Question 1

Baby Boy Doe is a newborn found outside of the emergency department (ED).He is hypothermic and has several deep lacerations across his back,abdomen,and legs that will require surgical repair.He is transferred to the surgical bay of the ED and prepared for anesthesia induction.What risk reduction strategies are appropriate during the preanesthetic phase to achieve and maintain normothermia?

Accepted Answer

Adjust room temperature approximately 1 hour before arrival of the child:26° to 27° C (78.8° to 80.6° F)for infants and newborns;23° to 24° C (73.4° to 75.2° F)for older children.Provide radiant heat lamp for use during placement of monitoring lines,induction of anesthesia,positioning,skin prep,and draping.Keep child covered as much as possible.Consider wrapping lower extremities in soft gauze or stockinette and encasing in plastic bag for newborns and infants.

Question 2

During the planning process,the perioperative nurse determines nursing interventions that will assist in meeting the appropriate goal statement of the desired nursing outcome.What nursing intervention is appropriate,when implemented,in protecting the pediatric patient from fluid volume imbalance?

Accepted Answer

The following are nursing interventions directed toward protecting the patient's fluid volume balance:maintain and protect patency of intravenous lines;review laboratory analyses for results of total blood volume;calculate estimated total blood volume using formula of 85 to 90 mL/kg of body weight if total blood volume has not been determined by laboratory tests;provide gram scales for weighing sponges discarded from operative field,weigh sponges,and report estimated loss;provide suction units with reservoirs that measure in 5- to10-mL increments;measure and record quantity of irrigating fluid used;provide appropriate amounts of intravenous fluid replacement (e.g.,250-mL containers);measure and record urinary output and output from other drainage tubes;send laboratory specimens for analysis as indicated;review results indicating fluid status.

Question 3

An orchiopexy is the surgical placement and fixation of the testicle in a normal anatomic position in the scrotal sac.If the testis fails to descend into the scrotum during gestation,it is considered undescended.Which statement regarding indications for orchiopexy is true?

Accepted Answer

All testes undescended after 1 year require surgical placement in the scrotum for optimum maturation.Retractile testes require no surgical or hormonal treatment.Laparoscopic exploration may also be used to determine position,existence,or size of a "hidden" testis.

Question 4

A child's comprehension of,and responses to,the environment are based on his or her developmental age.The works of Drs.Jean Piaget and Erik Erikson provide excellent guidelines for assessing the pediatric patient's developmental level in order to use appropriate interventions.The infant develops the belief that the world can be counted on to meet basic needs through the trust vs.mistrust concept based on the stages of psychosocial and emotional needs.This theoretical framework of stages was described by __,while the stages based on changes in cognition and ability to think were described by _.

Accepted Answer

Dr.Jean Piaget described the stages by changes in cognition and the ability to think,and Dr.Erik Erikson based the stages on psychosocial and emotional needs.For example,according to Erikson,infancy to 1 year:trust vs.mistrust;infant develops belief that world can be counted on to meet basic needs.According to Piaget,infancy to 2 years:Who to trust? Identifies strangers at 7 to 8 months of age.

Question 5

Cleft lip is usually associated with a notch or cleft of the underlying alveolus and a cleft of the palate.Cleft lip repair is most often performed when the infant is about 3 months of age.Cleft lip is described as:

Accepted Answer

A deficiency of tissue (skin,muscle,and mucosa)along one or both sides of the upper lip or,rarely,in the midline results in a cleft at the site of this deficiency.

Question 6

Carlos Gracia is a 12-year-old boy scheduled for a laparoscopic hernia repair.During the preoperative assessment and interview,the perioperative nurse notes that Carlos has mild myotonia congenita.Carlos' mother states that she is worried about the anesthesia because her husband's brother died many years ago when he became very feverish during surgery and they could not cool him.The perioperative nurse's appropriate risk reduction strategy in this situation would be to:

Accepted Answer

Careful assessment of family history is essential to identify patients at risk for developing MH.Malignant hyperthermia (MH),although very rare,may be more prevalent in the pediatric population as a result of the administration of inhalational anesthetics and succinylcholine.In addition,physiologic conditions present in some pediatric patients are associated with a higher risk of MH.These conditions are myotonia congenita,Duchenne's muscular dystrophy,Becker's muscular dystrophy,osteogenesis imperfecta,arthrogryposis,kyphoscoliosis,and King-Denborough syndrome.Careful assessment of family history is essential to identify patients at risk for developing MH.

Question 7

Neuropathologic conditions requiring surgical intervention can be found in any age group.What are the most common problems requiring neurosurgical procedures in infants and children?

Accepted Answer

The most common problems requiring neurosurgical procedures in infants and children include meningocele,myelomeningocele,encephalocele,craniosynostosis,hydrocephalus,brain tumors,and trauma.

Question 8

Improvements in instrumentation and the development of equipment in smaller sizes have resulted in the evolution of minimally invasive surgery (MIS)from that of a rapidly growing field to one of routine practice in the pediatric surgical arena.The advantages of MIS for the pediatric population include which true statement?

Accepted Answer

Advantages of minimally invasive surgery include diminished postoperative pain,improved cosmetic results,decreased prevalence of adhesion formation,and accelerated recovery periods and shorter hospital stays.Despite the technical congruence with adult MIS procedures,the pediatric populations undergoing these procedures have specific needs.Anesthesia providers must consider the size and age of the patient because of the risk of physiologic compromise related to insufflation.Likewise,steps are taken intraoperatively to decrease the likelihood of intra-abdominal injury,such as insertion of an appropriate size Foley catheter to decompress the bladder or application of thromboembolic hose or sleeves to prevent deep vein thrombosis.

Question 9

This orthopedic diagnosis is a complex deformity that is diagnosed prenatally through ultrasound or at birth.It may occur unilaterally or bilaterally and may be idiopathic or one in a combination of other syndromes with associated anomalies.The general characteristic for all cases includes inversion of the foot such that the anterior foot is located in the typical position of the posterior foot;often there is a deep crease in the midfoot.Select the orthopedic diagnosis.

Accepted Answer

Clubfoot is a complex deformity that is diagnosed prenatally through ultrasound or at birth.According to the American Academy of Orthopedic Surgeons (AAOS),clubfoot may occur unilaterally or bilaterally and may be idiopathic or one in a combination of other syndromes with associated anomalies (AAOS,2007).

Question 10

Personal comfort or security items should be permitted to accompany children to the OR who are in which developmental age?

Accepted Answer

Allow personal items into the OR for comfort/security in all developmental age groups.

Question 11

Young children are predisposed to parasympathetic hypertonia (increased vagal tone),which can be induced by:

Accepted Answer

Young children are predisposed to parasympathetic hypertonia (increased vagal tone),which can be induced by painful stimuli such as laryngoscopy,intubation,eye surgery,or abdominal retraction.

Question 12

It is important to recognize that the difference between pediatric care and adult care is not just a size issue.Major areas of distinction are the airway and pulmonary status,cardiovascular status,temperature regulation,metabolism,fluid management,and psychologic development.The most significant consideration when caring for pediatric patients that is not of concern when caring for adults is:

Accepted Answer

From birth onward,the body and organs exist in a continual state of development,and multiple physiologic changes occur with age.A thorough knowledge of these differences is integral to the provision of nursing care for the pediatric patient in the OR.

Question 13

The pediatric patient is at risk for imbalanced fluid volume related to invasive surgery and accompanying blood loss.Select the outcome indicator that would best reflect that the goal of maintained fluid balance was attained.

Accepted Answer

The child will maintain fluid balance as evidenced by blood pressure within expected/acceptable range,palpable peripheral pulses,moist mucous membranes,and absence of peripheral edema.

Question 14

Donna Antonio,the perioperative nurse,explained to the child,at a developmentally appropriate level,what he or she will experience in the preoperative,intraoperative,and postoperative phases of care.Donna briefly described the roles of various staff members who will be a part of the team responsible for the child's care in the OR.She explained,to the child and family,the length of time that they will be separated from each other during the procedure and when they can be reunited in the PACU.Donna addressed the child within a developmental framework,taking into account the child's cognitive and psychosocial abilities.She used medical play items,audiovisual aids,puppets,and photographs in the education process.While Donna addressed the need for knowledge of the impending surgical procedure and provided education,she also employed interventions aimed at which nursing diagnosis?

Accepted Answer

Nursing diagnoses related to the care of pediatric patients undergoing surgery might include the following:Anxiety related to separation from family and friends,Fear related to developmental level (fear of the unknown,fear of painful procedures and surgery),Risk for Infection related to surgical intervention and other invasive procedures,Risk for Imbalanced Fluid Volume related to invasive surgery and accompanying blood loss,Risk for Hypothermia related to loss of body surface heat to environment and immature temperature-control mechanisms.

Question 15

Infants and children with severe gastroesophageal (GE)reflux can have life-threatening complications,including obstructive apnea,aspiration pneumonia,esophagitis,and failure to thrive.What is the name of the procedure,performed open or laparoscopically,that is designed to create a competent antireflux barrier?

Accepted Answer

Nissen fundoplication is indicated for infants and children who experience severe gastroesophageal (GE)reflux.The goal of the Nissen fundoplication is to create a competent antireflux barrier.

Question 16

Any misalignment of the eyes is called strabismus.The goal for treatment of strabismus is to straighten the eyes so that binocular vision functions appropriately.Surgery may be recommended to change the alignment of the eyes relative to each other by:

Accepted Answer

Surgery may be recommended to change the alignment of the eyes relative to each other by strengthening,weakening,or repositioning the eye muscles.

Question 17

Children classified in the early childhood phase or who are preschool age begin to imagine and explore.Their thinking is dominated by perceptions and,often,distorted reasoning.They are magical thinkers.What would be an appropriate intervention for preschool age children?

Accepted Answer

For the preschool,early childhood patient,use stories during induction.They like colorful Band-Aids.Allow the child to handle unfamiliar objects to decrease stress (e.g.,mask,pulse oximeter probe).Allow personal item into OR for comfort/security.

Question 18

Sienna Morgan is a 7-year-old girl who was involved in a hit and run accident while riding her bike to school.She is attended by paramedics and has an unstable airway;blood pressure less than 50 mm Hg (systolic);a major open,penetrating wound;and open,multiple fractures of both legs.Sienna is comatose.During transport she is intubated and demonstrates persistent physiologic demise and possible traumatic brain injury.A significant risk reduction strategy for Sienna would be to:

Accepted Answer

Trauma Transfer Criteria for Pediatric Patients Ages 14 or Younger-Consider transfer to pediatric trauma center:nonoperative management of solid organ injury;assessment of any of the following "negative points" on the pediatric trauma scale:weight less than 10 kg,unstable airway,blood pressure less than 50 mm Hg (systolic),coma,major open,penetrating wound,open multiple fractures,injury severity score greater than 9;victim or nonaccidental injury that requires intervention from child protective team or other resources;anticipated complexity of care exceeds the capabilities of local resources at adult trauma center.Should transfer to pediatric trauma center:persistent physiologic demise,traumatic brain injury,intubation and mechanical ventilation with no expectation to wean within 24 hours,children with special needs or other co-morbid conditions.

Question 19

The immature blood-brain barrier and decreased protein binding in infants increase their sensitivity to which group of drugs?

Accepted Answer

Drug distribution is different in neonates and infants compared with older children and adults because of an increased percentage of total body weight and extracellular body fluid.Infants have an immature blood-brain barrier and decreased protein binding,which results in an increased sensitivity to sedatives,opioids,and hypnotics.

Question 20

The toddler uses symbols and engages in creative play.Toddlers are beginning to develop free will and control over their bodies.Which of the interventions below is age-appropriate for toddlers?

Accepted Answer

Toddlers are very egocentric.They develop free will and increasing control of their body and feel regret and sorrow for inappropriate behavior.Give only simple choices;involve child in actions when possible;use distractions;sing songs the child may recognize.Allow personal item into OR for comfort/security.

Quiz 25: Pediatric Surgery