Peds Exam 2 Davis NCLEX Questions

A newborn is diagnosed with a CHD. The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as

Patent Ductus Arteriosus

A 10 year old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess:

Pulses

Which finding might delay a cardiac catheterization procedure on a 1 year old?

Severe diaper rash

A toddler who has been hospitalized for vomiting because of gastroenteritis is sleeping and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, RR of 30, BP of 84/52, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child?

Supraventricular tachycardia

Which would be an early sign of respiratory distress in a 2-month-old?

Tachypnea

What would the nurse advise the parent of a child with a barky cough that gets worse at night?

Take the child outside into the more humid air for 15 minutes

A school-aged child is admitted to the hospital for a tonsillectomy. During the nurse's postoperative assessment, the child's parent tells then nurse that the cild is in pain. Which of the following observations would be of most concern to the nurse?

The child is swallowing excessively

Which would be the priority nursing intervention for a newly admitted child with Kawasaki disease?

continuous cardiovascular and oxygen-saturation monitoring

What is the most important piece of information that the nurse must ask the parent of a child in status asthmaticus?

"When was your child's last dose of medication?"

The parent of an infant with CF asks the nurse how to meet the infant's increased nutritional needs. Which is the nurse's best suggestion?

"You many need to change your infant to a higher-calorie formula"

A child's parent asks the nurse what treatment the child will need for the diagnosis of strep throat. Which is the nurse's best response?

"You child will need oral penicillin for 10 days and should feel better in a few days"

The parent of an 18-month-old brings him to the emergency department with the complaint that the toddler scratches his bottom. The nurse recommends the following. Select all that apply. 1. Be sure he washes his hands daily 2. Offer high-fiber foods 3. The mother performs the tape test tonight 4. Check his stool for worms 5. Keep him away from his siblings

3. the mother performs the tape test tonight 4. check his stool for worms

Which child is in the greatest need of emergency medical treatment?

A 6 year old who has high fever, no spontaneous cough, and froglike croaking Rationale: the child has signs and symptoms of epiglottitis and should receive immediate emergency medical treatment. The patient has no spontaneous cough and has a froglike croaking because of a significant airway obstruction

Which laboratory result will provide the most important information regarding the respiratory status of a child with an acute asthma exacerbation?

ABG

During play, a toddler with a history of TOF might assume which position?

Squatting

A 6 month old who has episodes of cyanosis after crying could have the CHD of decreased pulmonary blood flow called

Tetralogy of Fallot

Which assessment is of greatest concern in a 15 month old?

The child is in the tripod position and has diminished breath sounds and a muffled cough

Which signs and symptoms would the nurse expect to assess in a child with rheumatic fever?

ankle and knee joint pain

The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to:

apply direct pressure 1 inch above the puncture site

A child diagnosed with CHF is receiving maintenance doses of digoxin (Lanoxin) and furosemide (Lasix). 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 expects which laboratory finding?

Hypokalemia

The nurse is caring for a child 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 is:

Immunoglobulin G and aspirin

A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a strawberry tongues most likely has

Kawasaki Disease

What should be the nurse's first action with a child who has a high fever, dysphagia, drooling, tachycardia, and tachypnea?

Lateral neck radiographs

Which is a diagnostic for epiglottitis?

Lateral neck x-ray of the soft tissue

PDA causes what type of shunt?

Left to right

The flow of blood through the heart with an ASD is ______

Left to right

While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2 and decreased PO2. The nurse suspects that the newborn has:

PDA

For a child with hypoplastic left heart syndrome, which drug may be given to allow the PDA to remain open until surgery?

Prostaglandin E

A 5 year old is brought ot the ED with a temperature of 99.5℉, a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for?

Respiratory treatment of racemic epinephrine

A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is

Rheumatic Fever

The _________ serves as the septal opening between the atria of the fetal heart.

foramen ovale

A 3 month old has been diagnosed with a VSD. The flow of blood through the heart is____

left to right

How does the nurse interpret the laboratory analysis of a stool sample containing excessive amounts of azotorrhea nd steatorrhea in a child with CF? The values indicate the child is:

not compliant with taking her enzymes

Which signs and symptoms would the nurse expect to assess in a newborn with congenital hypothyroidism?

post-term, constipation, and bradycardia

The parents of a 3 month old ask why their baby will not have an operation to correct a VSD. The nurse's best response is:

"Your baby's defect is small and will likely close on its own by 1 year of age"

The parent of a child with frequent ear infections asks the nurse if there is anything that can be done to help avoid future ear infections. Which is the nurse's best response?

"Your child should be kept away from tobacco smoke"

The parents of a 6-year-old who has a new diagnosis of asthma ask the nurse what to do to make their home a more allergy-free environment. Which is the nurse's best response?

"Avoid purchasing upholstered furniture"

The parent of a child with croup tells the nurse that her other child just had croup and it cleared upon a couple of days without intervention. She asks the nurse why this child is exhibiting worsen symptoms and needs to be hospitalized. Which is the nurse's best response?

"Children younger than 3 years usually exhibit worse symptoms because their immune systems are not as developed"

A 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 to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation?

"Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly"

Which statement by the parent of a child using an albuterol inhaler leads the nurse to believe that further education is needed on how to administer the medication?

"I should administer two quick puffs of the albuterol inhaler using a spacer at one time." rationale: should wait one full minute in between puffs

Which statement indicates the parent needs further teaching on how to prevent his other children from contracting RSV?

"I should make sure that both my children receive palivizumab (Synagis) injections for the remainder of the year"

Which statement by a parent of an infant with CHF who is being sent home on digoxin (Lanoxin) indicates the need for further education?

"I will mix the digoxin in some formula to make it taste better"

Which statement by the parents of a toddler with repeated otitis media indicates they need additional teaching?

"My child will have fewer ear infections if he has his tonsils removed"

What would be the most appropriate advice to give to the parent of a child with slight visual blurring after being hit in the face with a basketball?

"Take him to the emergency department to ensure that he does not have any internal eye damage"

Which is the nurse's best response to the parent of an infant diagnosed with the first otitis media who wonders about long-term effects?

"The child could suffer recurrent ear infections"

On examination, a nurse hears a murmur at the LSB in a child with diarrhea and fever. The parent asks why the health-care provider never mentioned the murmur. The nurse explains:

"The fever increased the intensity of the murmur"

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?

"Thirty minutes before feeding the child breakfast"

Which response about safety measures is the most appropriate advice for the 2-year-old's mother who had her older home remodeled to reduce the lead level? Select all that apply. 1. wash and dry the child's hands and face before he eats 2. remodeling the home to remove the lead is all you need to do 3. it is best to use cold water to prepare the child's food to decrease the lead 4. diet does not matter in reducing lead levels in the child 5. drinking two cups of milk per day helps to decrease lead levels

1. "Wash and dry the child's hands and face before he eats." 3. "It is best to use cold water to prepare the child's food to decrease the lead"

Which child with asthma should the nurse see first?

A 12 month old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%

Which child is at highest risk for requiring hospitalization to treat RSV?

A 2 month old who was born at 32 weeks

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 doses not occur while sleeping. The nurse questions the parents about which recent illness?

Rheumatic Fever

The parents of a 5-week-old have just been told that their child has cystic fibrosis (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 about the current projected life expectancy. What is the nurse's best response?

The nurse answers their questions briefly, listens to their concerns, and is available later after they've processed the information.

Which plan would be appropriate in helping to control CHF in an infant?

Feeding in semi-Fowler position

Which are the most serious complications for a child with KD? Select all that apply.

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

Expected nursing assessment of a newborn with suspected cystic fibrosis would include which of the following? SATA 1. observe frequency and nature of stools 2.provide chest physical therapy 3. observe for weight gain 4. assess parents' compliance with fluid restrictions 5. Assess respiratory system frequently

1. observe frequency and nature of stools 3. observe for weight gain rationale: CF is inherited as an autosomal-recessive trait that causes exocrine gland dysfunction and affects the respiratory, GI, and reproductive systems.

Which of the following are examples of acquired heart disease? Select all that apply.

1. Infective endocarditis 3. Rheumatic Fever 4. Cardiomyopathy 5. Kawasaki Disease

What can an ECG detect? Select all that apply

1. Ischemia 2. Injury 4. Dysrhythmias 7. Conduction delay

Which is appropriate family discharge teaching following a child's cardiac catheterization? Select all that apply.

1. Remove pressure dressing the day after the catheterization 2. Avoid strenuous exercise for several days 5. Resume the child's normal diet once home

Hypoxic spells in the infant with a CHD can caused which of the following? Select all that apply

1. polycythemia 2. blood clots 3. CVA 4. Developmental delays 6. Brain damage

what does the therapeutic management of CF patients include? Select All that Apply.

1. providing a high-protein, high-calorie diet 3. Encouraging exercise 4. Minimizing pulmonary complications 5. encouraging medication compliance

TOF involves which defects? Select all that apply.

1. VSD 2. Right ventricular hypertrophy 4. PS 7. PDA

Which interventions decrease cardiac demands in an infant with CHF? Select all that apply.

1. allow parents to hold and rock their child 4. Make frequent position changes 5. Feed the child when sucking the fists 6. Change bed linens only when necessary 7. Organize nursing activities

Which child would benefit most from having ear tubes placed. Select all that apply. 1. A 9-month-old who has had one ear infection 2. a 13-month-old with recurrent ear infections 3. A 2-year-old who has had five previous ear infections 4. A 3-year-old whose sibling has had four ear infections 5. A 7-year-old who has had two ear infections this year

2. a 13 month old with recurrent ear infections 3. A 2 year old who has had five previous ear infections

Which statement by the mother of a child with RF shows she has good understanding of the care of her child? Select all that apply.

3. "I will give him his ordered anti-inflammatory medication for pain and inflammation" 5. "I will take my child every month to the health-care provider's office for his penicillin shot"

Which physical findings would be of most concern in an infant with respiratory distress?

Grunting rationale: grunting is a sing of impending respiratory failure and is a very concerning physical finding

CHDs are classified by which of the following? Select all that apply.

3. Defects with increased pulmonary blood flow 4. defects with decreased pulmonary blood flow 5. mixed defects 7. Pansystolic murmurs

A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include? Select all that apply. 1. Maintaining strict bedrest. 2. Avoiding contact with family members. 3. Instilling saline nose drops and bulb suctioning. 4. Keeping the head of the bed flat. 5. providing humidity and propping the head of the bed up

3. instilling saline nose drops and bulb suctioning 5. providing humidity and propping the head of the bed up

Which would be the most appropriate intervention for a 4-year-old brought to the emergency department after ingesting a small watch battery?

Assess and monitor airway, breathing, circulation, and abdominal pain; anticipate admission and prepare for surgical intervention

A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has:

Atrial stenosis

During a well-child checkup for an infant with TOF, the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to:

Hold the child in knee-chest position to decrease venous blood return

In which CHD would the nurse need to take upper and lower extremity BPs?

COA (Coarctation of Aorta)

The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has:

Coarctation of Aorta

Which is the nurse's best response to the parent of a child diagnosed with epiglottitis who asks what the treatment will be?

Complete a course of IV antibiotics

What should the nurse assess before administering digoxin (Lanoxin)?

Apical pulse rate

The nurse is caring for a 9 month old who was born with a CHD. Assessment reveals an HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of__________

Congestive Heart Failure

A child born with Down Syndrome should be evaluated for which associated cardiac manifestation?

CHD

What information should the nurse provide the parent of a child diagnosed with nasopharyngitis?

Use comfort measures for the child rationale: nursing care for nasopharyngitis is primarily supportive

A chloride level greater than_____ is a positive diagnostic indication of CF

60 meq/L

Indomethacin (Indocin) may be given to close which CHD in newborns?

Patent Ductus Arteriosus

While looking through the chart of an infant with a CHD of decreased pulmonary blood flow, the nurse would expect which laboratory finding?

Polycythemia