quiz 2 modules
Which are correct interventions for treating rheumatic fever?
Tell child and family that the chorea is temporary and related to the disease Administer antibiotics and anti-inflammatory medications as per order. Relate plan for secondary prophylaxis to caregivers.
Following a heart transplant for heart failure, a child has been placed on several medications to prevent rejection. These medications include cyclosporins and a corticosteroid. The nurse must be aware that medications to prevent rejection can lead to which complications?
Immunosuppression Coronary Artery Disease Renal Dysfunction
The nurse has given discharge instructions to a 14-year-old child and his family following treatment for cardiomyopathy. Which statement by the child would indicate that the teaching has been effective?
"I will not be able to play on the football team this year"
when educating the parents of a child with hemophilia, which statements indicate an understanding of their instructions?
- "at home, if my child has any pain, I will give him acetaminophen." - "My child must always have replacement factor with him" - "When my daughter has her menstrual period, she should expect the bleeding to be heavy."
in discharge planning for a client with hemophilia, what statements will best explain the care at home?
- "before you child goes home, you should remove any throw rugs in the living areas" - "a teacher at your child's school should be trained to help care for your child." - "the medical bracelet is an important way to let others know about your disorder."
the nurse caring for a client who has disseminated intravascular coagulation (DIC) secondary to sepsis identifies which treatments as priorities?
- administration of fresh frozen plasma - administration of antibiotics - administration of heparin for anticoagulation
When the nurse is planning care for a child with hemophilia, which interventions take into consideration the special needs of this child?
- assessment of the environment for any tripping hazards - elevation of any joints affected by hemarthrosis - blood specimens obtained by finger-stick instead of venipuncture
aspects of discharge care and teaching for ITP
- avoid aspirin, aspirin-containing drugs, and NSAIDs - advise no contact sports until thrombocytopenia and ITP improve - ask the family if they want to incorporate any cultural and religious practices into the child's care - educate about IV anti-D immunoglobulin
When assessing an 18-year-old with disseminated intravascular coagulation (DIC), which assessment data would the nurse immediately report to the health care provider?
- capillary refill of 5 sec - blood pressure of 68/32 mmHg - heart rate of 180 beats/min
treatment interventions of DIC
- control bleeding by placing pressure dressing on areas of bleeding - maintain skin integrity by turning client every 2 hours - administer blood products as ordered
treatment options for severe ITP
- corticosteriods - IV immune globulin - platelet infusions
supportive therapies for DIC
- fresh frozen plasma and platelet transfusions - anticoagulation therapy ie heparin - clotting factor replacement
Desmopressin (DDAVP) is indicated to treat which diseases?
- hemophilia A - von Willebrand disease
discharge teaching for children with hemophilia or von willebrand disease
- wear a med id bracelet or tag to alert others about their condition - school-age children may learn to give themselves factor replacement infusions - use only an electric razor for shaving
When assessing a client, the nurse would recognize which symptoms as clinical manifestations of thrombocytopenia?
-bleeding gums after client brushes teeth - frequent episodes of epistaxis (nosebleeds) - small pinpoint red or purple spots on the skin - occult or frank blood in stools
Matching Cause --> Type of Anemia
Increased Destruction of Cells= Sickle Cell disease Decreased Production of Cells = Aplastic Anemia Loss of Cells through Hemmorhage or Chronic Blood Loss = Trauma Increased Destruction of Cells = Hereditary spherocytosis Loss of Cells through Hemmorhage or Chronic Blood Loss = Cow milk intolerance Increased destruction of Cells = Thalassemias Loss of Cells through Hemorrhage or Chronic Blood Loss= Menorrhagia Decreased Production of Cells = Iron deficiency anemia
The nurse is caring for a 6-year-old client with hereditary spherocytosis. The client received a splenectomy 6 months ago. After a splenectomy, the client is at risk for which condition?
Infection
The nurse's assignment for the shift includes caring for a child with infective endocarditis. To provide quality care, the nurse is reviewing the etiology of this disease process. Which statement is most accurate?
Infective endocarditis is caused by a bacteria or fungus.
Callie Lozano has been diagnosed with a thalassemia. Which is an important part of her nutritional plan?
Supplement with folic acid
A child has been diagnosed with hypertrophic cardiomyopathy. Which would the nurse anticipate will be part of the treatment plan? Select all that apply:
A beta blocker An implantable defibrillator A left ventricular assist device (LVAD)
The nurse is caring for a child with infective endocarditis. Which intervention would be most effective for the treatment of this disease process?
Administer ordered antibiotics
Which of the following is not a part of discharge care and teaching for rheumatic fever?
After recovering from rheumatic fever, all children should be encouraged to be active in sports.
Which are aspects of the pathophysiology of aplastic anemia?
Anemia develops from lack of red blood cells Thrombocytopenia develops from lack of platelets Neutropenia develops from lack of white blood cells
Five-year-old Ella Minton is recovering from rheumatic fever. She appears to have no heart effects or damage. Which treatment options do you expect will be implemented for Ella?
Antibiotics as secondary prophylaxis until the age of 21
Which are aspects of assessment for aplastic anemia?
Assess for pallor, hypoxia, fatigue, activity intolerance. Assess for bruising, petechiae, purpura. Assess for fever, mouth and skin lesions.
A child has received IVIG for the treatment of Kawasaki disease. The nurse informs the child's family that any immunizations with a live virus vaccine should be postponed for how long?
At least 11 months
The nurse is caring for a 9-year-old client diagnosed with thalassemia. The nurse recognizes which findings on assessment as a distinctive sign of this specific disorder?
Bronzed skin
Which group is most likely to be affected by hereditary spherocytosis?
Children of northern European descent
Which are parts of discharge care and teaching for Kawasaki disease?
Clients might need medical care for head injuries that would be minor in other children. For children who have received IVIG, any immunization for live virus vaccines should be postponed for at least 11 months. Fever may recur and if it does, treatment should be sought
the nurse explains the disease to the parents of a child recently diagnosed with hemophilia A. What statement about the pathophysiology is most accurate?
Clotting factor VIII is low
hypotension DIC or ITP
DIC
oozing of blood from skin DIC or ITP
DIC
prolonged PT DIC or ITP
DIC
prolonged PTT DIC or ITP
DIC
Organ dysfunction (DIC or ITP)
DIC - disseminated intravascular coagulation
Matching: Condition --> Treatment option
Dilated Cardiomyopathy = Digoxin Endocarditis = Meticulous oral care Dilated Cardiomyopathy = Diuretics Hypertrophic Cardiomyopathy = Implantable defibrillators Kawasaki Disease = Corticosteroids Hypertrophic Cardiomyopathy = LVAD Endocarditis = IV Antibiotics Kawasaki Disease = Intravenous Immunoglobulin G (IVIG) Dilated Cardiomyopathy = Antihypertensives Kawasaki Disease = Aspirin
The nurse is caring for a 17-year-old client with mild iron deficiency anemia. Which interventions would be appropriate?
Encourage dried fruits in diet Limit cow milk in diet Encourage meats, fish, and poultry in diet
Which aspects of discharge care and teaching are appropriate for thalassemias?
Encourage genetic counseling to determine risks of disease for future children. Teach caregivers that the use of deferoxamine will turn the urine reddish brown in color.
Ten-year-old Peyton Kent has been brought in with these symptoms: low-grade chronic fever, fatigue, malaise, joint pain, and headaches. He has been recovering the last few months from cardiac surgery to install a prosthetic valve. What are these clinical manifestations most likely associated with?
Endocarditis
Matching: Condition --> Assessment Factor
Endocarditis = Observe for signs of infection Cardiomyopathy = Monitor for dysrhythmias Kawasaki Disease = Evaluate for murmurs Cardiomyopathy = Monitor for chest pain Endocarditis = Observe for signs of embolus Kawasaki Disease = Assess for signs of dehydration Cardiomyopathy = Assist with echocardiogram Kawasaki Disease = Assess skin as rash resolved Cardiomyopathy = Assist with electrocardiogram
The nurse is caring for an 8-year-old client with aplastic anemia. After reviewing the records, which intervention would be appropriate?
Enforce strict hand hygiene and screen visitors for infection
When caring for a 15-year-old client with anemia, the nurse recognizes which signs and symptoms of anemia?
Fatigue Dizziness Pallor
An 8-month-old infant has been diagnosed with cardiomyopathy. Which signs and symptoms would the nurse expect to find on assessment?
Fatigue Jugular venous distention An audible murmur
The nurse is documenting the assessment of a child with rheumatic fever. Which assessment finding would the nurse be most concerned about?
Heart murmur
The nurse is caring for a 14-year-old female client with iron deficiency anemia. Which interventions can assist the client in obtaining normal iron levels?
Help the client pick iron-rich foods Assess client compliance with iron supplements
The nurse is caring for a child with a recent diagnosis of infective endocarditis. The child's mother appears very upset and asks the nurse what can be done to help her son. Which would be the best response by the nurse?
High-dose antibiotics will help kill the bacteria that are causing the problem
6 yr old Adina Feldspar has been brought to the hospital for testing. After recently receiving the MMR vaccine, she has been bleeding in the nose and mouth, bruising easily, and having prolonged bleeding after a minor scrape. Which condition should you expect to be ruled out first? (as in what are doctors most likely to test for first)
ITP
GI bleeding DIC or ITP
ITP
bleeding in the mouth or nose DIC or ITP
ITP
intracranial hemorrhage DIC or ITP
ITP
seizures (DIC or ITP)
ITP
vomiting DIC or ITP
ITP
Fourteen-year-old Tory Kendrick is in the hospital to be treated for a sickle cell disorder crisis. His symptoms are pain and dehydration. What interventions should you take immediately?
IV opioids and salie flush bolouses
Matching Type of Anemia --> Tx option
Iron deficiency = limit cow milk aplastic anemia = treat toxin with antidote sickle cell anemia = oxygen for hypoxia aplastic anemia = control infection iron deficiency anemia = eat iron-rich foods aplastic anemia = prevent falls sickle cell = warm blankets aplastic = immunosuppressents sickle cell = heat packs aplastic = dialysis sickle cell = normal saline fluid boluses iron deficiency = oral iron supplement
Eleven-year-old Jenna O'Reilly is of northern European descent. She has always been a healthy child, but in recent months she has manifested fatigue, listlessness, pallor, and occasional dizziness. She has no other symptoms. Which of the following is the most likely diagnosis for her?
Iron deficiency anemia
The nurse is caring for a 9-year-old client with iron deficiency anemia. When providing discharge teaching about iron supplements, what information should the nurse give to the caregivers?
Iron supplements can cause constipation Iron supplements can cause nausea on an empty stomach Give with orange juice to increase absorption
The nurse is providing discharge teaching for an 8-year-old client with spherocytosis. Which information needs to be provided for the caregivers?
Keeping the child out of school when there are outbreaks of illness
Which are treatment options for hypertrophic cardiomyopathy?
Left ventricular assist device Beta Blockers Implantable defibrillators
The nurse is caring for an 8-year-old client with beta-thalassemia major. When doing discharge teaching, the nurse should provide which information for the caregivers?
Maintain regular evaluations of hemoglobin levels
Which treatment options are appropriate for beta-thallasemia
Monthly transfusion of packed RBC Splenectomy Bone marrow transplant
Which are correct statements concerning treatment of patients who have received a heart transplant?
Most transplant recipients require other surgeries and medical bridging interventions. The client shows few outward signs of chronic rejection. Antirejection medications can cause problems such as immunosuppression and hypertension.
The nurse is caring for a 6-year-old client whose bone marrow is suppressed. When the client develops a fever, the nurse suspects which complication?
Neutropenia
The nurse is caring for a 14-year-old female client diagnosed with anemia. Which risk factors for anemia in clients of this age group should the nurse be aware of?
Onset of menses Poor intake of iron-rich foods Prone to eating disorders
Four-year-old Timothy Tanaka has been diagnosed with Kawasaki disease. Which of the following should be an intervention in your plan of care?
Oral hygiene to keep mouth moist
Seven-year-old Peter Reilly has been diagnosed with aplastic anemia. What is an important part of discharge care to discuss with his parents?
Talk to them about the use of a helmet during active play.
What is the main goal of discharge care and teaching for hereditary spherocytosis?
Teach the family and child to do as much as possible to be aware of and prevent signs of infection.
The nurse is caring for an 8-year-old client with aplastic anemia. Which interventions will assist the client in recovering from thrombocytopenia?
Place the client on fall risk precautions Limit venipuncture and needle sticks Provide padding to bed rails
The nurse is caring for a 5-year-old client with hereditary spherocytosis. What is the primary goal of nursing care for this client?
Preventing infection
Which are part of discharge care and teaching for families of children with endocarditis?
Prophylaxis, if indicated, should be strictly followed. Echocardiograms will be needed to evaluate valvular function. Electrocardiogram will be used to monitor for resulting dysrhythmias.
Which of the following is not an intervention in the care of a heart transplant recipient?
Relate plan for secondary prophylaxis to caregivers.
The nurse is caring for a 6-year-old client with thalassemia. The client is diagnosed with splenomegaly. Which medical treatment should the nurse anticipate for the client?
Removal of the spleen by surgical procedure
Characteristics of Rheumatic fever?
Repeated streptococcal infections increase the risk The age of most children affected is between 5-15 It is almost nonexistent in the U.S
Nursing assessment of a school-age child reveals inflamed joints, rash on the trunk, and aimless movements of the extremities. The nurse recognizes these findings as characteristic of which acquired cardiac disease?
Rheumatic fever
The nurse is caring for a 10-year-old client with thalassemia who has had a splenectomy. Which nursing diagnosis would be appropriate for this client?
Risk for sepsis
What is the main nursing diagnosis for hereditary spherocytosis?
Risk for sepsis related to asplenia
Matching type of anemia = intervention
Sickle cell = patient controlled analgesia thalassemia = deferoxamine as indicated sickle cell = moist heat thalassemia = supplement with folic acid sickle cell = anti-inflammatory meds hereditary spherocytosis = influenza vaccine thalassemia = administer packed RBCs
The nurse is giving discharge instructions for a child with minor valve damage from rheumatic fever. What should the nurse include in the teaching?
The child may require surgery in the future. The child will be at risk of developing an embolus as an adult. The child will require secondary prophylaxis.
The nurse is caring for a 10-year-old client with aplastic anemia who was admitted for thrombocytopenia. The nurse should teach the caregivers about which precautions?
The child should wear a helmet when biking Install stair and window guards Seek medical care for even minor head injuries
The nurse has received report on patients for the night shift and is reviewing the charts. What information would be most important for the nurse to ensure had been reported to this child's health care provider? Temperature 99.2°F (37.3°C) Blood pressure 126/84 mmHg Heart rate 78 beats/min Oxygen saturation 98% Client is a 6-year-old male recently diagnosed with cardiomyopathy. No previous history of hospitalizations. Had a mild heart murmur at birth that had resolved by the age of 2. Alert and orientated, follows commands, hands and feet cool to the touch, lung sounds clear to auscultation bilaterally, cardiac dysrhythmia noted, hypoactive bowel sounds in all four quadrants, equal strength in all extremities.
The dysrhythmia
The family of a 10-year-old child has just been informed of the child's need for a heart transplant. To help determine the family's readiness for this procedure, the nurse must consider which factors?
The family's needs The child's opinion Compliance with health care regimens The family's support system
Seven-year-old Shala Mohamed is being released from the hospital after being treated for rheumatic fever. Which of the following should be part of the discharge teaching you provide to her mother?
The plan for secondary prophylaxis, based on cardiac involvement
A 4-year-old child with infective endocarditis will be discharged in 2 days. When completing the discharge plan, which should the nurse include?
The use of prophylactic antibiotics
In the treatment of hereditary spherocytosis, what is a positive effect of the removal of the spleen?
Treats the excessive hemolysis
Caregivers of children with aplastic anemia must learn to recognize the signs of bleeding. Which symptoms are signs of bleeding?
Unexplained bruising Stools that are tarry in color Bleeding gums
A 7-year-old child has experienced no heart effects from an episode of rheumatic fever. When discussing secondary prophylaxis with the child's parents, how long would the nurse tell them that this would be required?
Until age 21
Desmopressin (DDAVP) increases which available clotting factor?
VIII- which is low in patients with hemophilia A and von Willebrand disease
What is an accurate description of disseminated intravascular coagulation?
a condition that causes a child to bleed excessively at the same time that the blood is trying to clot
nursing diagnosis for ITP
bleeding and hemorrhage from idiopathic immune process
DIC
disseminated intravascular coagulation
x- linked recessive (most common type)
hemophilia A
decrease in clotting factor 8
hemophilia A (classic)
autosomal recessive
hemophilia C
decrease in clotting factor 11
hemophilia C
ITP
idiopathic thrombocytopenic purpura
The diagnosis of rheumatic fever is being ruled out for a child. The nurse is obtaining a history from the child's parents. Which would be the most significant finding for this diagnosis?
the child had strep for 3 weeks
the most important message to impart to parents of a child with DIC
the child must never be left alone int he hospital room
what is the pupose of desmopressin (DDAVP) in treatment for hemophilia and von Willebrand disease?
to increase the relase of stored factor 8 and vWF
4 yr old Tyler James has been diagnosed with disseminated intravascular coagulation (DIC). he is not in shock. which of the following would most likely be part of your treatment plan for him?
treatment of underlying cause
autosomal dominant bleeding d/o
von Willebrand Disease
gene on chromosome 12
von Willebrand disease