PEDS! Exam 2 !!

You are working with a new grad on the pediatric unit and your patient is returning from the cardiac cath lab. You feel the graduate understands the important nursing interventions when she says which of the following? a. Check pulses especially below the cath site for equality and symmetry. b. Check vital signs, which may be taken as frequently as 30-45 minutes, with special emphasis on the heart rate, which is counted for 1 full minute for evidence of dysrhythmias or bradycardia. c. Special attention needs to be given to the BP, especially for hypertension, which may indicate hemorrhage or bleeding from the cath site. d. Check the dressing for evidence of bleeding or hematoma formation in the femoral or antecubital area. e. Allow the child to ambulate because this will prevent skin breakdown from lying so long in one place.

a, d.

When assessing a child after heart surgery to correct TOF, which of the following would alert the nurse to suspect low cardiac output? 1. Bounding pulses and mottled skin 2. Altered LOC and thready pulse 3. Capillary refill of 2 seconds and blood pressure 96/67 4. Extremities warm to the touch and pale skin

2

A 2-year-old is brought to the emergency department for fever and ear pain. The parents note the child has had many ear infections and that polyethylene tubes have been recommended, but the parents cannot afford surgery. The child is diagnosed with bilateral otitis media. The toddler is carrying a baby bottle full of juice, and a parent is carrying a pack of cigarettes. What one preventive measure could be taught the parents to decrease the incidence of ear infections? 1. Wean the toddler from the bottle. 2. Give the toddler a decongestant before bedtime. 3. Encourage the parent to smoke outside the house. 4. Have the child's hearing checked.

1

A child born with Down syndrome should be evaluated for what associated cardiac manifestation? 1. CHD. 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy

1

Parents are told by the genetic counselor that they have a 1:4 probability of having a second child with cystic fibrosis (CF). They already have one child who is affected. The parents state their risk is lower now than when they had the previous child. What should the nurse tell the parents about the 1:4 probability? 1. Each pregnancy is an independent event. 2. The probability of having another child with CF is twice as likely as it was when they had the first child. 3. The probability of having a healthy child is twice as likely with this pregnancy. 4. The probability of miscarrying is greater now than with the previous pregnancy.

1

Which of the following initial physical findings would indicate the development of carditis in a child with rheumatic fever? 1. Heart murmur 2. Low blood pressure 3. Irregular pulse 4. Anterior chest wall pain

1

Which of the following would the nurse expect to include in the plan of care for a child diagnosed with TOF who has undergone corrective surgery? 1. Two -3g of sodium in the diet each day 2. Physical activity restrictions 3. Visits limited to a selected few 4. Assignment to an isolation room

1

The nurse is assisting with a sports physical session at a local grade school. A fixed splitting of the S2 sound is heard in an otherwise healthy child. The nurse knows that this is a diagnostic sign of which cardiac defect? 1. Mitral regurgitation. 2. Atrial septal defect. 3. Functional murmur. 4. Pericardial friction rub.

2

Hypoxic spells in the infant with CHD can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. CVA. 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

1, 2, 3, 4, 6

A child has been diagnosed with KD. The parents are asking questions about the child's outcome. The nurse explains the most serious complications. 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, 2, 3.

A child returns from surgery, having had tonsils and adenoids removed. When the parents are getting ready for discharge, the nurse instructs them to do what to care for their child. Select all that apply. 1. Some secretions may be blood-tinged for a few days. 2. Run a cool mist vaporizer in the bedroom. 3. Pain relief should be provided every 4 hours. 4. The child can resume a normal diet. 5. The child should blow the nose and cough every 4 hours.

1, 2, 3.

The parent of an infant newly diagnosed with TOF is asking the nurse which defects are involved. Select all that apply. 1. VSD. 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. PS. 5. Pulmonic atresia. 6. Overriding aorta. 7. PDA.

1, 2, 4, 6.

What does the therapeutic management of CF patients include? Select all that apply. 1. Providing a high-protein, high-calorie diet. 2. Providing a high-fat, high-carbohydrate diet. 3. Encouraging exercise. 4. Minimizing pulmonary complication. 5. Encouraging medication compliance.

1, 3, 4, 5. 1. Children with CF have difficulty absorbing nutrients because of the blockage of the pancreatic duct. Pancreatic enzymes cannot reach the duodenum to aid in digestion of food. These children often require up to 150% of the caloric intake of their peers. The nutritional recommendation for CF patients is high-calorie and high-protein. 2. A high-fat, high-carbohydrate diet is not recommended for adequate nutrition. 3. Exercise is effective in helping CF patients clear secretions. 4. Minimizing pulmonary complications is essential to a better outcome for CF patients. Compliance with CPT, nebulizer treatments, and medications are all components of minimizing pulmonary complications. 5. Medication compliance is a necessary part of maintaining pulmonary and gastrointestinal function.

The physician orders montelukast (Singulair) for a 10-year-old who has moderate, persistent asthma. The nurse should instruct the child and parents about which characteristic of the medication? Select all that apply. 1. This is an add-on medication to the child's regular medications. 2. The child is too young to be taking this medication. 3. It is not to be used to treat acute episodes. 4. The parents will need to give up smoking. 5. The child will require chest physiotherapy in conjunction with the medication.

1, 3.

The nurse is caring for an infant with CHF. The following are interventions to decrease cardiac demands on the infant. Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

1, 4, 5, 6, 7.

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by RSV. Which interventions should the nurse include in the plan of care? Select all that apply. 1. Place the infant in a private room 2. Ensure the infants head is in a flexed position 3. Wear a mask at all times when in contact with the infant 4. Place the infant in a tent that delivers warm humidified air 5. Position the infant on the side, with the head lower than the chest 6. Ensure the nurses caring for the infant with RSV do not care for other high risk children.

1, 6. cool humidified air - not warm. private room or with another with RSV head and chest at 30-40 degree angle

A nursing action that promotes ideal nutrition in an infant with CHF is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using firm nipples with small openings to slow feedings.

1.

Which of the following would the nurse expect to include in the plan of care for a child who is diagnosed with rheumatic fever and carditis and admitted to the hospital? 1. Ensuring continuous parental presence at the childs bedside 2. Providing the child with periods of rest 3. Encouraging participation in age appropriate activities 4. Advising the child to eat as much as possible

2

While looking through the chart of an infant with a CHD of decreased pulmonary blood flow, the nurse would expect what laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left.

2

A 1-year-old child is being prepared for a cardiac catheterization procedure. Which of the following findings about the child might delay the procedure? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

2 - potential for infection

Aspirin has been ordered for the child with RF in order to: 1. Keep the PDA open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis.

2.

The nurse is caring for a 1-year-old who has been diagnosed with CHF. Treatment began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear and equal bilaterally, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr 2. 1 cc/kg/hr 3. 30 cc/hr 4. 1 oz/hr

2.

The nurse is caring for a 3-month-old with a VSD. The physicians have decided not to repair it surgically. The parents express concern that this is not best for their child and ask why their daughter will not have an operation. The nurse's best response to the parents is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your daughter's defect is small and will likely close on its own by the time she is 2 years old." 3. "It is common for the physicians to wait until an infant develops respiratory distress before they do the surgery because of the danger." 4. "With a small defect like this, we will wait until the child is 10 years old to do the surgery."

2.

The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur when she is sleeping. The nurse questions the parents about what recent illness? 1. KD. 2. RF. 3. Malignant hypertension. 4. Atrial fibrillation.

2.

An 11-month-old was born at 28 weeks' gestation and required 2 weeks of ventilation. The baby is currently well and is being seen in the clinic. The physician recommends that the baby receive preventive therapy for respiratory syncytial virus for the next 5 months. The nurse knows that the physician will order which medication? 1. RespiGam. 2. Ribavirin. 3. Palivizumab (Synagis). 4. Pneumococcal vaccine.

3

During play, a toddler with a history of TOF might assume which of the following positions? 1. Sitting. 2. Supine. 3. Squatting. 4. Left lateral recumbent.

3

CHDs are classified by which of the following? Select all that apply. 1. Cyanotic defect. 2. Acyanotic defect. 3. Defects with increased pulmonary blood flow. 4. Defects with decreased pulmonary blood flow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.

3, 4, 5, 6

A 2-month-old is being treated with furosemide for CHF. Which of the following plans would also be appropriate in helping to control the CHF? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

3.

A 5-month-old has been diagnosed with an ASD. The flow of blood through the heart with this type of defect is: 1. Right to left. 2. Equal between the two chambers. 3. Left to right. 4. Bypassing the defect.

3.

An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1. Prone position 2. On the stomach 3. Left lateral position 4. Right lateral position

3.

Family discharge teaching has been effective when the parents of a female toddler diagnosed with KD states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her a pain reliever for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."

3.

Which patient could require feeding by gavage? 1. A patient with KD in the acute phase. 2. A toddler with repair of transposition of the great vessels. 3. An infant with CHF. 4. A school-ager with RF and chorea.

3.

Which statement by the mother of a patient with RF shows she has an understanding of prevention in her other children? 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A streptococcus, I will give them their antibiotic." 4. "If their culture is positive for staphylococcus A, I will give them their antibiotic.

3.

A 2-year-old is admitted to the hospital in respiratory distress. The physician tells the parents that the child probably has RSV. The parents ask the nurse how they will determine if their child has RSV. Which is the nurse's best response? 1. "We will need to do a simple blood test to determine whether your child has RSV." 2. "There is no specific test for RSV. The diagnosis is made based on the child's symptoms." 3. "We will swab your child's nose and send those secretions for testing." 4. "We will have to send a viral culture to an outside lab for testing."

3. The child is swabbed for nasal secretions. The secretions are tested to determine if a child has RSV.

A pediatric client was seen at the pediatrician's office and was diagnosed with viral tonsillitis. The parent asks how to care for the child at home. Which is the nurse's best response? 1. "You will need to give your child a prescribed antibiotic for 10 days." 2. "You will need to schedule a follow-up appointment in 2 weeks." 3. "You can give your child Tylenol every 4 to 6 hours as needed for pain." 4. "You can place warm towels around your child's neck for comfort."

3. Tylenol is recommended prn for pain relief.

A 2-month-old is diagnosed with otitis. The parent asks the nurse if the otitis will have any long-term effects for the child. Understanding the complications that can occur with otitis, which is the nurse's best response? 1. "The child could suffer hearing loss." 2. "The child could suffer some speech delays." 3. "The child could suffer recurrent ear infections." 4. "The child could require ear tubes."

3. When children acquire an ear infection at such a young age, there is an increased risk of recurrent infections.

A child with moderate asthma is wheezing and coughing. Before the physician sees the child, the nurse should perform which test? 1. Skin testing for allergens. 2. PCO2 levels. 3. Metered dose inhaler. 4. Peak flowmeter.

4

Gamma globulin is being given to a 1-year-old being treated for KD. Which of the following vaccines must be delayed for 11 months after the administration of gamma globulin? 1. Diphtheria, tetanus, and pertussis. 2. Hepatitis B. 3. Inactivated polio virus. 4. Measles, mumps, and rubella.

4

Which of the following is the primary goal for a newborn with a cleft of the soft palate? 1. Prevent ear infections. 2. Help the mother bond with the baby. 3. Repair the cleft palate. 4. Establish feeding and sucking.

4

A 2-month-old with TOF is seen in your clinic for a check-up. During the examination, the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.

4.

A child with Croup is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the most appropriate nursing action? 1. Tell the mother that the child must stay in the tent. 2. Place a toy in the tent to make the child feel more comfortable 3. Call the health care provider and obtain a prescription for a mild sedative 4. Let the mother gold the child and direct the cool mist over the child's face

4.

A child with LTB (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the most appropriate nursing action? 1. Tell the mother that the child must stay in the tent 2. Place a toy in the tent to make the child feel more comfortable 3. Call the HCP and obtain a prescription for a mild sedative 4. Let the mother hold the child and direct the cool mist over the child's face.

4.

The clinic nurse it providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent? 1. The immunization schedule will need to be altered 2. The child should not receive any hepatitis vaccines 3. The child will receive all the immunizations except for the polio series 4. The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination.

4.

A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all that apply. a. Provide a soft diet b. Position the child on the left side c. Administer an antihistamine twice daily d. Irrigate the right ear with normal saline every 8 hours e. Administer motrin for fever every four hours f. instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy

a, e, f.

A 10-month-old infant who was seen in the Emergency Department for respiratory distress is admitted to the pediatric unit with a diagnosis of bronchiolitis. Which of these, if assessed in the infant, alerts the healthcare provider the bronchiolitis is worsening? a. Head bobbing b. Inspiratory stridor c. Drooling d. Pleuritic chest pain

a.

Problem The healthcare provider is preparing to administer indomethacin to an infant with a persistent patent ductus arteriosus (PDA). The mother of the baby asks why the medication is being given to her baby. What is the healthcare provider's best response? A. "Your baby needs help clearing the extra fluid from the lungs." B. "Your baby needs this drug because it interferes with substances that keep the PDA open." C. "This drug will help your baby's heart contract with a stronger force." D. "This drug is a non-steroidal anti-inflammatory drug, so it will help control your baby's pain."

b.

The nurse is reviewing the lab results for a child scheduled for tonsillectomy. The nurse determines that which lab value is most significant to review? a. Creatinine b. Prothrombin c. Sedimentation d. Blood urea nitrogen

b. post op bleeding is a concern, the prothrombin time would identify a potential for bleeding.

On assessment of a child admitted with a diagnosis of acute-stage kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? a. cracked lips b. Normal appearance c. Conjunctival hyperemia d. Desquamation of the skin

c.

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure. The nurse should assess the infant for which early sign of hf? a. Pallor b. Cough c. Tachycardia d. Slow and shallow breathing

c. Early signs include tachycardia, tachypnea, scalp sweating, fatigue, irritability, sudden weight gain, resp distress.

A health care provider has prescribed oxygen as needed for infant with heart failure. In which situation should the nurse administer the oxygen to the infant? a. During sleep b. When changing the infant's diapers c. When the mother is holding the infant d. When drawing blood for electrolyte level testing

d

A child with rheumatic fever will be arriving in the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? a. Has the child complained of back pain? b. Has the child complained of headaches? c. Has the child had any nausea or vomiting? d. Did the child have a sore throat or fever within the last two months?

d.

The healthcare provider has an order to administer indomethacin to an infant with a patent ductus arteriosus. Which intervention is a priority to implement? a. Assess peripheral pulses b. Auscultate lung sounds c. Monitor urine output d. Monitor heart rate and rhythm

d.

The healthcare provider is caring for a child with congenital heart disease. When planning care, monitoring for which of the following complications will be included in the plan of care? a. Bradycardia and hepatomegaly b. Pulmonary hypotension and cyanosis c. Increased pulmonary compliance and cyanosis d. Congestive heart failure and hypoxemia

d.

The healthcare provider is caring for an infant with a diagnosis of a congenital heart defect. The baby's pulse is 158 and the respiratory rate is 74. Which of the following is the best position for the baby to be placed? A. Side-lying with a blanket roll at the back B. Supine with the legs slightly elevated C. Prone position with the head elevated D. Upright in an infant seat

d.

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further teaching? a. I will not mix the medication with food b. I will take my child's pulse before administering the medication c. If more than one dose is missed, I will call the health care provider d. If my child vomits after medication administration, I will repeat the dose.

d.

The nurse reviews the lab results for a child with a suspected diagnosis of rheumatic fever, knowing that which lab study would assist in confirming the diagnosis? a. Immunoglobulin b. Red blood cell count c. White blood cell count d. Anti-streptolysin O titer

d.

The nurse is caring for a child after a tonsillectomy. The nurse monitors the child, knowing that which finding indicates the child is bleeding? a. frequent swallowing b. a decreased pulse rate c. complaints of discomfort d. an elevation in blood pressure

a.

The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output? a. Weighing the diapers b. Inserting a foley catheter c. Comparing intake with output d. Measuring the amount of water added to the formula

a.

A 6-month-old infant who was seen in the Emergency Department with wheezing and coughing is admitted to the pediatric unit with a diagnosis of bronchiolitis. During the admission assessment, which of these will alert the healthcare provider the infant's condition is worsening? a. Respiratory rate of 38 breaths/min b. Decreased inspiratory breath sounds c. Irritability and crying d. Dysphasia and loss of appetite

b

During an examination of an infant with a patent ductus arteriosus (PDA), the healthcare provider should expect to observe: Choose all answers that apply: A. Profound cyanosis B. Widening pulse pressure C. Systolic murmur D. Bounding peripheral pulses E. Clubbing of fingers and toes

b, c, d.

A pediatric client is admitted in status asthmaticus. The parent reports that the child is currently taking Singulair, albuterol, and Flovent. What is the most important piece of information that the nurse must ask the parent in order to best treat the patient? 1. "What time did your child eat last?" 2. "Has your child been exposed to any of the usual asthma triggers?" 3. "When was your child last admitted to the hospital for asthma?" 4. "When was your child's last dose of medication?"

4. The nurse needs to know what medication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.

An 8-month-old male twin is in the hospital with RSV. The nurse educated the parent on how to prevent the healthy twin at home from contracting RSV. Which statement indicates the parent needs further teaching? 1. "I should make sure that both my children receive Synagis injections for the remainder of this year." 2. "I should be sure to keep my infected son away from his brother until he has recovered." 3. "I should insist that all people who come in contact with my twins thoroughly wash their hands before playing with them." 4. "I should insist that anyone with a respiratory illness avoid contact with my children until the children are well."

1. Synagis will not help the child who has already contracted the illness. Synagis is an immunization and a method of primary prevention.

The nurse is caring for a school-aged boy with KD. A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen.

1.

A 6-year-old is receiving aspirin therapy for KD. Exposure to what illnesses should be a cause to discontinue therapy and substitute dipyridamole (Persantine)? 1. Chickenpox or flu. 2. E. coli or staphylococcus. 3. Mumps or streptococcus A. 4. Streptococcus A or staphylococcus.

1. they are viral in nature, can lead to development of reye syndrome

The parent of a 4-month-old with CF asks the nurse what time to begin the child's first CPT each day. Which is the nurse's best response? 1. "You should do the first CPT 30 minutes before feeding the child breakfast." 2. "You should do the first CPT after deep-suctioning the child each morning." 3. "You should do the first CPT 30 minutes after feeding the child breakfast." 4. "You should do the first CPT only when the child has congestion or coughing."

1. CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting

A pediatric client is diagnosed with epiglottitis. The parents ask the nurse what treatment their child will receive. Which is the nurse's best response? 1. "Your child will need to complete a course of intravenous antibiotics." 2. "Your child will need to have surgery to remove her tonsils." 3. "Your child will need 10 days of aerosolized ribavirin." 4. "Your child will recover without any intervention in about 5 days."

1. Epiglottitis is bacterial in nature and requires intravenous antibiotics. A 7- to 10-day course of oral antibiotics is usually ordered following the intravenous course of antibiotics.

The nurse is caring for a preschool female diagnosed with CHF. She is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse suspects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.

1. Rubbing eyes may indicate halos > hypokalemia

While assessing a newborn with respiratory distress, the nurse auscultates a machinelike heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2. The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. A PDA. 3. A VSD. 4. Bronchopulmonary dysplasia.

2.

The parent of a pediatric client calls the ER. The parent reports that the child has had a barky cough for the last 3 days and it always gets worse at night. The parent asks the nurse what to do. Which is the nurse's best response? 1. "Take your child outside in the night air for 15 minutes." 2. "Bring your child to the ER immediately." 3. "Give your child an over-the-counter cough suppressant." 4. "Give your child warm liquids to soothe the throat."

1. The night air will help decrease subglottic edema, easing the child's respiratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider.

The parent of a pediatric client with asthma is talking to the nurse about administering the child's albuterol inhaler. Which statement by the parent leads the nurse to believe that the parent needs further education on how to administer the medication? 1. "I should administer two quick puffs of the albuterol inhaler using a spacer." 2. "I should always use a spacer when administering the albuterol inhaler." 3. "I should be sure that my child is in an upright position when administering the inhaler." 4. "I should always shake the inhaler before administering a dose."

1. The parent should always give one puff at a time and should wait 1 minute before administering the second puff.

When developing a plan of care for a newly admitted 2yo child with a diagnosis of kawasaki disease, which of the following would be the priority? 1. Taking vital signs every 6 hours 2. Monitoring intake and output every hour 3. Minimizing skin discomfort 4. Providing passive ROM exercises

2

Which of the following nursing diagnoses would the nurse identify as the priority for a 4 yo child diagnosed with a ventricular septal defect who will be undergoing a cardiac cath? a. Pain related to the structural defect b. Deficient knowledge (parental) related to cardiac cath c. Risk for infection related to decreased oxygenation d. DEcreased cardiac output related to the structural defect

2

A child with kawasaki disease is receiving low dose aspirin. The mother calls the clinic and states that the child has been exposed to influenza. Which recommendations would the nurse make? Select all that apply. 1. Increase fluid intake 2. Stop the aspirin 3. Alternate aspirin and acetaminophen 4. Watch for fever 5. WEigh the child daily

2, 4

A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

2.

An infant with CHF is receiving digoxin to enhance myocardial function. What should the nurse assess prior to administering the medication? 1. Yellow sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

2.

The ED nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indication that the child is experiencing airway obstruction? 1. The child exhibits nasal flaring and bradycardia 2. The child is leaning forward, with the chin thrust out 3. The child has a low grade fever and complains of a sore throat 4. The child is leaning backward, supporting himself with the hands and arms

2.

Which of the following children would benefit most from having ear tubes placed? 1. A 2-month-old who has had one ear infection. 2. A 2-year-old who has had five previous ear infections. 3. A 7-year-old who has had two ear infections this year. 4. A 3-year-old whose sibling has had four ear infections.

2. A 2-year-old who has had multiple ear infections is a perfect candidate for ear tubes. The other issue is that a 2-year-old is at the height of language development, which can be adversely affected by recurrent ear infections.

The parent of an 18-year-old with CF is excited about the possibility of the child receiving a double lung transplant. What should the parent understand? 1. The transplant will cure the child of CF and allow the child to lead a long and healthy life. 2. The transplant will not cure the child of CF but will allow the child to have a longer life. 3. The transplant will help to reverse the multisystem damage that has already been caused by CF. 4. The transplant will be the child's only chance at surviving long enough to graduate college.

2. A lung transplant does not cure CF, but it does offer the patient an opportunity to live a longer life. The concerns are that, after the lung transplant, the child is at risk for rejection of the new organ and for development of secondary infections because of the immunosuppressive therapy.

The nurse is preparing to care for a child after a tonsillectomy. The nurse documents on the plan of care to place the child in which position? 1. Supine 2. Side-lying 3. high fowlers 4. Trendelenburgs

2. the child should be placed prone or side lying to facilitate drainage.

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed RSV. On the basis of this finding, which is the most appropriate nursing action? 1. Initiate strict enteric precautions 2. Move the infant to a room with another child with RSV. 3. Leave the infant in the present room because RSV is not contagious 4. Inform the staff that they must wear a mask, gloves, and gown when caring for the child.

2. Not transmitted via airborne. usually transferred by hands. Contact & standard precautions! gloves and gown.

A 5-year-old is brought to the ER with a temperature of 99.5° F (37.5°C), a barky cough, stridor, and hoarseness. Which of the following nursing interventions should the nurse prepare for? 1. Immediate IV placement. 2. Respiratory treatment of racemic epinephrine. 3. A tracheostomy set at the bedside. 4. Informing the child's parents about a tonsillectomy.

2. The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.

A 2-year-old is diagnosed with asthma. The parents are big sports fans and want their child to play sports. The parents ask the nurse what impact asthma will have on the child's future in sports. Which is the nurse's best response? 1. "As long as your child takes prescribed asthma medication, the child will be fine." 2. "The earlier a child is diagnosed with asthma, the more significant the symptoms." 3. "The earlier a child is diagnosed with asthma, the better the chance the child has of growing out of the disease." 4. "Your child should avoid playing contact sports and sports that require a lot of running."

2. When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging.

A 10yo child with asthma treated for acute exacerbation in the ED. The nurse caring for the child should monitor for which sign, knowing that it indicates worsening of the condition? 1. Warm, dry skin 2. Decreased wheezing 3. Pulse rate of 90 beats per min 4. Respiration of 18 breaths per min

2. it may signal an inability to move air. a silent chest can indicate severe bronchial spasm or obstruction.

After a tonsillectomy, a child begins to vomit bright red blood. The nurse should take which initial action? 1. Maintain NPO status 2. Turn the child to the side 3. Administer the prescribed antiemetic 4. Notify the HCP.

2. prevent aspiration then notify the HCP. NPO would be maintained and an antiemetic may be prescribed.

After a tonsillectomy the nurse reviews the health care providers postop prescriptions. Which prescription should the nurse question? a. Monitor for bleeding b. Suction every 2 hours c. Give no milk or milk products d. Give clear, cool liquids when awake and alert

2. suctioning is anot performed unless there is an airway obstruction because of the risk of trauma to the surgical site.

A 16mo child diagnosed with KD is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. Which of the following would the nurse interpret as the priority? 1. Applying lotion to the hands and feet 2. Offering foods the toddler likes 3. Placing the toddler in a quiet environment 4. Encouraging the parents to get some rest

3

When developing a plan of care for a 3yo child diagnosed with ventricular septal defect, the nurse would include which actions that foster the development of which of following psychosocial tasks according to Erikson? 1. Autonomy vs shame and doubt 2. Identity vs role diffusion 3. Initiative vs guilt 4. Industry vs guilt

3

When developing the discharge teaching plan for the parents of a child who has undergone a cardiac cath for ventricular septal defect, which of the following would the nurse expect to include? 1. REstriction of the child's activities for the next 3 weeks 2. Use of sponge baths until the stitches are removed 3. Use of prophylactic antibiotics before receiving any dental work 4. Maintenance of a pressure dressing until return visit with the physician.

3

When teaching a child how to perform coughing and deep breathing exercises before corrective surgery for TOF, which of the following principles would the nurse address first? 1. Organizing info to be taught in a logical sequence 2. Arranging to use actual equipment for demonstrations 3. Building the teaching on the childs current level of knowledge. 4. Presenting the information in order from simplest to most complex.

3

The mother of a hospitalized 2 year old child with Croup asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make? 1. The child may be allergic to antibiotics 2. The child is too young to receive antibiotics 3. Antibiotics are not indicated unless a bacterial infection is present 4. The child still has the maternal antibodies from birth and does not need antibiotics.

3.

The mother of a hospitalized 2yo child with viral LTB (croup) asks the nurse why the HCP did not prescribe antibiotics. Which response should the nurse make? 1. The child may be allergic to antibiotics 2. The child is too young to receive antibiotics 3. Antibiotics are not indicated unless a bacterial infection is present. 4. The child still has the maternal antibodies from birth and does not need antibiotics

3.

Which statement by the mother of a male toddler with RF shows she has good understanding of the care of her child? 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him the aspirin that is ordered for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain."

3.

A 3-year-old female is admitted to the ER with drooling, difficulty swallowing, sore throat, and a fever of 39°C (102.2° F). The physician suspects epiglottitis. The parents ask the nurse how the physician will know for sure if their daughter has epiglottitis. Which is the nurse's best response? 1. "A simple blood test will tell us if your daughter has epiglottitis." 2. "We will swab your daughter's throat and send it for culture." 3. "We will do a lateral neck x-ray of the soft tissue." 4. "The diagnosis is made based on your daughter's signs and symptoms."

3. A lateral neck x-ray is the method used to diagnose epiglottitis definitively. The child is at risk for complete airway obstruction and should always be accompanied by a nurse to the x-ray department.

A 3-year-old female is admitted to the hospital with asthma. The nurse is trying to work with the child on breathing exercises to increase her expiratory phase. What should the nurse have the child do? 1. Use an incentive spirometer. 2. Breathe into a paper bag. 3. Blow a pinwheel. 4. Take several deep breaths

3. Blowing a pinwheel is an excellent means of increasing a child's expiratory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child's expiratory phase.

A female child with CF is hospitalized with constipation. The parent asks the nurse what will need to be done to relieve the child's constipation. Which is the nurse's best response? 1. "Your child likely has an obstruction and will require surgery." 2. "Your child will likely be given IV fluids to relieve her constipation." 3. "Your child will likely be given GoLYTELY to relieve her constipation." 4. "Your child will be placed on a clear liquid diet to relieve her constipation."

3. CF patients with constipation commonly receive a stool softener or an osmotic solution orally to relieve their constipation.

The parent of a 10-month-old with CF asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion? 1. "You may need to increase the number of fresh fruits and vegetables you give your child each day." 2. "You may need to advance your child's diet to whole cow's milk because it is higher in fat than formula." 3. "You may need to change your child to a higher-calorie formula." 4. "You may need to increase your child's carbohydrate intake each day."

3. Often infants with CF need to have a higher-calorie formula to meet their nutritional needs. Infants may also be placed on hydrolysate formulas that contain added medium-chain triglycerides.

A 6-month-old is diagnosed with an ear infection. The parents report that the child is not sleeping well and is crying frequently. The child also has a moderate amount of yellow drainage coming from the infected ear. This is the parents' first baby. Which of the following nursing objectives is the priority for this family at this time? 1. Educating the parents about signs and symptoms of an ear infection. 2. Providing emotional support for the parents. 3. Providing pain relief for the child. 4. Promoting the flow of drainage from the ear.

3. Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better.

A 6-year-old presents to the ER with respiratory distress and stridor. The child is diagnosed with RSV. The parent asks the child's nurse how the child will be treated. Which is the nurse's best response? 1. "We will treat your child with intravenous antibiotics." 2. "We will treat your child with intravenous steroids." 3. "We will treat your child with nebulized racemic epinephrine." 4. "We will treat your child with alternating doses of Tylenol and Motrin."

3. Racemic epinephrine promotes mucosal vasoconstriction.

The nurse is caring for a 22-month-old male who has had repeated bouts of otitis media. The nurse is educating the parents about otitis media. Which of the following statements from the parents indicates they need additional teaching? 1. "If I quit smoking, my child may have less chance of getting an ear infection." 2. "As my child gets older, he should have fewer ear infections, because his immune system will be more developed." 3. "My child will have fewer ear infections if he has his tonsils removed." 4. "My child may need a speech evaluation."

3. Removing children's tonsils may not have any effect on their ear infection. Children who have repeated bouts of tonsillitis can have ear infections secondary to the tonsillitis, but there is no indication in this question that the child has a problem with tonsillitis.

A physician diagnoses a school-age child with strep throat and pharyngitis. The child's parent asks the nurse what treatment the child will need. Which is the nurse's best response? 1. "Your child will be sent home on bedrest and should recover in a few days without any intervention." 2. "Your child will need to have the tonsils removed to prevent future strep infections." 3. "Your child will need oral penicillin for 10 days and should feel better in a few days." 4. "Your child will need to be admitted to the hospital for 5 days of intravenous antibiotics."

3. The child will need a 10-day course of penicillin to treat the strep infection. It is essential that the nurse always tell the family that, although the child will feel better in a few days, the entire course of antibiotics must be completed.

A child diagnosed with TOF becomes upset, crying and thrashing around when a blood specimen is obtained. The childs color becomes blue and the RR increases to 44 breaths per min. Which of the following actions should the nurse do first? 1. Obtain an order for sedation for the child 2. Assess for an irregular heart rate and rhythm 3. Explain to the child that it will only hurt for a short time 4. Place the child in a knee to chest position

4

Which of the following would the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? 1. Maintaining the joints in an extended position 2. Applying gentle traction to the child's affected joints 3. Supporting proper alignment with rolled pillows 4. Using a bed cradle to avoid the weight of bed linens on joints

4

The nurse is caring for a child who has undergone cardiac catheterization. During the recovery phase, the nurse notices the dressing is saturated with bright red blood and a 6-inch circle of blood on the crib sheet. The nurse's first action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

4.

Which statement by the mother of an infant boy with CHF who is being sent home on digoxin indicates she needs further education on the care of her child? 1. "I will give him the medication at regular 12-hour intervals." 2. "If he vomits, I will not give him a make-up dose." 3. "If I miss a dose, I will not give an extra dose, but keep him on his same schedule." 4. "I will mix the digoxin in some of his formula to make it taste better for him."

4.

A 3-year-old is admitted to the hospital with a diagnosis of epiglottitis. The child is in severe distress and needs to be intubated. The mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response? 1. "Children this age rarely get epiglottitis; you should not blame yourself." 2. "It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen." 3. "Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son's symptoms." 4. "Epiglottitis is rapidly progressive; you could not have predicted that his symptoms would worsen so quickly."

4. Epiglottitis is rapidly progressive and cannot be predicted.

Which of the following statements about the inheritance of CF is most accurate? 1. CF is an autosomal-dominant trait that is passed on from the child's mother. 2. CF is an autosomal-dominant trait that is passed on from the child's father. 3. The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF. 4. The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF

4. If the child is born to a mother with CF and a father who is a carrier, the child has a 50% chance of acquiring the disease and a 50% chance of being a carrier of the disease.

A 5-year-old female is diagnosed with pharyngitis. The child is complaining of throat pain. Which of the following statements by the mother indicates that she needs more education regarding the care and treatment of her daughter's throat pain? 1. "I will have my daughter gargle with warm saline three times a day." 2. "I will offer my daughter ice chips several times a day." 3. "I will give my daughter Tylenol every 4 to 6 hours as needed." 4. "I will give my daughter her amoxicillin until all doses of the antibiotic are gone."

4. Pharyngitis is a self-limiting viral illness that does not require antibiotic therapy. Pharyngitis should be treated with rest and comfort measures, including Tylenol, throat sprays, cold liquids, and popsicles.

A school-age child is admitted to the hospital for a tonsillectomy. The nurse caring for this patient is assessing the child 8 hours after surgery. During the nurse's assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations should be of most concern to the nurse? 1. The child's heart rate and blood pressure are elevated. 2. The child complains of having a sore throat. 3. The child is refusing to eat solid foods. 4. The child is swallowing excessively.

4. Soft foods are recommended to limit the child's pain and to decrease the risk for bleeding.

The parents of a 5-week-old have just been told that their child has CF. The mother had a sister who died of CF when she was 19 years of age. The parents are sad and ask the nurse several questions about CF and the current projected life expectancy. What is the nurse's best initial intervention? 1. The nurse should tell the parents that the life expectancy for CF patients has improved significantly in recent years. 2. The nurse should tell the parents that their child might not follow the same course that the mother's sister did. 3. The nurse should listen to the parents and tell them that the physician will come to speak to them about treatment options. 4. The nurse should listen to the parents and be available to them anytime during the day to answer their questions.

4. The nurse's best intervention is to let the parents express their concerns and fears. The nurse should be available if the parents have any other concerns or questions or if they just need someone with whom to talk.

A 2-year-old child is brought to the ER with a high fever, dysphagia, drooling, rapid pulse, and tachypnea. What should the nurse's first action be? 1. Prepare for immediate IV placement. 2. Prepare for immediate respiratory treatment. 3. Place the child on a stretcher for a thorough physical assessment. 4. Allow the child to sit in the parent's lap while awaiting an x-ray.

4. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. The child should be allowed to remain in the parent's lap until a lateral neck film is obtained for a definitive diagnosis.

A 2-year-old has just been diagnosed with CF. The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response? 1. "You can expect your child to develop a barrel-shaped chest." 2. "You can expect your child to develop a chronic productive cough." 3. "You can expect your child to develop bronchiectasis." 4. "You can expect your child to develop wheezing respirations."

4. Wheezing respirations and a dry nonproductive cough are common early symptoms in CF.

A 2-year-old is admitted to the hospital with croup. The parent tells the nurse that her 7-year-old just had croup and it cleared up in a couple of days without intervention. She asks the nurse why her 2-year-old is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response? 1. "Some children just react differently to viruses. It is best to treat each child as an individual." 2. "Younger children have wider airways that make it easier for bacteria to enter and colonize." 3. "Younger children have short and wide eustachian tubes, making them more susceptible to respiratory infections." 4. "Children younger than 3 years usually exhibit worse symptoms because their immune systems are not as developed."

4. Younger children have less developed immune systems and usually exhibit worse symptoms than older children.

Nursing care of a 9 month old who has recently undergone cleft palate lip repair can be expected to include feeding with a(n): a. Plastic spoon b. Open cup c. Pigeon bottle d. Special needs feeder

B.

A 3 month old infant is seen in the clinic with the following symptoms: irritability, crying, refusal to nurse for more than 2-3min, rhinitis, and a rectal temperature of 101.8F (38.8). The labor, delivery and postpartum history for this term infant is unremarkable. The nurse anticipates a diagnosis of: a. Acute Otitis Media b. Otitis Media with effusion (OME) c. Otitis externa d. Respiratory syncitial virus (RSV)

a.

An infant is being prepared for surgical repair of a ventricular septal defect (VSD). Which of the following problems will be prevented by closing the defect? A. Failure to thrive B. Ventricular dysrhythmias C. Heart block D. Respiratory alkalosis

a.

Antibiotics are prescribed for a child with otitis media who underwent a myringotomy with insertion of tubes. The nurse provides discharge instructions to the parents regarding the administration of the antibiotics. Which statement, if made by the parents, indicates understanding of the instructions provided? a. Administer the antibiotics until they are gone b. Administer the antibiotics if the child has a fever c. Administer the antibiotics until the child feels better d. Begin to taper the antibiotics after 3 days of a full course.

a.

The healthcare provider is planning the discharge for a child with a ventricular septal defect. Which of the following is a priority to include in the discharge instructions? a. Provide instructions for a monthly immunoglobulin shot during RSV season. b. Ensure the parents know how to take the child's blood pressure at home. c. Advise the family provide meals that are low in fat and calories. d. Suggest quiet activities for the child to decrease physical activity.

a.

You are working in the pediatric clinic, and a child presents with symptoms that are suspicious of the acute phase of Kawasaki disease. Which of the following symptoms are included? Select all that apply. a. Periungual desquamation (peeling that begins under the fingertips and toes) of the hands and feet is present. b. The bulbar conjunctivae of the eyes has become reddened, with clearing around the iris. c. A temporary arthritis is evident, which may affect the larger weight bearing joints d. Inflammation of the pharynx and the oral mucosa develops with red, cracked lips and the characteristic "strawberry tongue" e. Loud pansystolic murmur along with ECG changes are present.

b, d.

A newborn has just returned to the nursing unit after surgical repair of the a cleft lip on the right side. The nurse should place the infant in which best position at this time? a. prone position b. on the stomach c. left lateral position d. right lateral position

c. left lateral position