Deck 26: Pediatric Surgery

Question 1

Children are more prone to foreign-body ingestion than adults.What is the most significant risk?

A) Aspiration with airway obstruction
B) Esophageal impaction
C) Mucosal tear
D) Poisoning

Answer 1

A
The most significant risk of foreign-body ingestion is aspiration.Children are more prone to aspiration than adults because their laryngeal sphincters are immature,they do not have molars to chew all foods adequately,and they often run,shout,and play with objects in their mouths.Commonly aspirated food items include candy/gum,peanuts and other nuts,seeds,popcorn,hot dogs,vegetable matter,meat matter,and fish bones.Commonly aspirated nonfood items include coins,toy parts,crayons,pen tops,tacks,nails,needles,pins,beads,and screws.Aspiration may produce a complete or partial airway obstruction.

Question 2

A child's comprehension of,and responses to,the environment are based on his or her developmental age.Many theorists have provided excellent guidelines for assessing the pediatric patient's developmental level to use appropriate interventions.The infant develops the belief that the world can be counted on to meet basic needs through the trust versus mistrust concept based on the stages of psychosocial and emotional needs.This theoretical framework of stages based on emotional needs was described by ______________,while the stages based on changes in cognition and ability to think were described by _____________.

A) Dr. Erik Erikson; Dr. Jean Piaget
B) Dr. John Watson; Dr. Albert Bandura
C) Dr. Jean Piaget; Dr. John Watson
D) Dr. Karl Jung; Dr. Sigmund Freud

Answer 2

A
The stages of growth have been described from a variety of different aspects.Dr.Jean Piaget described the stages by changes in cognition and the ability to think,and Dr.Erik Erikson based on the stages of psychosocial and emotional needs.Their work provides an excellent guideline for assessing the pediatric patient's developmental level to use appropriate interventions.

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?

A) The normal path of the testis becomes obstructed.
B) The testis is strangulated by contraction of the cremaster muscle.
C) All testes that are undescended after 1 year require surgical placement in the scrotum.
D) Retractile testes require surgical or hormonal treatment.

Answer 3

C
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

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:

A) two skin ridges situated near the midline of the central philtrum of the lip.
B) absence of one or both philtral clefts with a notch in the alveolus.
C) a deficiency of tissue (skin, muscle, and mucosa) along one or both sides of the upper lip.
D) absence of the frenulum with resultant mandibular defect.

Question 5

A 12-year-old boy is scheduled for a laparoscopic hernia repair.During the preoperative assessment and interview,the perioperative nurse notes that he has mild myotonia congenita.The patient's 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:

A) perform a careful assessment of family history to identify risk for developing malignant hyperthermia (MH).
B) advise the anesthesia provider to find an alternative to succinylcholine and sevoflurane.
C) arrange for transfer to a tertiary care facility.
D) pursue a physician order for a laboratory test to rule out MH.

Question 6

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.The nurse briefly described the roles of various staff members who will be a part of the team responsible for the child's care in the operating room (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 postanesthesia care unit (PACU).She addressed the child within a developmental framework,considering the child's cognitive and psychosocial abilities.She used medical play items,audiovisual aids,puppets,and photographs in the education process.While the nurse addressed the need for knowledge of the impending surgical procedure and provided education,she also employed interventions aimed at which nursing diagnosis?

A) Ineffective coping related to developmental age.
B) Fear related to unmet goals.
C) Anxiety related to separation from family and friends.
D) Parental Role Conflict related to upcoming surgery.

Question 7

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:

A) strengthening the lower eyelids.
B) strengthening the upper eyelids.
C) repositioning the eye muscles.
D) performing bilateral blepharoplasty.

Question 8

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.Which risk reduction strategies are appropriate during the preanesthetic phase to achieve and maintain normothermia?

A) Adjust room temperature to 23° to 24° C (73.4° to 75.2° F).
B) Provide a radiant heat lamp during placement of monitoring lines and induction.
C) Wrap lower extremities in elastic bandages and encase in a plastic bag for newborns.
D) Keep child exposed as much as possible to benefit from the heat lamp.

Question 9

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?

A) Skull fractures and epilepsy
B) Craniosynostosis and hydrocephalus
C) Occipital neuroma and trauma
D) Aneurysms and craniostenosis

Question 10

Select all the injuries or conditions that reflect probable child abuse or neglect.

A) Abrasions of both knees
B) Multiple bug bites
C) Severe injuries inconsistent with the history
D) Severe diaper rash with the presence of ammonia burns

Question 11

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?

A) Sing songs from your own childhood that the child may be able to learn.
B) Give only simple choices and involve them in actions when possible.
C) Make up a story about their personal comfort item as you give it to their parent to keep.
D) Ask them about their concerns and offer information to decrease their fears.

Question 12

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?

A) Nissen fundoplication
B) Esophagectomy
C) Pyloromyotomy with pyloroplasty
D) Sphincterotomy

Question 13

Much like the adult population,many traditional "open" pediatric surgical procedures are being replaced by MIS procedures.Because the field of pediatric MIS is relatively new,surgeons are at an advantage because they can combine virtual reality techniques and robotics with the most current technology and instrumentation.Select the MIS procedures commonly performed in pediatric patients.

A) Living-related donor kidney transplant
B) Gastric fundoplication
C) Correction of pectus excavatum
D) Closure of patent ductus arteriosus

Question 14

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

A) painful stimuli such as eye surgery or abdominal retraction.
B) anxiety stimuli such as separation from a parent.
C) environmental stimuli such as loud noise or flashes of light.
D) thermal stimuli such as ambient excessive heat or cold.

Question 15

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

A) Anticholinergics, parasympatholytics
B) Antidysrhythmic agents
C) Opioids and hypnotics
D) Adrenergics

Question 16

A 14-year-old boy is scheduled for spinal fusion with implantation of rods from T₁0 to L2.During the preoperative interview and assessment,he asks the perioperative nurse how bad his pain will be when he wakes up and if he will have enough pain medicine available.He also wonders how the nurse will know when his pain is severe enough to give him pain medicine.The perioperative nurse assures the patient that he will have many options available to him to manage his pain after the surgery.An appropriate risk reduction strategy that the nurse can implement during the preoperative assessment is to:

A) explain and demonstrate the adolescent pediatric pain tool.
B) explain that he will have patient-controlled analgesia (PCA) and his parents can help manage his pain for him.
C) tell him to teach his parents what he knows about the pain scale.
D) request a consult with the pain service to explain the pain management plan to him.

Question 17

The pediatric patient is at risk for surgical site infection related to surgical intervention.Select the outcome indicator that would best reflect that the goal of freedom from signs and symptoms of infection was attained.

A) The surgical site heals by first intention.
B) The patient is at or returning to normothermia at the conclusion of the immediate postoperative period.
C) The patient's fluid, electrolyte, and acid-base balances are maintained at or improved from baseline levels.
D) The patient demonstrates or reports adequate pain control.

Question 18

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

A) Infancy to 1 year
B) Toddler to early childhood
C) School age to adolescence
D) Infancy through adolescence

Question 19

This diagnosis describes the protrusion of the viscera through a defect in the abdominal wall to the right of the umbilical cord.It may be idiopathic or one in a combination of other syndromes with associated anomalies.Select the diagnosis.

A) Omphalocele
B) Congenital talipes equinovarus
C) Umbilical hernia
D) Gastroschisis

Question 20

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?

A) There is less risk for injury or complications with pneumoperitoneum insufflation.
B) Pediatric patients having MIS procedures have less prevalence of adhesion formation.
C) There is less possibility for abdominal injury from Foley catheter decompression.
D) MIS procedures on children do not require the use of thromboembolic devices.

Question 21

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 interventions are appropriate,when implemented,in protecting the pediatric patient from hypothermia?

A) Keep the child covered as much as possible.
B) Adjust room temperature approximately 1 hour before arrival of the child.
C) Provide a radiant heat lamp during anesthesia induction.
D) Administer antibiotic prophylaxis.

Question 22

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 appropriate interventions for preschool age children?

A) Allow them to play with a saline-filled syringe to decrease their fear of injections.
B) Allow them to play with their own mask and place on their stuffed bunny's face.
C) Tell them a story during anesthesia induction.
D) Draw faces on inflated latex gloves and give each glove a name of a surgical team member.

Question 23

Vascular access in pediatric patients may be established intraoperatively for short-term (weeks)or long-term (months,years)use.Select all the examples of a long-term (months,weeks)use vascular access catheter.

A) Central venous line
B) Implanted port
C) Peripherally inserted central venous catheter (PICC)
D) Power injection port