Liquids

1 oz = 30 milliliters (ml)
1 tbsp = 3 teaspoons (tsp) = 15 ml
1 tsp = 5 ml
2 tbsp = 1 fl oz
4 tbsp = 1/4 c = 2 oz
1 ml = 1 cc
1 cup (c) = 8 fl. oz = 16 tablespoons (tbsp) = 1/2 pt
2 c = 16 fl oz = 1 pt = 1/2 qt
4 qt = 1 gal
1 L = 1000 ml
 The symptoms of scarlet fever begin abruptly and include
fever, sore throat, rash, and a bright red tongue.
The rash appears 12 to 72 hours after the onset of a fever.
The tonsils are inflamed and often covered with a white
coating.
Scarlet fever is caused by streptococcus pyogenes and most
commonly affects children age 4 to 8 years.
Incorrect options:
Diphtheria causes a purulent nasal discharge, a brassy
cough, and bluish skin coloration.
Pertussis causes whooping cough and vomiting.
Mumps generally presents with painful swelling of the
salivary glands.

Physical features of Fetal Alcohol Syndrome include

deformities such as a small head and brain, sunken nasal
bridge, thin upper lip, small teeth, and an upturned nose.
FAS can also cause vision difficulties, intellectual disabilities, a
short attention span, delayed cognitive development, and
poor impulse control.
Alcohol exposure presents a risk of fetal brain damage at any
point during pregnancy because brain development is ongoing
throughout pregnancy.
Incorrect options:
Down syndrome symptoms include short stature, short and
wide neck, slanted eyes, low-set ears, hypotonia, intellectual
disability, and learning disabilities.
Klinefelter syndrome presents in males as less facial and
body hair, reduced muscle mass and strength, broad hips,
gynecomastia, and hypogonadism.
Signs and symptoms of mercury poisoning are systemic,
including peripheral neuropathy, skin discoloration (pink),
swelling, shedding of the skin, tremors, visual and hearing
impairment, and fatigue.

Regurgitation is found in children with GERD.

Pyloric stenosis causes projectile vomiting.
Currant jelly stool is seen in intussusception.

celiac disease.- Steatorrhea, deficiency of fat-soluble vitamins,

malnutrition, and distended abdomen

Early signs of hypoxia include restlessness, headache,

fatigue, shortness of breath, and cyanosis

metered dose inhaler

The patient should be instructed to:
1. Exhale completely.
2. Place inhaler between open lips or about 2 inches from
open mouth.
3. Start inhaling, then press down on the canister while
continuing to inhale.
4. Hold for 10 seconds.
The Jones criteria state that the diagnosis of rheumatic fever
can be made with two major criteria or one major with two
minor criteria along with evidence of a streptococcal infection.
Major criteria include polyarthritis, carditis, subcutaneous
nodules, erythemic rash, and chorea.
Minor criteria include fever, elevated ESR, elevated C-reactive
protein, leukocytosis, arthralgia, and a prolonged PR interval.
Rheumatic fever is an autoimmune disease that occurs as a
reaction to a group A beta-hemolytic streptococcal infection.
Inflammation from the immune response leads to fibrin
deposits on the endocardium and valves, in particular the
mitral valve, and in the major body joints. The disease often
follows an attack of pharyngitis, tonsillitis, scarlet fever, strep
throat, or impetigo.
 Chest radiography revealing cardiomegaly and pulmonary
congestion, hyponatremia, hyperkalemia, and ventricular
hypertrophy are signs of congestive heart failure.

An occupational therapist has specialized training to help

patients adapt to their physical limitations in order to perform
their activities of daily living.
Incorrect answers:
A palliative care nurse is not needed for this patient problem.
A dietician can recommend a diet plan to meet the patient's
nutritional needs but cannot help the patient with activities of
daily living.
Physical therapists can help the child be more active and
functional, but they cannot assist the child with feeding.

Birth weight should be doubled by 6 months

and be tripled by 12 months. This infant has only doubled the
birthweight in almost a year and will not be able to achieve the
goal of 3 times the birthweight in the next month. This is cause
for concern and the cause should be investigated immediately.
 Kawasaki disease is an autoimmune disease involving the
inflammation of blood vessels, lymph nodes, skin, and
mucosa.
Initial symptom is a high fever unresponsive to
antipyretics.
Later symptoms include conjunctivitis, rash, peeling, and
edema.
This disease is most common among children. Boys are
affected more than girls, and people of Asian descent are at
high risk.
Hypothyroidism, hypomagnesemia, hypokalemia, hypoxemia,
and advanced heart disease all increase the patient's risk for
developing digitalis toxicity.

Drugs
Racemic epinephrine acts on adrenergic receptor sites
causing a reduction in airway inflammation and edema. It is
most commonly used in croup and when stridor is present.
Incorrect answers:
Ipratropium is an anticholinergic used for the treatment of
asthma and chronic obstructive pulmonary disease.
Salmeterol is a long-acting beta agonist used for the
treatment of asthma and chronic obstructive pulmonary
disease.
Theophylline is a xanthine derivative used to treat apnea of
prematurity and sometimes chronic obstructive pulmonary
disease or asthma.

During ketoacidosis, potassium serum levels rise, causing

hyperkalemia. Also, potassium needs close monitoring when
insulin is given, because this pushes the K+ back into the cells,
causing a drop in serum levels. Potassium imbalances can
cause harmful cardiac arrhythmias.

Desmopressin is a synthetic antidiuretic hormone.

Desmopressin increases water reabsorption in the kidneys
leading to decreased urine output. (Desmopressin is also used
to treat diabetes insipidus.)
Desmopressin also induces the release of von Willebrand
factor from its storage sites in endothelial cells, allowing better
platelet adhesion and improved clotting time (shortened
aPTT).
Desmopressin has been successfully used in the treatment of
bleeding episodes in patients with VWD types 1 and 2, mild to
moderate haemophilia A, platelet function defects related to
aspirin use, bleeding related to cirrhosis, and heparin use.

9090 traction is a type of skeletal traction often used for

femur or tibia fractures.

Thomas splint traction is a skin traction. It involves bandages

wrapped around the entire length of the leg. An attached ring
applies traction at the heel. (In adults, the knee is left slightly
bent.) Skin traction would not be the first choice with an open
compound fracture because it dislocates tissue while in
traction, and this patient has a wound that requires dressing
changes.

Buck's traction is another skin traction that applies simple

horizontal traction. This is also not ideal with an open fracture
due to dislocation and pull on the skin.

Fisk traction is a skin tractionspecifically, a modification of

a Thomas splint that allows for 90-degree movement of the
knee. Skin traction is contraindicated with open compound
fractures.

Children with PKU must avoid foods high in phenylalanine,

which include milk, soy, eggs, meat, fish, beans, cheese,
chocolate, and regular grains.
PKU is an autosomal recessive metabolic disorder. The
absence of the liver enzyme phenylalanine hydroxylase
prevents the conversion of phenylalanine, an essential amino
acid, into tyrosine. As a result, excessive phenylalanine builds
up in the bloodstream and tissues, causing permanent
damage to brain tissue.
The parents must calculate the total intake of phenylalanine
in foods they feed their child that contain a moderate amount
of phenylalanine. The foods that are allowed but must be
moderated include bananas, potatoes, PKU milk, concentrated
fruit juices, and ice cream.
Foods that can be eaten without calculation of phenylalanine
include most fruits, lettuce, tomatoes, carrots, butter and
margarine, and low-protein grains.

Neuroblastomas are tumors that arise from cells of the

sympathetic nervous systems. Cells are highly undifferentiated
and invasive, occurring most frequently in the abdomen near
the adrenal gland or spinal ganglia.
Bilateral iliac crest bone marrow aspirate and
biopsy are used to confirm the diagnosis and to determine
the extent of the tumor.
 Maintaining a patent airway with the child lying on his side is
the intervention used during the active seizure

Tonic-clonic (also called grand mal) seizures are characterized

by stiffening of the arms and/or legs, a loss of consciousness,
and then rhythmic jerking of the extremities lasting 2 to 5
minutes. Excessive salivation may present as frothing at the
mouth. The pulse rate and blood pressure increase and may
take time to return to normal. Breathing is impaired during the
seizure, and the patient is often incontinent of urine or feces
during the episode. The patient is often very lethargic and
confused for hours afterwards.
Monitor oxygen saturation and respiratory rate and depth
while the patient rests or sleeps. Some patients may start to
have another seizure while in the recovery phase. Their
breathing may become very shallow, or they may become
apneic during the sleep phase.

Hydrocephalus can cause an increase in intracranial pressure

(ICP).
The nurse should monitor for signs of increasing ICP and
assess for frontal bossing, dilated scalp veins, diplopia,
vomiting, tense fontanelles, irritability, decreased level of
consciousness, and changes in vital signs.
Incorrect answers:
Increases in ICP can cause brain-stem compression, which
can result in respiratory or cardiac failure. For this reason,
while vital signs will be monitored, the ICP is the priority
assessment because managing the ICP will control its effects
on the vital signs.
Measuring head circumference regularly is one indication of
whether the condition is improving, but it is not the priority
assessment.
Promoting normal growth and development is not a priority
during a severe acute illness.

Normal lab values:

WBC: 4,00010,000 cells/ml
Hemoglobin: 1418 g/dl (men), 1216 g/dl (women)
Hematocrit: 4252% (men), 3747% (women)
Platelets: 150,000400,000

Famotidine is a histamine 2 receptor antagonist (H2RA) used

to treat GERD or prevent peptic ulcer disease by decreasing
gastric acid secretion.
H2RAs are commonly used in place of proton pump
inhibitors for the prevention of peptic ulcers.
Incorrect options:
Ondansetron (Zofran) is an anti-emetic.
Loperamide (Imodium) is an antidiarrheal.
Metoclopramide (Reglan) is a prokinetic used to stimulate GI
motility.
 Skeletal traction is used primarily to align the ends of the
fractured bone.
Skeletal traction involves the use of a pin or wire passed
through the skin into the end of a long bone.
With skeletal traction, ropes and pulleys are attached to
weights to exert a pull on the extremity at the pin site. Cotton
gauze squares are usually placed around the ends of the pins
to protect and cushion the surrounding skin.
Immobilization also prevents further trauma to tissue and
will reduce pain.

Status asthmaticus is an acute, prolonged, and severe

asthmatic attack that is unresponsive to usual treatment.
Hospitalization is usually required.
Asthma is a chronic, obstructive airway disease characterized
by wheezing. It is caused by a spasm of the bronchial tubes or
the swelling of the bronchial mucosa after exposure to various
stimuli.
Incorrect options:
Mild intermittent asthma is characterized by brief
exacerbations occurring fewer than three times per week.
Mild persistent asthma is characterized by exacerbations
three or more times per week or three to four nighttime
symptoms per month.
Moderate persistent asthma is characterized by daily
exacerbations and one or more nighttime exacerbations per
week.
 Severe persistent asthma is characterized by continual
symptoms, frequent exacerbations, and frequent nighttime
symptoms.

Artificially acquired, active immunity results from the use of

ingested or injected vaccines, medically altered substances,
which stimulate the immune system to produce antibodies.
Naturally acquired, active immunity occurs when antibodies
develop after natural exposure to a pathogen.
Naturally acquired, passive immunity occurs when antibodies
are directly received through the placenta or breast milk. (In
passive immunity, the antibodies are given, not developed by
that patient.)
 Artificially acquired, passive immunity results when
antibodies are artificially delivered to the body such as with
blood transfusions. (In passive immunity, the antibodies are
given, not developed by that patient.)

Petit mal (absence seizure) is classified as a generalized

seizure. A petit mal seizure usually lasts less than 20 seconds
and always involves loss of consciousness. Rhythmic blinking
and twitching of the mouth or of an extremity often indicates a
petit mal seizure is starting.
Typical tonic-clonic seizures are generalized seizures. There
are usually three stages. 1) Aura: a strange, dizzy, ominous
feeling that can last minutes or hours. 2) Tonic phase: the
person loses consciousness, and muscles tense. This only lasts
a few seconds. 3) Clonic phase: Muscles contract and relax
rapidly in convulsions.
Status epilepticus refers to a seizure that lasts continuously
for more than 5 minutes or a series of seizures from which the
child does not return to his or her previous level of
consciousness. This is a medical emergency.

For adults with meningitis, the common triad of symptoms is

fever, neck stiffness, and mental status changes. However, this
occurs in only 44% of adults with meningitis and in even fewer
children.
Fever, headache, photophobia, nausea, vomiting, confusion,
lethargy, and irritability are the most common symptoms in
children.
Diarrhea and blurred vision are not common in pediatric
meningitis.

Aspirin is a poison frequently ingested by children. It causes

hyperventilations, which leads first to respiratory alkalosis and
then to metabolic acidosis and hypokalemia. The kidneys
compensate by excreting bicarbonate and potassium in the
urine.
The immediate treatment is to remove the drug from the
childs stomach by inducing vomiting, using gastric lavage, or
by administering activated charcoal.
Incorrect options:
Administering an antacid and obtaining a urine specimen are
not necessary.
Osmotic laxatives are not used because aspirin is eliminated
through the urine.

Diphenoxylate with atropine (Lomotil) is effective against

diarrhea but can cause anticholinergic side effects such as
urinary retention, dry mouth and eyes, tachycardia, and
flushing.