Peds Exam #3

CF patho

obstruction of ducted glands and lungs by thick mucus

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first? A. "You need to take him to the emergency department right away." B. "Have him use his short-acting bronchodilator right away." C. "Continue to watch his PEFR readings and call back if they go below 40%." D. "Have him use his low-dose steroid inhaler now and again in 15 minutes."

B. "Have him use his short-acting bronchodilator right away."

What is a complication of cystic fibrosis? A. urinary tract infection B. pneumothorax C. Crohn disease D. kidney disease

B. pneumothorax

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education? A. "Surgery is usually performed in the first two months of life for this." B. "The medication indomethacin is used to try to close the hole." C. "Most infants do not need surgical repair for this." D. "The medication prostaglandin E1 is used to try to close the hole."

C. "Most infants do not need surgical repair for this."

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed? A. "Our family dog will need to go live with a grandparent." B. "We will keep an albuterol inhaler with our child at all times." C. "We will both enroll in smoking cessation classes." D. "It is okay for our child to do chores such as sweeping the floor."

D. "It is okay for our child to do chores such as sweeping the floor."

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta? A. Pulses weaker in upper extremities compared to lower extremities B. Cyanosis with feeding C. Cyanosis with crying D. Pulses weaker in lower extremities compared to upper extremities

D. Pulses weaker in lower extremities compared to upper extremities

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding? A. appropriate mastery of developmental milestones B. steady weight gain since birth C. intact rooting reflex D. softening of the nail beds

D. softening of the nail beds

A nurse is providing discharge teaching for a child who has cystic fibrosis. Which of the following instructions should the nurse include? a. Provide a low-calorie, low-protein diet b. Administer pancreatic enzymes with meals and snacks c. Implement a fluid restriction during times of infection d. Restrict physical activity

b. Administer pancreatic enzymes with meals and snacks

A nurse planning care for a child who has asthma. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) a. Perform chest percussion b. Place the child in an upright position c. Monitor oxygen saturations d. Administer bronchodilators e. Administer dornase alfa daily

b. Place the child in an upright position c. Monitor oxygen saturations d. Administer bronchodilators

A nurse in the emergency department is assessing a newly-admitted infant. Which of the following findings is an early indication of hypoxemia? a. Nonproductive cough b. Hypoventilation c. Tachypnea d. Nasal stuffiness

c. Tachypnea

best position to put infant in if becomes cyanotic when crying

knee to chest

atrioventricular canal

large central atrioventricular valve created, allowing blood to flow between all chambers

ductus arteriosus function

shunts blood from pulmonary artery to aorta

foramen ovale function

shunts blood from right atria to left atria

hallmark sign of transposition of great arteries

significant cyanosis at birth

defect that may close by 12 months

ventricular septal defect

cyanotic sub categories

-decreased pulmonary blood flow -mixed blood flow

body systems effected by CF

-respiratory -GI -reproductive -integumentary

early signs of respiratory distress

-restlessness -confusion -tachypnea -tachycardia -retractions

vitamins and enzymes for CF pts

-ADEK -pancreatic enzymes

specific asthma meds

-Inhaled Fluticasone -oral prednisone -Montelukast -Cromolyn -Albuterol -Salmeterol -Atropine -Ipratropium

types of meds used in asthma

-anti inflammatory (corticosteroids) -bronchodilators

increased pulmonary blood flow defects

-atrial septal defect -ventricular septal defect -atrioventricular canal -patent ductus arteriosu

acyanotic heart defects

-atrial septal defect -ventricular septal defect -patent ductus arteriosus -atrioventricular canal -coarcation of the aorta -aortic stenosis -pulmonic stenosis

asthma patho

-bronchoconstriction -airway edema -mucus production

obstructive disorders

-coarctation of the aorta -aortic stenosis -pulmonic stenosis

MDI inhaler steps

-shake 5-6 times -attach spacer -take deep breath, exhale -close lips around mouthpiece -press inhaler, breath slow deep breath 3-5 sec -hold for 5-10 sec -wait 1 min between puffs -resume normal breathing

decreased pulmonary blood flow defects

-tetralogy of fallot -tricuspid atresia

cyanotic heart defects

-tetralogy of fallot -tricuspid atresia -transportation of great arteries -truncus arteriosus -total anomalous pulmonary venous return -hypoplastic left heart syndrome

mixed blood flow defects

-transposition of great arteries -truncus arteriosus -total anomalous pulmonary venous return -hypoplastic left heart syndrome

peak flow technique

-zero out -stand up straight -close lips around mouthpiece -blow hard and fast -read number on meter -repeat 3 times -record highest number

A nurse caring for a child who is receiving oxygen therapy and is on a continuous oxygen saturation monitor that is reading 89%. Which of the following actions should the nurse take FIRST? a. Increase the oxygen flow rate b. Encourage the child to take deep breaths c. Ensure proper placement of the sensor probe d. Place the child in the Fowler's position

c. Ensure proper placement of the sensor probe

respiratory treatment to avoid at mealtimes

chest physiotherapy and postural drainage

A nurse is teaching an adolescent to self-administer a corticosteroid medication using a metered-dose inhaler (MDI). Which of the following instructions should the nurse include? (Select all that apply) a. Shake the device prior to use b. Rinse and expectorate after administration c. Inhale slowly with medication administration d. Exhale quickly after medication administration e. Wait 30 seconds between puffs

a. Shake the device prior to use b. Rinse and expectorate after administration c. Inhale slowly with medication administration

A nurse is reviewing the diagnostic findings for a preschool age child who is suspected of having cystic fibrosis. Which of the following findings should the nurse identify as an indication of cystic fibrosis? a. Sweat chloride content 85mEeq/L b. Increased blood levels of fat-soluble vitamins c. 72 hr stool analysis sample indicating hard, packed stools d. Chest x-ray negative for atelectasis

a. Sweat chloride content 85mEeq/L

A nurse is admitting a child who has cystic fibrosis. Which of the following medications should the nurse expect to include in the plan of care? a. Tobramycin b. Loperamide c. Fat-soluble vitamins d. Albuterol e. Dornase alfa

a. Tobramycin c. Fat-soluble vitamins d. Albuterol e. Dornase alfa

A nurse is performing an admission assessment for a child who has cystic fibrosis. Which of the following findings should the nurse expect? (Select all that apply) a. Wheezing b. Clubbing of fingers and toes c. Barrel-shaped chest d. Thin, watery mucus e. Rapid growth spurts

a. Wheezing b. Clubbing of fingers and toes c. Barrel-shaped chest

A nurse is teaching a child who has asthma how to use a peak flow meter. Which of the following information should the nurse include in the teaching? (Select all that apply) a. Zero the meter before each use. b. Record the average of the attempts c. Perform three attempts d. Deliver a long, slow breath into the meter e. Sit in a chair with feet on the floor

a. Zero the meter before each use. c. Perform three attempts

atrial septal defect

abnormal opening between atria

ventricular septal defect

abnormal opening between ventricles

acyanotic sub categories

-increased pulmonary blood flow -obstructive disorders

drug that closes PDA

Indomethacin

pulmonic stenosis

narrowing of entrance of pulmonary artery

drug that keeps PDA open

prostaglandin E1

The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse? A. 1-week-old newborn whose oxygenation is not improving with oxygen B. 1-year-old child with a temporal temperature of 101°F (38.3°C) C. 6-month-old infant with edema on the face and presacral area D. 2-year-old child with clubbing noted on the fingers

A. 1-week-old newborn whose oxygenation is not improving with oxygen

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority? A. Place the infant in the knee-chest position. B. Raise the head of the bed. C. Start an IV for fluids. D. Prepare the infant for surgery.

A. Place the infant in the knee-chest position.

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of what factor as the major mechanism involved? A. obstruction of blood flow to the lungs B. increased pulmonary blood flow C. narrowing of the major vessel D. mixing of well-oxygenated and poorly oxygenated blood

A. obstruction of blood flow to the lungs

The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level? A. Albuterol sulfate B. Spironolactone C. Digoxin D. Ferrous sulfate

C. Digoxin

The parents of a 2-year-old toddler newly diagnosed with tricuspid atresia ask the nurse, "I do not understand why our toddler's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is best? A. "Increased cardiac workload from your toddler's heart defect affects various parts of the body, including the fingers." B. "The number of red blood cells has significantly increased from the heart defect, resulting in the cells pooling in the fingertips." C. "This is a common complication of tricuspid atresia. Unfortunately, there is nothing we can do to treat it." D. "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes."

D. "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes."

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition? A. Auscultating for a cardiac murmur B. Observing for excessive crying C. Recording an upper extremity blood pressure D. Assessing for the presence of femoral pulses

D. Assessing for the presence of femoral pulses

A nurse is assessing a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status? (Select all that apply) a. Oxygen saturation 95% b. Wheezing c. Retraction of sternal muscles d. Warm extremities e. Nasal flaring

b. Wheezing c. Retraction of sternal muscles e. Nasal flaring

A nurse is teaching an adolescent about the appropriate use of his asthma medications. Which of the following medications should the nurse instruct the client to use as needed before exercise? a. Fluticasone/salmeterol b. Montelukast c. Prednisone d. Albuterol

d. Albuterol

patent ductus arteriosus

failure of ductus arteriosus to close within first few weeks

tricuspid atresia

failure of tricuspid valve to develop, no communication between RA and RV

truncus arteriosus

failure to form separate pulmonary artery and aorta

aortic stenosis

narrowing of stricture of aortic valve

coarctation of the aorta

narrowing of the aorta, often near ductus arteriosus, obstructing systemic blood flow

PDA kept open to ensure oxygenated blood circulates in which disorders (3)

-hypoplastic left heart syndrome -transposition of great arteries -tricuspid atresia

4 categories of asthma diagnosis

-intermittent -mild persistent -moderate persistent -severe persistent

late signs of respiratory depression

-lethargy (decreased LOC) -bradypnea -bradycardia -grunting -flaring -head bobbing -seesaw breathing -absence of wheezing in asthma

cardiac cath

-measures pressure and oxygen levels in heart chambers -visualizes structures and blood patterns

A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia? A. Increased WBC B. Decreased WBC C. Decreased RBC D. Increased RBC

D. Increased RBC

When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover? A. Anemia B. Leukopenia C. Increased platelet level D. Polycythemia

D. Polycythemia