increased by 1 cm since
yesterday. The infant’s pupils are responding a little sluggish to light. While you are
obtaining vital signs the child has a seizure and his oxygen saturation level drops to 80%,
his heart rate is 82, and respirations 12.
What are your next nursing actions?
What further assessments are needed?
What other diagnostic tests are indicated?
What are some possible medical diagnosis?
Azh/dec09
Week 9 – Neurologic Alteration, Emergency Care, Musculoskeletal Problems
Prior to activities 1-3, instructor to review/ discuss/ demonstrate: neurologic/
neurovascular/ reflexes assessment on Sim- BabyInfant Reflexes: Babinski, Moro, Palmar Grasp, Plantar Grasp, Rooting, Sucking
Neurovascular & M/S: Assess extremities for movement, strength, symmetry,
tone, #digits, color, temperature, capillary refill time, alterations in sensation,
pain. Assess fontanel. Use the pediatric Glascow Coma Scale to assess LOC.
Next: Divide total group into 3 small groups. Groups will rotate through 3 stations:
work on Sim Baby; observe work on Sim Baby; working on questions in activity 2
(below). At the end of lab debriefing with all 3 groups should take place with discussion
on how each group worked on Sim Baby.
Activity 1: Sim Baby
Activity 2: Observing work on Sim Baby
Activity 3: Read and complete the following: Emergency Care
Answer the following:
1. What are the 2 most common causes of cardiopulmonary arrest in children?
_____________ ________________
2. What is the drug of choice for management of cardiac arrest in children?
__________
3. What is the leading cause of death in children? _____________
4. List 5 indicators or physical findings that should raise suspicion of child
maltreatment?
5. List 5 methods used for removal of toxic substances in children (ingestions and
poisonings).
______________, ____________, __________, _____________, ____________
6.
7.
8.
9.
Emesis should not be induced for what type of ingestions? __________________
What should be given to dilute ingested acids? ________________.
What is the antidote for acetaminophen ingestion? __________________.
What are environmental sources of lead that can be ingested by children?
____________, ________________, __________________, ________________
10. Describe the nursing care for a child with an injury from a dog bite.
__________________, _______________________, _______________________
11. What are the priorities in the management of pediatric heat related illnesses/heat
exhaustion? ________________________________________
12. An avulsed tooth can be placed in _________ for transport to emergency care.
13. Case Study:
You are in the ER when a 5 year old male who has been hit by a car is brought in.
He has a deep head laceration, is crying, and complaining of pain in his abdomen and
right leg.
 What assessments should you perform?

What diagnostic tests should be indicated?

What questions should be directed to the mother, who witnessed the
event?
14. Which symptoms should be reported to the doctor if they occur when a child with an
infectious disease is febrile? Select all that apply.
a. Anorexia
b. Fatigue
c. Vomiting
d. Headache
e. Visual Disturbance
15. Which of the following may cause hypovolemic shock in children? Select all that apply.
a. Hyperthermia
b. Burns
c. Vomiting
d. Diarrhea
e. Skin Abscess that cultures positive for MRSA (Methycillin Resistan
Staphylococcus Aureus)
16. A 2-year-old child is in the playroom. The nurse observes him picking up a lego and putting
it in his mouth. The child begins to choke. He is unable to speak. Which intervention is
appropriate?
a. Heimlich maneuver
b. Abdominal thrusts
c. Five back blows
d. Five chest thrusts
17.Which initial assessment made by the triage nurse would suggest that a child requires
immediate intervention?
a. The child has thick yellow rhinorrhea.
b. The child has a frequent nonproductive cough.
c. The child’s oxygen saturation is 95% by pulse oximeter.
d. The child is grunting.
Azh/jan10