Deck 25: Pediatric Surgery

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?

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.

Answer 1

B
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?

A) Measure and record the amount of irrigation solution poured onto the sterile back table.
B) Weigh sponges on a gram scale and report estimated loss.
C) Provide suction collection canisters with milliliter measurement indicators.
D) Calculate the estimated total blood volume for the patient according to the patient's age.

Answer 2

B
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?

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

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 _.

A) Dr.Erick Erikson;Dr.Jean Piaget
B) Dr.Geoffery Barns;Dr.Jules Junger
C) This statement is a combined consensus of both of their theories.
D) Neither theory is represented by this statement.

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:

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) disarrangement of existing lip tissues associated with a cleft of the palate.

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:

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) plan an inservice for the OR staff on MH crisis management.
D) pursue a physician order for a laboratory test to rule out 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?

A) Meningocele,myelomeningocele,and encephalocele
B) Craniosynostosis and hydrocephalus
C) Brain tumors and trauma
D) All of the options are correct.

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?

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 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.

A) Foot dystonia
B) Clubfoot
C) Orthopedia
D) Subtalar orthopnea

Question 10

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) Adolescence
D) All of options are correct.

Question 11

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 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:

A) congenital birth anomalies and conditions are the most frequent surgical diagnoses.
B) from birth onward,the child is in a continual state of development and physiologic change.
C) thorough knowledge of the differences between children and adults is integral to the provision of nursing care.
D) a proportionally large head,short neck,and large tongue influence anesthesia care.

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.

A) Blood pressure within acceptable range
B) Bounding peripheral pulses
C) Three wet diapers in 24 hours
D) Intact mucous membranes

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?

A) Risk for Infection related to surgical intervention
B) Fear related to unmet goals
C) Anxiety related to separation from family and friends
D) Risk for hypothermia related to loss of body surface heat

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?

A) Nissen fundoplication
B) Roux-en-Y bypass
C) Pyloromyotomy with pyloroplasty
D) Sphincterotomy

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:

A) strengthening the eye muscles
B) weakening the eye muscles
C) repositioning the eye muscles
D) All of the options are correct.

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?

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 scary story during anesthesia induction.
D) Draw faces on inflated latex gloves and give each glove a name of a surgical team member.

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:

A) consider transport to a pediatric trauma center.
B) transport to the nearest emergency department.
C) transport immediately to a pediatric trauma center.
D) transport to the ambulatory surgery center across the street for stabilization.

Question 19

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 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?

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 21

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

Question 22

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 23

Pharyngeal obstruction is revealed by a history of sleep-disordered breathing.Mouth breathing,snoring,pauses in breathing,restless sleep,waking at night,and enuresis may be related to obstruction.Pharyngeal obstruction may also be caused by recurrent pharyngitis or tonsillitis.Select all the procedures that are designed for the relief of pharyngeal obstruction.

A) Tonsillectomy
B) Adenoidectomy
C) Flexible nasolaryngoscopy
D) Pharyngotomy

Question 24

Sheldon Swanson is a 14-year-old boy scheduled for spinal fusion with implantation of rods from T₁₀ to L2.During the preoperative interview and assessment,Sheldon asks the perioperative nurse how bad his pain will be when he wakes up,and if he will have enough pain medicine available.Sheldon also wonders how the nurse will know when his pain is severe enough to ask for pain medicine.The perioperative nurse assures Sheldon 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 and demonstrate the Likert-type pain rating scale with scores ranging from 0 (no pain) to 10 (worst pain).
C) ask Sheldon to teach back what he knows about the pain scales.
D) All of the options are correct.

Question 25

Much like the adult population,many traditional "open" pediatric surgical procedures are being replaced by minimally invasive surgery (MIS)procedures.Because the field of pediatric MIS is relatively new,surgeons are at an advantage because they are able to combine virtual reality techniques and robotics with the most current technology and instrumentation.Select all of 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