Texas A & M International University

NURS 4410 – Child Health Nursing

Test II – Fall 2019

There are a total of 65 test questions. Review the following chapters: 5, 6, 7, 15, 25, and 26

Chapter 5 - Toddler
a. Mental processes of the preschooler
a. Self-centered understanding of the world. Magical thinking, imaginary friends, and
animism is common.
b. Imagination allows for anything to be possible so he or she does not have a logical view
of the world.
b. Night terrors vs nightmares
a. Night terrors:
i. partial arousal from deep sleep, screaming and thrashing after awake, usually
about an hour after child falls asleep, does not respond to parents consoling the
child, rapidly returns to sleep without full awakening, no memory of the event.
ii. One technique that may help to decrease the incidence of night terrors is to
wake the child about 30 to 45 minutes into the sleep cycle and continue doing it
for a week.
b. Nightmares:
i. Scary or bad dream followed by awakening, child wakes parent up, second half
of the night, responsive to parent, may remember the dream and talk about it
later.
c. Immunizations
a. (4-6 years old)
i. DTaP
ii. Polio
iii. MMR
iv. Varicella
d. Psychosocial development
a. Initiative vs. guilt (3-6 years old)
b. Likes to please parents, makes up games, initiates activities with others, develops sexual
identity, negotiates solutions to conflicts, and feels remorse when one does something
bad (develops a conscience).
e. Developmental theories
a. Pg. 129

Chapter 6 – School-age Child

a. Promoting Safety
a. Pg. 163
b. Immunizations
a. (4-6 years old)
i. DTaP
ii. Polio
iii. MMR
iv. Varicella
c. Psychosocial development, Developmental theories, Cognitive development
 a.

Chapter 7 – Adolescent
a. Physiologic Changes Associated w/Puberty: Physiologic Changes of Puberty
a. Increased sebum production which leads to acne and oily hair.
b. Exocrine and apocrine glands work at adult levels at this stage.
b. Psychosocial development
a. Achieve a sense of identity.
c. Developmental Theories: Theorist, stages & characteristics
a. Pg. 184
d. Peers
a. Essential role in their identity
b. Learn many social behaviors, such as the way they dress and their language. learn to
workout differences with peers and can vent about family problems.
c. They can have positive or negative influences on the teen.
e. Eating disorders
a. Anorexia nervosa:
i. Refusal to maintain normal body weight. severe weight loss
ii. Altered metabolic state
iii. Bradycardia, low blood pressure, amenorrhea, hypothermia, dry skin, brittle
hair and nails, appearance of lanugo, muscle wasting (cachectic), constipation,
bloating, and abdominal pain.
iv. 3 major goals: nutrition therapy, behavioral therapy, and psychotherapy.
v. In an acute care setting monitor fluid and electrolytes and signs of cardiac
complications such as cardiac arrest (consequence of bradycardia)
b. Bulimia nervosa:
i. Binge eating followed by purging of food by laxative abuse, self-induced
vomiting, diuretic abuse, and rigorous exercise regimens.
 ii. Tooth erosion, esophageal damage, hx of unsuccessful dieting, low impulse
control, overweight in childhood.
iii. Hospitalization is due to potassium depletion and esophageal damage. Cardiac
monitoring and behavioral management, with tricyclic anti-depressants.
f. Acne
a. Accutane (isotretinoin):
i. For nodular acne that is not cured with conventional therapy.
ii. Extreme high risks of birth defects in the fetus.
iii. Avoid sun exposure and alcohol.
g. Suicide and Risk Factors for Suicide in Adolescents
a. Risk factors:
i. Depression or other mental illness
ii. History of previous suicide attempt
iii. Poor school performance
iv. Family disorganization
v. Substance abuse
vi. Homosexuality
vii. Giving away valued possessions
viii. Being a loner
ix. Changes in behavior
x. Incarceration
b. Having these risk factors does not mean suicide will occur in all.
h. Tanner Stages 4 & 5.
a. Girls:
i. Breast take a fuller shape, passing the bud stage, Start their first period (12-14
years old), Height growth slow, Pubic hair gets thicker
ii. Breast reach adult size and shape, period becomes regular, reach adult height
one to two years after their first period, pubic hair reaches thighs, reproductive
organs and genitals are full developed, hips, thighs, and butt fill out in shape.
b. Boys:
i. Testicles, penis, and scrotum grow bigger and scrotum darker in color, Armpit
hair grows, deepening of the voice, Acne may start to appear
ii. Penis, testicles, and scrotum reach adult size, pubic hair has filled and spread to
inner thighs, facial hair will start to come in, height will slow down, by age 18
men have reached their full growth.
Chapter 15 - Infection
a. Lice
a. Transmission is with direct contact of infested hair. Most common symptom is extreme
itching.
b. Treatment is washing hair with pediculicide such as permethrin,, pyrethrin’s, and
lindane. Repeat treatment 9 days after first treatment is given.
c. Place on contact precautions, check hair after treatment, clean all bed sheets, towels,
and clothing.
d. Affects all socioeconomic groups.
b. Conjunctivitis
c. Fever
a. Do not give aspirin to avoid Reye Syndrome
b. Ibuprofen is shown to last longer than acetaminophen.
 c. Be careful with dosages for acetaminophen to avoid toxicity.
d. Dress child lightly and avoid warming the child with heavy clothing and or blankets.
d. Skin Rashes
a. Maintain skin integrity to prevent infection and scarring.
b. Keep fingernails short and clean
c. Cool compresses and cool baths relieve itching.
d. Press on rather than scratching.
e. Impetigo
f. Lyme disease
a. Clinical manifestations include fever, malaise, mild neck stiffness, headache, fatigue,
myalgia, and arthralgia, and pain in joints. Late disease symptoms include arthritis of
larger joints such as the knees.
b. Via the bite of a black legged deer tick causing a ring like rash.
c. Administer antibiotics

g. Varicella
a. Human herpes virus 3, varicella zoster virus.
b. Clinical manifestations: fever, malaise, headache, mild abdominal pain. lesions appear
first on scalp, face, trunk, then extremities. Erythematous macule that evolve to papules
then form clear fluid filled vesicles that will pop then scab and crust.
c. Management: supportive such as fever reduction, antipruritic, and skin care to prevent
infection of lesions. Antiviral therapy
d. Reactivation of herpes zoster is called shingles.
h. Meningitis
a. Inflammation of the CSF and meninges.
b. Viral meningitis is supportive care and bacterial meningitis is treated with antibiotics.
c. Clinical manifestations:
i. Seizures (initial sign), nuchal rigidity, positive Brudzinski’s sign (flexion of
extremities occurring with flexion of neck), positive kerning’s sign (resistance to
extension of the child’s leg from flexed position), fever, chills, headache,
vomiting.
d. CSF analysis:
i. Bacterial: cloudy color, ^ WBC count, ^ protein content, decreased glucose
ii. Viral: clear color, slightly elevated WBC count, normal or slightly elevated
protein, normal glucose.
e. Definitive diagnosis is lumbar puncture.
f. Presence of petechiae requires immediate attention.
g. Decrease environmental stimuli, correct fluid volume deficits, droplet precautions.
h. Medications include antibiotics, corticosteroids, analgesics.
i. Chain of Infection: isolation precautions help nurses break the chain of infection.
a. Infectious agent
b. Reservoir
c. Portal of exit
d. Mode of transmission
e. Portal of entry
f. Susceptible host

Chapter 25 – Immunologic
a. Latex allergy
a. IgE meditated response. Cross activity with pear, peach, passion fruit, plum, pineapple,
kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut,
carrot, celery, avocado, tomato, or potato.
b. Common Drugs for Immunologic Disorders
a. Cytotoxic drugs: cyclophosphamide (treatment for severe SLE). Causes bone marrow
suppression. Monitor for signs of infection. Administer in the morning. Provide
hydration and have child void frequently to decrease risk of hemorrhagic cystitis.
b. Immunosuppressant drugs: cyclosporine A. monitor CBC, creatinine, K+, Mg. monitor BP
and look for signs of infection. Draw blood before morning dose. DO NOT give with
grapefruit juice.
c. Antimalarial: hydroxychloroquine sulfate (prevent flareups in SLE and juvenile arthritis).
Preform a fundoscopic eye examination and visual field testing every year.
d. Disease modifying antirheumatic drugs (DMARDS): methotrexate and etanercept.
i. Methotrexate: do not give with dairy products, salicylates may delay clearance,
protect medication from light, monitor CBC, renal, liver function.
ii. Etanercept: monitor for infection, do not give live vaccines, give SQ twice
weekly.

e.
c. Wiskott-Aldrich Syndrome
a. Affects males ONLY. Results in immunodeficiency, eczema, and thrombocytopenia.
b. Complications include hemolytic anemia, neutropenia, skin or cerebral; vasculitis,
arthritis, IBD, and renal disease.
c. Only cure is hematopoietic stem cell transplantation. Splenectomy to correct
thrombocytopenia. Give IVIG to decrease frequency of bacterial infections.
d. Autoimmune disorders (Systemic Lupus, Juvenile idiopathic arthritis (JIA) including types of JIA)
a. SLE:
i. Multisystem autoimmune disorder in which the antibodies attack various of
organs causing inflammation in the vascular system leading to vasculitis. Injury
of the tissues and pain occur.
ii. Focus of treating inflammation response with NSAIDS, corticosteroids, and
antimalarial agents. Healthy diet, regular exercise, and adequate sleep and rest.
iii. Clinical manifestations: alopecia, anemia, arthralgia, arthritis, fatigue, Raynaud
phenomenon, skin rashes, thrombocytopenia.
b. JIA:
i. Autoantibodies target the joints causing pain, redness, warmth, stiffness, and
swelling.
ii. Therapeutic management includes management of inflammation control, pain,
promotion of remission, and maintenance of mobility.
iii. Prednisone is used to decrease inflammatory process and methotrexate is used
to prevent disease progression.
iv. Types of JIA:
1. Pauciarticular (oligoarticular): <4 joints usually the knees are involved.
Non joint manifestations are eye inflammation, malaise, poor appetite,
poor weight gain. Complications include iritis, uveitis, uneven leg bone
growth. (positive antinuclear antibody)
2. Polyarticular: >5 small joints. Malaise, lymphadenopathy,
organomegaly, poor growth. Complications include severe forms of
arthritis, rapid progression of joint damage, and rheumatoid nodules.
(positive rheumatoid factor)
3. Systemic: joint involvement, fever, and rash. Enlarged spleen, liver, and
lymph nodes. Myalgia and severe anemia. Complications include
pericarditis, pericardial effusion, pleuritis, and pulmonary fibrosis.
e. HIV Infection, HAART, etc.
a. Vertical transmission: perinatal (in utero or during birth) or via breast milk
b. Horizontal transmission: nonsterile needles (tattoos or drug use) or via intimate sexual
contact.
c. Survival rates increase because of highly active antiretroviral therapy (HAART).
d. Nursing management includes avoid infection, promoting compliant with medication
regimen promoting nutrition, and providing pain management and comfort measures.
f. IVIG: Indications, nursing actions, etc.
a. Helps decrease incidences of bacterial infections.
b. Assess BUN and creatinine as acute renal insufficiency may occur.
c. Do not shake IVIG, roll between palms to mix.
d. Baseline vital signs, start infusion slowly, monitor vital signs every 15 minutes.
e. May give Benadryl or Tylenol prior to those who have not had IVIG.
g. Corticosteroids: Indications, nursing actions, etc.
 a. Anti-inflammatory and immunosuppressive. Used for JIA and SLE
b. Administer with food to decrease GI upset, may mask signs of infection, monitor BP and
glucose in urine, do not stop treatment abruptly, monitor for Cushing syndrome, if IV
monitor for HTN during infusion.

Chapter 26 – Endocrine
Common Drugs for Endocrine Disorders
a. Precocious Puberty (Central precocious puberty and Peripheral precocious puberty)
b. Delayed Puberty
c. Diabetes Insipidus
d. SIADH
e. Disorders Related to Adrenal Gland Dysfunction: Congenital Adrenal Hyperplasia & Polycystic
Ovary Syndrome. Note Polycystic Ovary Syndrome not covered in PP still needs to be addressed
f. “Other Disorders of the Adrenal Gland” Table 26.3
g. Diabetes
h. Hypothyroidism
i. Lymphocytic thyroiditis
j. Growth Hormone Deficiency
k. Hypothyroid disorder
l. Hyperthyroid disorder (Graves Disease)