Editing Pediatric Nursing – RN Flashcards

Rapid-review flashcards at NCLEX-RN depth for pediatric nursing. Cover the answer, recall it, then check.

== Assessment and physiologic norms ==

;Why is hypotension a late sign of shock in children, and what should the RN act on instead?
:Children maintain cardiac output through tachycardia and intense peripheral vasoconstriction, so blood pressure stays normal until a large volume deficit exists. Act on tachycardia, capillary refill greater than 2 to 3 seconds, cool or mottled skin, weak peripheral pulses relative to central pulses, oliguria, and declining level of consciousness. Once the blood pressure falls, arrest may be imminent.

;State the systolic blood pressure thresholds that define hypotension by age.
:Neonate under 60 mmHg; infant 1 to 12 months under 70 mmHg; child 1 to 10 years under 70 + (2 x age in years) mmHg; child over 10 years under 90 mmHg.

;Why do most pediatric cardiac arrests differ in mechanism from adult arrests?
:Pediatric arrests are usually asphyxial, resulting from progressive respiratory failure or shock, rather than from sudden ventricular fibrillation. That is why airway and breathing are the priority and why prevention of respiratory failure is the highest-value intervention.

;What does a falling respiratory rate in a previously tachypneic child in distress signify?
:Exhaustion and impending respiratory arrest, not improvement. Accompanying bradycardia, a silent chest, and decreasing responsiveness confirm decompensation and require immediate escalation.

;Which fontanel findings are abnormal and what do they suggest?
:A tense, bulging fontanel in a quiet infant suggests increased intracranial pressure. A sunken fontanel suggests dehydration. Transient bulging with crying, coughing, or vomiting is normal. Anterior fontanel open beyond 18 months, or head circumference crossing percentiles upward, suggests hydrocephalus.

;Describe the Cushing response in an infant with increased intracranial pressure.
:Bradycardia, widening pulse pressure (rising systolic with stable or falling diastolic), and irregular respirations. It is a very late, ominous sign. Earlier infant signs are a bulging fontanel, suture separation, high-pitched cry, vomiting without diarrhea, poor feeding, and the setting-sun sign.

;What are the expected urine output ranges by age?
:Infants about 2 mL/kg/hr, children 1 to 2 mL/kg/hr, adolescents 0.5 to 1 mL/kg/hr. Diaper weight is converted at 1 gram equals 1 mL.

;Why is a fever of 38.0 degrees Celsius in an infant under 28 days an emergency?
:Neonates have immature immune function and can be bacteremic or meningitic without localizing signs. A full sepsis evaluation and empiric antibiotics are indicated.

== Growth, development, and psychosocial care ==

;Match Erikson's stage to each pediatric age band.
:Infant, trust versus mistrust. Toddler, autonomy versus shame and doubt. Preschooler, initiative versus guilt. School-age, industry versus inferiority. Adolescent, identity versus role confusion.

;How does the RN individualize hospital care to the toddler's developmental task?
:Support autonomy: offer limited real choices, preserve home rituals and comfort objects, allow the caregiver to stay, tolerate regression, and avoid unnecessary restraint. Expect protest behavior as normal.

;Why is the "detachment" stage of separation anxiety a red flag rather than a good sign?
:A toddler who stops protesting and behaves pleasantly toward all staff may have given up on the caregiver's return. It signals emotional withdrawal, and the priority is restoring caregiver presence.

;How does magical thinking change how the RN prepares a preschooler?
:Preschoolers may believe illness or a procedure is punishment for misbehavior. The nurse states plainly that the procedure is not a punishment, uses concrete simple language, allows play with equipment, and applies a bandage because the child fears the body will "leak out."

;Which pain scales match which pediatric ages?
:FLACC or NIPS for neonates and preverbal infants; FACES for roughly 3 to 7 years; a 0 to 10 numeric scale from about 7 years; revised FLACC with caregiver input for nonverbal children with cognitive impairment.

== Medications and calculations ==

;Outline the safe-dose verification process and the RN's action if the order is out of range.
:Convert weight to kilograms (pounds divided by 2.2), multiply by the reference range while noting whether it is per dose or per day in divided doses, compare with the order, and confirm the dose does not exceed the usual adult dose. If the order is outside the safe range, hold the medication and contact the prescriber. Never adjust a dose independently.

;State the Holliday-Segar maintenance fluid formula.
:100 mL/kg/day for the first 10 kg, plus 50 mL/kg/day for the second 10 kg, plus 20 mL/kg/day for each kilogram above 20. Divide the daily total by 24 for the hourly rate.

;What is the standard pediatric fluid resuscitation bolus?
:20 mL/kg of isotonic crystalloid (0.9 percent sodium chloride or lactated Ringer's) given rapidly, with reassessment of perfusion after each bolus to decide whether to repeat.

;When is digoxin held in a child, and what is the earliest sign of toxicity?
:Take the apical pulse for one full minute and hold, then notify the provider, if the rate is below roughly 90 to 110 in an infant, 70 in a child, or 60 in an adolescent. Bradycardia with vomiting and anorexia is the typical early toxicity picture. Do not repeat a vomited dose.

;Which medication-safety practices are specific to pediatrics?
:Weigh and document in kilograms only; use oral syringes in milliliters, never household spoons; use a leading zero and never a trailing zero; two-nurse independent double check for high-alert drugs including insulin, opioids, heparin, and chemotherapy; volume-control sets or syringe pumps to prevent fluid overload; vastus lateralis for infant intramuscular injections; never mix medication into a full bottle of formula or call it candy.

== Emergencies and complication management ==

;What is absolutely contraindicated in suspected epiglottitis, and what is the priority?
:Do not inspect the throat, obtain a throat culture, or place anything in the mouth, because laryngospasm and complete obstruction may follow. Keep the child upright and calm in the caregiver's lap, give nothing by mouth, provide oxygen if tolerated, and get skilled airway personnel and equipment to the bedside immediately.

;Differentiate croup from epiglottitis.
:Croup is viral with gradual onset, low-grade fever, barking cough, hoarseness, inspiratory stridor, and a steeple sign; it is treated with dexamethasone and nebulized epinephrine. Epiglottitis is abrupt, with high fever, a toxic appearance, drooling, dysphagia, dysphonia, distress, tripod positioning, and no cough; it is an airway emergency.

;Why is a "silent chest" in an asthma exacerbation an emergency?
:Wheezing requires turbulent airflow. Loss of wheezing while work of breathing increases means airflow has fallen too low to generate sound, indicating severe obstruction and impending respiratory failure.

;What is the feared complication of Kawasaki disease, and how is it managed and monitored?
:Coronary artery aneurysm. Treat with intravenous immunoglobulin plus aspirin and obtain serial echocardiograms. Because IVIG confers passive antibody, defer live vaccines such as MMR and varicella for about 11 months.

;Distinguish pyloric stenosis from intussusception.
:Pyloric stenosis: 3 to 6 weeks old, non-bilious projectile vomiting with immediate hunger, olive-shaped right upper quadrant mass, visible peristalsis, hypochloremic hypokalemic metabolic alkalosis; treated by pyloromyotomy. Intussusception: 3 months to 3 years, colicky pain with knees drawn up alternating with calm intervals, sausage-shaped mass, currant jelly stools; treated by air or contrast enema. Passage of a normal brown stool suggests spontaneous reduction and must be reported at once.

;Which prescriptions should the RN question in sickle cell vaso-occlusive crisis?
:Cold applications (worsen sickling; use warmth), fluid restriction (hydration is essential), and meperidine (normeperidine accumulation lowers the seizure threshold). Appropriate care includes hydration above maintenance, oxygen, warmth, rest, and scheduled or patient-controlled opioid analgesia.

;What defines splenic sequestration crisis and why is it urgent?
:Rapid pooling of blood in the spleen with a rapidly enlarging, tender spleen, falling hemoglobin, tachycardia, pallor, and hypovolemic shock. It can be fatal within hours and requires immediate volume resuscitation and transfusion.

;Summarize nursing care in suspected bacterial meningitis.
:Initiate droplet precautions on suspicion and continue for 24 hours after effective antibiotics; assist with lumbar puncture and give antibiotics promptly; keep the environment quiet and dim and cluster care; elevate the head of the bed slightly with the head midline; institute seizure precautions; monitor neurologic status, fluid balance, and for syndrome of inappropriate antidiuretic hormone.

;How should the RN manage a hypercyanotic "tet" spell in tetralogy of Fallot?
:Place the infant in the knee-chest position, which raises systemic vascular resistance and reduces right-to-left shunting, administer oxygen, calm the infant, and notify the provider. Morphine and fluids may be ordered.

;What findings suggest heart failure in an infant?
:Poor feeding with diaphoresis during feeds, tachypnea, tachycardia, hepatomegaly, periorbital edema, poor weight gain, and fatigue. Infants show fluid overload in the liver and periorbital tissue rather than as dependent leg edema.

;Why is aspirin avoided in children with viral illness?
:Salicylate exposure during influenza or varicella is associated with Reye syndrome, an acute encephalopathy with fatty degeneration of the liver. Kawasaki disease is the notable exception in which aspirin is deliberately used.

;What is the RN's obligation when child maltreatment is suspected?
:Nurses are mandated reporters and must report reasonable suspicion; proof is not required and is not the nurse's role. Ensure the child's immediate safety, document objectively with direct quotations and body maps, avoid confronting the caregiver, and interview the child separately with trained personnel.

[[Category:Pediatric Nursing]]
[[Category:Registered Nurse (NCLEX-RN)]]
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