OB/Pedi Test 5

An infant is brought to the emergency department with poor skin turgor, weight loss, lethargy, and tachycardia. This is suggestive of:

Dehydration

In providing nourishment for a child with CF, which factor should the nurse keep in mind?

Diet should be high in carbohydrates and protein

A child with congestive heart failure is placed on a maintenance dosage of digoxin. The dosage is 0.07 mg/kg/day, and the child's weight is 7.2 kg. The physician prescribes the digoxin to be given once a day by mouth. Each dose will be _____ mg. Record your answer using one decimal place.

0.5 0.07 mg/day x 7.2kg = 0.5 mg/d

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? a. Atrial septal defect b. Tetralogy of Fallot c. Ventricular septal defect d. Patent ductus arteriosus

Tetralogy of Fallot

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurses reply should be based on knowing that:

The child needs opportunities to play with peers

What name is given to identify an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets? a. Aplastic anemia b. Thalassemia major c. Disseminated intravascular coagulation d. Immune thrombocytopenia

d. Immune thrombocytopenia

Which statement most accurately describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen b. Sickle-shaped cells decrease blood viscosity c. Increased red blood cell destruction occurs d. Decreased red blood cell destruction occurs

c. Increased red blood cell destruction occurs

What beneficial effect is achieved by administering digoxin? a. Decreases edema b. Decreases cardiac output c. Increases heart size d. Increases venous pressure

Decrease edema

Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a/an:

Decrease in blood platelets.

Which are the most serious complications for a child with Kawaski disease (KD)? Select all that apply 1. coronary thrombosis 2. Coronary stenosis 3. coronary artery aneurysm 4. Hypocoagulability 5. decreased sedimentation rate 6. hypoplastic left heart syndrome

1. coronary thrombosis 2. Coronary stenosis 3. coronary artery aneurysm

A nurse is caring for several patients with acute lymphocytic leukemia (ALL). Which children does the nurse understand have the best prognosis?

<10 years of age White count 4,200/mm3

Which of the following is TRUE about sickle cell disease (SCD)? Select all that apply. A. Sickle cell anemia (SCD) is an inherited disorder of the hemoglobin in blood. B. Sickle cell anemia requires the inheritance of two sickle cell genes. C. Sickle cell trait, which is the inheritance of one sickle gene, almost never causes problems. D. Virtually all of the major symptoms of sickle cell anemia are the direct result of the abnormally shaped sickled red blood cells obstructing the flow of blood. E. The contemporary treatment of sickle cell anemia is focused primarily toward managing the individual features of the illness as they occur.

A. Sickle cell anemia (SCD) is an inherited disorder of the hemoglobin in blood. B. Sickle cell anemia requires the inheritance of two sickle cell genes. C. Sickle cell trait, which is the inheritance of one sickle gene, almost never causes problems. D. Virtually all of the major symptoms of sickle cell anemia are the direct result of the abnormally shaped sickled red blood cells obstructing the flow of blood. E. The contemporary treatment of sickle cell anemia is focused primarily toward managing the individual features of the illness as they occur.

Which clinical manifestation would most suggest acute appendicitis?

Abdominal pain that is most intense at McBurneys point

When teaching the mother of a 9-month-old about administering liquid iron preparations, the nurse should include that:

Adequate dosage will turn the stools a tarry green color

A school-age child is admitted in vaso-occlusive sickle cell crisis. The childs care should include:

Adequate hydration pain management. The management of crises includes adequate hydration, minimizing energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated.

A school-age child diagnosed with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? a. Encourage drinking large amounts of favorite fluids. b. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. c. Administer an antiemetic at least 30 minutes before chemotherapy begins. d. Administer an antiemetic as soon as child has nausea.

Administer an antiemetic at least 30 minutes before chemotherapy begins.

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? a. Administering penicillin b. Avoiding salicylates (aspirin) c. Imposing strict bed rest for 4 to 6 weeks d. Administering corticosteroids if chorea develops

Administer penicillin

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well?

Alert the physician

When assessing a child for possible congenital heart defects, where should the nurse measure blood pressure?

All four extremities

What is the nurses first action when planning to teach the parents of an infant with a congenital heart defect (CHD)?

Assess the parents anxiety level and readiness to learn

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests

Asthma

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child (SATA)?

Avoidance of intramuscular (IM) injections Acetaminophen for mild pain control Soft toothbrush for dental hygiene

A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention? A. Fatigue and Anorexia B. Fever and Petechiae C. Swollen lymph nodes in the neck and lethargy. D. Enlarged liver and spleen

B. Fever and Petechiae

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered?

Before chest physiotherapy (CPT)

One of the most frequent causes of hypovolemic shock in children is:

Blood loss.

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) a. Warm flushed extremities b. Weight loss c. Decreased urinary output d. Sweating (inappropriate) e. Anorexia

Decreased urinary output Sweating Anorexia/Fatigue

A child being treated for Acute Lymphocytic Leukemia (ALL) has a white blood cell (WBC) count of 7,000/mm3. the nursing care plan lists risk for infection as a priority nursing diagnosis, and measures are being taken to reduce the child's exposure to infection. the nurse determines that the plan has been successful when which outcome has been met? A. child's WBC count goes up .B. child's WBC count goes down. C. child's temperature remains within normal range. D. parents demonstrate good hand washing technique."

C. child's temperature remains within normal range.

A common, serious complication of rheumatic fever is:

Cardiac valve damage

A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient?

Chemotherapy

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child (SATA)?

Chlorhexidine gluconate (Peridex) Antifungal troches (lozenges) Lip balm (Aquaphor)

The nurse is assessing a child with acute epiglottitis. Examining the childs throat by using a tongue depressor might precipitate which symptom or condition?

Complete obstruction

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

Congestive Heart Failure

A nurse is preparing for the admission of a child with Kawasaki disease. On assessment of the child, the nurse expects to note which clinical manifestation of the acute stage of the disease?

Conjunctival hyperemia

A child has the following laboratory values: WBC, 7.2mm3; bands, 4%; and neutrophils, 60%. Based on these values, which action by the nurse is the most appropriate?

Continue monitoring the child for infection.

Which clinical manifestations would the nurse expect to see as shock progresses in a child and becomes decompensated shock (SATA)? Cool extremities and decreased skin turgor Confusion and somnolence Tachypnea and poor capillary refill time

Cool extremities and decreased skin turgor Confusion and somnolence Tachypnea and poor capillary refill time

Which description of a stool is characteristic of intussusception?

Currant jelly stools

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include:

Elevating the head but giving nothing by mouth.

Which type of croup is always considered a medical emergency?

Epiglottitis

What is the principle clinical feature of Kawasaki disease?

Fever presenting for 5 days and acute erythema/edema of hands and feet

A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse give the family to help maintain a safe environment for the child?

Flowers, plants, and produce are not allowed

When caring for an infant with an upper respiratory tract infection and elevated temperature, an appropriate nursing intervention is to:

Give small amounts of favorite fluids frequently to prevent dehydration.

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

Heart failure

An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is:

Idiopathic thrombocytopenic purpura.

A child is receiving chemotherapy. The nurse assesses the childs oral cavity and notes the following: raspy voice, thick saliva, and debris on the teeth. Which action by the nurse is the most appropriate?

Increase the frequency of oral care.

Which clinical changes occur as a result of septic shock?

Increased cardiac output

A young child is brough to the emergency department with severe dehydration secondary to acute diarrhea and vomiting. Therapeutic management of this child will begin with

Intravenous fluids

A child is being discharged after surgical resection of a retinoblastoma with enucleation. Which discharge instruction is most important based on the diagnosis?

Irrigation of the surgical site

Which of the following is the most common cause of acquired coronary artery disease in children? a. Hypertension b. Scarlet fever c. Kawasaki disease d. Steven Johnson Syndrome

Kawasaki disease (because it affects the coronary arteries)

An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during a routine blood draw. Which interventions should the nurse implement? Place in order from the highest-priority intervention to the lowest-priority intervention. a. Administer 100% oxygen by blow-by b. Place infant in knee-chest position c. Remain calm d. Give morphine subcutaneously or by an existing intravenous line

Knee chest Oxygen Morphine Calm

A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp. The parent also reports that the child seems lethargic and tired all the time. The nurse notes that the child appears pale. Which other finding would warrant immediate notification of the health-care-provider?

Left-sided abdominal enlargement.

Which medication is the most effective choice for treating pain associated with sickle cell crisis in a newly admitted 5-year-old child? a. Morphine b. Acetaminophen c. Ibuprofen d. Midazolam

Morphine

A nurse notes in a patients medical record high levels of vanillymandelic acid (VMA). Based on this information, which condition does the nurse prepare to educate the patient and family about?

Neuroblastoma

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool. The most appropriate nursing action is to:

Notify the practitioner

A nurse works on a pediatric oncology unit. After receiving report, which child should the nurse assess first?

On high-dose methotrexate (Rheumatrex), urine pH of 7.8

Therapeutic management of the child with acute diarrhea and dehydration usually begins with:

Oral rehydration solution (ORS)

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis?

Painful swelling of hands and feet, painful joints

A clinic nurse notes that a child brought in for a physical has swelling and bruising around the eyes. The patient denies any trauma and the parent reports no environmental allergies. Which assessment is most important?

Palpate abdomen and neck.

A nursing student is caring for a child diagnosed with Wilms tumor. Which action by the student causes the faculty member to intervene?

Palpates the abdomen in all four quadrants

Pancreatic enzymes are administered to the child with cystic fibrosis. Nursing considerations should include:

Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

The parents of a young child with congestive heart failure tell the nurse that they are nervous about giving digoxin. The nurse's response should be based on knowing what information? a. It is a safe, frequently used drug. b. It is difficult to either overmedicate or under medicate with digoxin. c. Parents lack the expertise necessary to administer digoxin. d. Parents must learn specific, important guidelines for administration of digoxin

Parents must learn specific, important guidelines for administration of digoxin

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect? a. Pulmonary stenosis b. Patent ductus arteriosus c. Ventricular septal defect d. Coarctation of the aorta

Patent ductus arteriosus

A nurse is caring for a child who has acute lymphocytic leukemia and has been treated with doxorubicin (Adriamycin). Which assessment finding would the nurse report immediately?

Peripheral edema

Which term is used to describe a clinical manifestation of the systemic venous congestion that can occur with congestive heart failure? a. Tachypnea b. Tachycardia c. Peripheral edema d. Pale, cool extremities

Peripheral edema

A major clinical manifestation of rheumatic fever is:

Polyarthritis

As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in what electrolyte? a. Chlorides b. Potassium c. Sodium d. Zinc

Potassium

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents (strokes) exists. An important objective to decrease this risk is to:

Prevent dehydration.

Which structural defects constitute tetralogy of Fallot?

Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics:

Rarely cause addiction because they are medically indicated. The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild-to moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and given around the clock.

A 7-year-old child presents to the emergency department, where the parent reports a 3-week history of pale skin, extreme fatigue, and dizziness. Which laboratory value would the nurse correlate with the patients current condition?

Red blood cell count: 2.8/mm3

Which action by the school nurse is important in the prevention of rheumatic fever? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

Refer children with sore throats for cultures

When caring for a child with probable appendicitis, the nurse should be alert to recognize that a sign of perforation is:

Sudden relief from pain.

Parents of a school-age child with hemophilia ask the nurse, ―Which sports are recommended for children with hemophilia?‖ Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

Swimming Golf Bowling

A nurse works on the pediatric oncology floor. After receiving the handoff report, which child does the nurse assess first?

Temperature of 101.5F

A nurse is looking at photographs of a friends infant. The nurse notes a whitish glow in the childs eyes, and the friend asks why the babys eyes look so odd. Which response by the nurse is the most appropriate?

This is called leukocoria and may signify retinoblastoma.

In which situation is there the greatest risk that a newborn infant will have a congenital heart defect (CHD)?

Trisomy 21 detected on amniocentesis

Which is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. First stage of coagulation process is abnormally stimulated.

c. Unrestricted proliferation of immature white blood cells (WBCs) occurs.

The nurse is evaluating a child who is taking digoxin for her cardiac condition. The nurse is cognizant that a common sign of digoxin toxicity is:

Vomiting

What is a common sign of digoxin toxicity? a. Seizures b. Vomiting c. Bradypnea d. Tachycardia

Vomiting

Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure? a. Weigh the infant every day on the same scale at the same time. b. Notify the physician when weight gain exceeds more than 20 g/day. c. Put the infant in a car seat to minimize movement. d. Administer digoxin as ordered by the physician.

Weigh the infant every day on the same scale/time

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct?

You may need to increase the caloric density of your infants formula

As related to inherited disorders, which statement is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? a. Immobilization and elevation of the affected joint b. Administration of acetaminophen for pain relief c. Assessment of the child's response to hospitalization d. Assessment of the impact of hospitalization on the family system

a. Immobilization and elevation of the affected joint

The nurse is caring for an infant diagnosed with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands? a. Organize nursing activities to allow for uninterrupted sleep. b. Allow the infant to sleep through feedings during the night. c. Wait for the infant to cry to show definite signs of hunger. d. Discourage parents from rocking the infant.

a. Organize nursing activities to allow for uninterrupted sleep.

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? a. Perinatal transmission b. Sexual abuse c. Blood transfusions d. Poor hand washing

a. Perinatal transmission

young child diagnosed with leukemia is experiencing anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? a. Relax any eating pressures. b. Firmly insist that child eat normally. c. Begin gavage feedings to supplement diet. d. Serve foods that are either hot or cold.

a. Relax any eating pressures.

The nurse is administering an IV chemotherapeutic agent to a child diagnosed with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? a. Stop drug infusion immediately. b. Recheck rate of drug infusion. c. Observe child closely for next 10 minutes. d. Explain to child that this is an expected side effect.

a. Stop drug infusion immediately.

what are the signs and symptoms of immune thrombocytopenia purpura (ITP)?

acute onset bruising petechiae low platelets

A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain? a. Edema b. Bone involvement c. Petechial hemorrhages d. Changes within the muscles

b. Bone involvement

A young child with human immunodeficiency virus is receiving several antiretroviral drugs. What is the expected outcome of these drug therapies? a. Cure the disease. b. Delay disease progression. c. Prevent spread of disease. d. Treat Pneumocystis jiroveci pneumonia.

b. Delay disease progression.

To detect human immunodeficiency virus (HIV), most laboratory tests focus on the a. virus. b. HIV antibodies. c. CD4 counts. d. CD8 counts

b. HIV antibodies.

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5C (101.3F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vaso-occlusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of cold.

b. Notify the health care provider if a fever of 38.5C (101.3F) or greater occurs. c. Give penicillin as prescribed. d. Notify the health care provider if your child begins to develop symptoms of cold.

What term is used to identify the condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

b. Sickle cell anemia

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? a. Atrial septal defect b. Tetralogy of Fallot c. Ventricular septal defect d. Patent ductus arteriosus

b. Tetralogy of Fallot

Which immunization should be given with caution to children infected with human immunodeficiency virus? a. Influenza b. Varicella c. Pneumococcus d. Inactivated poliovirus

b. Varicella

The nurse is caring for a child with Kawasaki disease in the acute phase. Which of the following clinical manifestations would the nurse expect to observe? a. osler nodes b. cervical lymphadenopathy c. strawberry tongue d. chorea e. erythmatous palms f. polyarthritis

b. cervical lymphadenopathy c. strawberry tongue e. erythmatous palms

When caring for the child with Kawasaki disease, the nurse should understand that principle of care? a. The child's fever is usually responsive to antibiotics within 48 hours. b. The principal area of involvement is the joints. c. Aspirin is contraindicated. d. Therapeutic management includes administration of gamma globulin and aspirin.

d. Therapeutic management includes administration of gamma globulin and aspirin.

In children diagnosed with sickle cell disease, tissue damage results from which of the following? a. air hunger and respiratory alkalosis due to deoxygenated red blood cells b. hypersensitivity of the central nervous system due to elevate serum bilirubin c. a general inflammatory response to to an autoimmune reaction from hypoxia d. local tissue damage with ischemia and necrosis due to obstructed circulation

d. local tissue damage with ischemia and necrosis due to obstructed circulation

The nurse is caring for a child witha diagnosis of kawasaki disease. The child's parent asks the nurse, How does Kawasaki disease affect my childs heart and blood vessels? The nurses response is based on the understanding that:

inflammation weakens blood vessels, leading to aneurysm