PEDs exam 3

The parents of a child with sickle cell disease ask the nurse why their child's hemoglobin was normal at birth but now the child has S hemoglobin. Which response by the nurse is appropriate? □ 1. "The placenta prevents the passage of the hemoglobin S from the mother to the fetus." □ 2. "The red bone marrow does not begin to produce hemoglobin S until several months after birth." □ 3. "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." □ 4. "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

4. Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborn's hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester. Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.

42. The mother tells the nurse she will be afraid to allow her child with hemophilia to participate in sports because of the danger of injury and bleeding. After explaining that physical fitness is important for children with hemophilia, which activity should the nurse suggest as ideal? □ 1. snow skiing □ 2. swimming □ 3. basketball □ 4. gymnastics

42. 2. Swimming is an ideal activity for a child with hemophilia because it is a noncontact sport. Many noncontact sports and physical activities that do not place excessive strain on joints are also appropriate. Such activities strengthen the muscles surrounding joints and help control bleeding in these areas. Noncontact sports also enhance general mental and physical well-being. Falls and subsequent injury to the child may occur with snow skiing. Basketball is a contact sport and therefore increases the child's risk for injury. Gymnastics is a very strenuous sport. Gymnasts frequently have muscle and joint injuries that result in bleeding episodes.

47. The nurse teaches the family of child with leukemia about preventing infections. How should the nurse explain to the parents why their child is at risk for infections? □ 1. "Abnormal platelets lead to bruising and bleeding." □ 2. "There are an insufficient number of circulating white blood cells." □ 3. "The number of red blood cells is inadequate for carrying oxygen." □ 4. "Immature white blood cells are incapable of handling an infectious process."

47. 4. In leukemia, although there is an increased number of immature white blood cells, they are unable to combat infection. Lack of mature white blood cells puts a child with leukemia at risk for infection. The major morbidity and mortality factor associated with leukemia is infection resulting from the presence of granulocytopenia. Decreased red blood cells are not directly caused by infection. While platelets play a role in the body's response to infection, bleeding does not directly cause infections. CN: Reduction of risk potential; CL: Apply

50. After teaching a child with leukemia about a scheduled bone marrow aspiration, the nurse determines that the teaching has been successful when the child identifies which place as the site for the aspiration? □ 1. right lateral side of the right wrist □ 2. middle of the chest □ 3. distal end of the thigh □ 4. back of the hipbone

50. 4. Although bone marrow specimens may be obtained from various sites, the most commonly used site in children is the posterior iliac crest, the back of the hipbone. This area is close to the body's surface but removed from vital organs. The area is large, so specimens can easily be obtained. For infants, the proximal tibia and the posterior iliac crest are used. The middle of the chest or sternum is the usual site for bone marrow aspiration in an adult. The wrist, chest, and thigh are not sites from which to obtain bone marrow specimens. CN: Reduction of risk potential; CL: Evaluate

59. The nurse assists with conscious sedation of a school-age client undergoing a bone marrow biopsy. What is the nurse's most important responsibility during the procedure? □ 1. administering the topical anesthetic □ 2. keeping the parents informed □ 3. monitoring the client □ 4. recording the procedure

59. 3. During conscious sedation, the client may lose protective reflexes, and adequate respiratory and cardiac function may be impaired. At every procedure, there must be one health care professional whose sole responsibility is to monitor the client. Topical agents must be given in advance of the procedure to be effective. During the procedure, the nurse would not leave the child to speak with the parents. While the procedure would be documented according to the facility's protocols, proper monitoring of the client is the intervention most associated with reducing risks. CN: Reduction of risk potential; CL: Apply

38. What is the most appropriate method to use when drawing blood from a child with hemophilia? □ 1. Use finger punctures for lab draws. □ 2. Prepare to administer platelets. □ 3. Apply heat to the extremity before venipunctures. □ 4. Schedule all labs to be drawn at one time.

38. 4. Coordinating labs to minimize sticks reduces trauma and the risk of bleeding. Fingersticks in general are more painful and associated with more bleeding than are venipunctures. In hemophilia, platelets are typically normal. Heat would increase vasodilatation and increase bleeding. CN: Reduction of risk potential; CL: Apply

At a wellness check, the nurse monitors the routine laboratory values of an asymptomatic school-age client with sickle cell anemia. The reports reveal that the child has a hemoglobin of 10 g/100 mL (100 g/1 L). The nurse plans the client's care based on which interpretation of the hemoglobin level? □ 1. The child will most likely need a blood transfusion for the low hemoglobin. □ 2. This hemoglobin level is a typical finding in children with this disease. □ 3. The folic acid dose may need to be increased to improve hemoglobin production. □ 4. Additional tests are needed to determine if a sequestration crisis is causing the low hemoglobin.

2. Between crises, hemoglobin levels between 6 and 9 g/100 mL (60 to 90/L) are typical for children with sickle cell anemia. The decision to transfuse a child must be weighed against the risks. Transfusions are most often considered to treat life-threatening sickle cell complications, to keep HbS levels within a desired range, or as prophylaxis before surgery. Oral folic acid is frequently prescribed to rebuild hemolyzed RBCs. It would be appropriate for the nurse to verify that the client was taking folic acid as prescribed before making any further interpretations. Clients with sequestration crisis present with symptoms including pain and signs and symptoms of hypovolemia.

The nurse is teaching the parents of a child with sickle cell disease. What information should the nurse give the family on how to prevent sickle cell crisis? □ 1. Exercise in cool temperatures. □ 2. Drink at least 2 quarts of fluids per day. □ 3. Avoid contact sports. □ 4. Take anti-inflammatory medications before exercising.

2. Increasing fluid intake and being well hydrated will help prevent cell stasis in the small vessels. Restricting fluids causes stasis of red blood cells and promotes obstruction and increases the chance of sickling with hypoxia and pain to the part that is involved. Clients with sickle cell disease should avoid exercising in cool temperatures or swimming in cold water. While contact sports are not recommended because of bleeding risks, they do not cause sickle crisis. Taking an anti-inflammatory medication before

61. The nurse prepares to administer furosemide to a preschooler with a heart defect. The nurse verifies the child's identity by checking the arm band and using which method? □ 1. asking the child to state her name □ 2. checking the room number □ 3. asking the child to tell her birth date □ 4. asking the parent the child's name

61. 4. Safety standards require the use of two identifiers prior to medication administration. A parent can be used as the second identifier. Many young children will only answer to a nickname that does not coincide with the medical identification band or may answer to any name. It is common for children on a pediatric floor to go into each other's rooms. Small children may not know their birth date. CN: Safety and infection control; CL: Synthesize

The nurse admits a 1-year-old child to the hospital with the diagnosis of sickle cell crisis. The nurse explains to the parents that which condition leads to local tissue damage during a sickle cell crisis? □ 1. autoimmune reaction complicated by hypoxia □ 2. lack of oxygen in the red blood cells □ 3. obstruction to circulation □ 4. elevated serum bilirubin concentration

3. Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of the red blood cells. The erythrocytes are sickle shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.

34. Which action indicates that the parents of a 12-month-old with iron-deficiency anemia understand how to administer iron supplements? Select all that apply. □ 1. administering iron supplements in combination with fruit juice □ 2. scheduling iron supplements with meals □ 3. verbalizing the need to report dark stools □ 4. brushing the child's teeth after administering the iron supplements □ 5. decreasing the dietary intake of foods fortified with iron

34. 1, 4. Parent teaching concerning a child with iron-deficiency anemia should include directions about giving iron combined with fruit juice, in divided doses, between meals, and with a dropper for a 12-month-old or through a straw for older toddlers. Iron stains teeth, so brushing the teeth and administering liquid iron through a dropper or straw are necessary to prevent staining the teeth. Iron should not be given with milk, antacids, or tea and should be administered on an empty stomach. Iron will cause the stool to become black or green, which is normal and does not need to be reported. However, light-colored stools indicate the iron is not being absorbed and should be reported.

35. During a health history the nurse learns that a pediatric client seldom eats foods high in iron. Which physical assessment findings would suggest that the child has developed iron-deficiency anemia? Select all that apply. □ 1. decreased heart rate □ 2. pale skin □ 3. swollen tongue □ 4. systolic murmur □ 5. yellowed sclera

35. 2, 3, 4. Pale skin is one of the most common physical findings associated with iron-deficiency anemia. Lower levels of myoglobin lead to soreness and swelling of the tongue. Low levels of hemoglobin force the heart to work harder to pump blood. Tachycardia and systolic murmurs may result. Anemia presents as an elevated heart rate not decreased. Yellowed sclera is consistent with hemolytic anemia. CN: Physiological adaptation; CL: Analyze

36. Which statement by the parent of a toddler most suggests that the child is at risk for iron-deficiency anemia? □ 1. "He drinks over four glasses of milk per day." □ 2. "He must drink over 10 oz (300 mL) of apple juice per day." □ 3. "He refuses to eat more than two different kinds of vegetables." □ 4. "He does not like meat, but he will eat small amounts of it."

36. 1. Milk is a poor source of iron. Toddlers should have between two and three servings of milk per day. Iron-deficiency anemia can be caused when excessive milk intake of more than 32 oz (1 L)/day intake displaces iron-rich food in the diet. While 6 oz (300 mL) is the recommended daily limit for apple juice, it does contain more iron than milk. Food preferences vary among children. It is acceptable for the child to refuse foods as long as the diet is balanced and contains adequate calories. CN: Basic care and comfort; CL: Analyze

37. Which foods should the nurse encourage a parent to offer to a child with iron-deficiency anemia? □ 1. cereal, milk, and yellow vegetables □ 2. potato, peas, and chicken □ 3. macaroni, cheese, and ham □ 4. pudding, green vegetables, and rice The Client with Hemophilia

37. 2. Potatoes, peas, chicken, green vegetables, and fortified cereal contain significant amounts of iron and therefore would be recommended. Milk and yellow vegetables are not good iron sources. Rice by itself also is not a good source of iron. Macaroni, cheese, and ham are not high in iron. While pudding (made with fortified milk) and green vegetables contain some iron, the better diet has protein and iron from the chicken and potato. CN: Basic care and comfort; CL: Apply The Client with Hemophilia

39. A diagnosis of hemophilia A is confirmed in an infant. Which instruction should the nurse provide the parents as the infant becomes more mobile and starts to crawl? □ 1. Administer one-half of a children's aspirin for a temperature higher than 101°F (38.3°C). □ 2. Sew thick padding into the elbows and knees of the child's clothing. □ 3. Check the color of the child's urine every day. □ 4. Expect the eruption of the primary teeth to produce moderate to severe bleeding

39. 2. As the hemophilic infant begins to acquire motor skills, falls and bumps increase that risk of bleeding. Such injuries can be minimized by padding vulnerable joints. Aspirin is contraindicated because of its antiplatelet properties, which increase the infant's risk for bleeding. Because genitourinary bleeding is not a typical problem in children with hemophilia, urine testing is not indicated. Although some bleeding may occur with tooth eruption, it does not normally cause moderate to severe bleeding episodes in children with hemophilia. CN: Safety and infection control; CL: Synthesize

40. A child with hemophilia presents with a burning sensation in the knee and reluctance to move the body part. The nurse collaborates with the care team to provide factor replacement and implements which intervention? □ 1. administers an aspirin-containing compound □ 2. institutes rest, ice, compression, and elevation □ 3. begins physical therapy with active range of motion □ 4. initiates skin traction immobilization

40. 2. The child is displaying symptoms of bleeding in the joint, and factor replacement is indicated. The RICE method is used as a supportive measure to help control the bleeding. Aspirin-containing compounds contribute to bleeding and should never be used to control pain. Physical therapy is instituted after acute bleeding to prevent further damage. Orthopedic traction is considered in some rare cases during the rehabilitation phase, but not the acute phase. CN: Physiological adaptation; CL: Synthesize

41. The nurse creates a teaching plan for the family of a child with hemophilia who receives recombinant antihemophilic factor. Which problem is most important for the nurse to teach the family to report immediately? □ 1. yellowing of the skin □ 2. constipation □ 3. abdominal distention □ 4. hives

41. 4. Administration of antihemolytic factor (recombinant) is a biosynthetic preparation of factor VIII that carries the risk of severe allergic reaction. Signs include hives, difficulty breathing, tachycardia, chills, and fever. Originally, factor VIII preparations were derived from large pools of human plasma and carried the risk of hepatitis, but recombinant preparations do not. Antihemolytic factor (recombinant) is not associated with constipation or abdominal distention. CN: Pharmacological and parenteral therapies; CL: Synthesize

43. An adolescent client is admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which signs and symptoms require the most urgent nursing intervention? □ 1. fatigue and anorexia □ 2. fever and petechiae □ 3. swollen neck lymph glands and lethargy □ 4. enlarged liver and spleen

43. 2. Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable, but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority. CN: Reduction of risk potential; CL: Analyze

44. A school-age client with leukemia is receiving cyclophosphamide. The nurse should assess the client for which adverse effect of cyclophosphamide? □ 1. photosensitivity □ 2. ataxia □ 3. cystitis □ 4. cardiac arrhythmias

44. 3. Cystitis is a potential adverse effect of cyclophosphamide. The client should be monitored for pain on urination. Photosensitivity, ataxia, and cardiac arrhythmias are not adverse effects associated with cyclophosphamide. CN: Pharmacological and parenteral therapies; CL: Analyze

45. After the nurse teaches the parent of a child newly diagnosed with leukemia about the disease, which description if given by the parent best indicates understanding the nature of leukemia? □ 1. "Leukemia is an infection resulting in increased white blood cell production." □ 2. "Leukemia is a type of cancer characterized by an increase in immature white blood cells." □ 3. "Leukemia is an inflammation associated with enlargement of the lymph nodes." □ 4. "Leukemia is an allergic disorder involving increased circulating antibodies in the blood."

45. 2. Leukemia is a neoplastic, or cancerous, disorder of blood-forming tissues that is characterized by a proliferation of immature white blood cells. Leukemia is not an infection, inflammation, or allergic disorder. CN: Physiological adaptation; CL: Evaluate

46. The nurse reviews the laboratory report of a child with leukemia (see exhibit). What does the nurse determine is the priority problem for this client? □ 1. activity intolerance □ 2. risk of bleeding □ 3. impaired tissue perfusion □ 4. risk for infection

46. 2. A normal platelet count is 150,000 to 400,000 μL (150 to 400 × 109/L). A platelet count of 40,000 μL (40 × 109/L) is low and puts the child at risk for injury, bruising, and bleeding. Hematocrit of 41.2% (0.41) is normal; therefore, the child will have adequate oxygenation and tissue perfusion. The white blood cell count of 6,500 mm3 (6.5 × 109/L) is normal; therefore, the child has no increase in risk for infection. CN: Reduction of risk potential; CL: Analyze

48. Which beverage should the nurse plan to give a child with leukemia to relieve nausea? □ 1. orange juice □ 2. weak tea □ 3. plain water □ 4. carbonated soda

48. 4. Carbonated beverages ordinarily are best tolerated when a child feels nauseated. Many children find cola drinks especially easy to tolerate, but noncola beverages are also recommended. Orange juice usually is not tolerated well because of its high acid content. Tea may also be too acidic, and many children do not like tea. Water does not relieve nausea. CN: Basic care and comfort; CL: Apply

49. Which medication prescription to help relieve pain in a child with leukemia should the nurse question? □ 1. hydromorphone □ 2. acetaminophen with codeine □ 3. ibuprofen □ 4. hydrocodone

49. 3. Ibuprofen prolongs bleeding time and is contraindicated in clients with leukemia. Nonnarcotic drugs other than ibuprofen or aspirin, such as acetaminophen, may be prescribed to control pain and may be used in combination with codeine or hydrocodone if pain is more severe. Hydromorphone may also be used for severe pain. CN: Pharmacological and parenteral therapies; CL: Synthesize

51. The nurse and parents plan for the discharge of a child with leukemia who is receiving dactinomycin and vincristine. Which intervention should the nurse include in the teaching plan? □ 1. Encourage increased fluid intake. □ 2. Keep the child out of the sun. □ 3. Monitor the child's heart rate. □ 4. Observe the child for memory loss.

51. 1. Dactinomycin and vincristine both cause nausea and vomiting. Oral fluids are encouraged, and antiemetics are given to prevent dehydration. Avoiding sun exposure is not necessary because photosensitivity is not associated with these drugs. Heart rate changes and memory issues also are not associated with either of these two drugs. CN: Pharmacological and parenteral therapies; CL: Synthesize

60. The nurse transfers a child who has had open heart surgery from the intensive care unit to the pediatric unit. The child's blood pressure has been fluctuating but has been stable during the last 2 hours. What information should the nurse include in the handoff report? Select all that apply. □ 1. medications being used □ 2. current vital signs □ 3. potential for blood pressure to drop □ 4. drip rate for the intravenous infusion □ 5. time of the most recent dose of pain medication □ 6. medications given during surgery

60. 1, 2, 3, 4, 5. The report made when nurses are "handing off" a client from one nursing unit to another must include information about the condition of the client, potential for changes in the client's condition, current medications, and care and services received. It is not necessary to know what medications were given in surgery to provide safe care at this point. CN: Safety and infection control; CL: Synthesize

52. After doing well for a period of time, a child with leukemia develops an overwhelming infection. The child's death is imminent. Which statement offers the nurse the best guide in making plans to assist the parents in dealing with their child's imminent death? □ 1. Knowing that the prognosis is poor helps prepare parents for the death of children. □ 2. Parents are especially grieved when a child does well at first but then declines rapidly. □ 3. Parents' trust in health care personnel is most often destroyed by a death that is considered untimely. □ 4. It is more difficult for parents to accept the death of an older child than that of a toddler.

52. 2. It has been found that parents are more grieved when optimism is followed by defeat. The nurse should recognize this when planning various ways to help the parents of a dying child. It is not necessarily true that knowing about a poor prognosis for years helps prepare parents for a child's death. Death is still a shock when it occurs. Trust in health care personnel is not necessarily destroyed when a death is untimely if the family views the personnel as having done all that was possible. It is not more difficult for parents to accept the death of an older child than that of a younger child. CN: Psychosocial integrity; CL: Synthesize

53. A school-age child with leukemia will be taking vincristine. The nurse should encourage the child to eat what kind of diet? □ 1. high-residue □ 2. low-residue □ 3. low-fat □ 4. high-calorie

53. 1. Vincristine may cause constipation, so the client should be encouraged to eat a high-residue (fiber) diet. The other diets do not help with constipation that can occur while receiving vincristine. CN: Pharmacological and parenteral therapies; CL: Apply

54. A school-age child with leukemia is taking immunosuppressive drugs. What health maintenance recommendation should the nurse include in the teaching plan? □ 1. Monitor the child's temperature at school. □ 2. Avoid any live attenuated vaccines. □ 3. Take daily vitamin and mineral supplements. □ 4. Stay away from other children.

54. 2. Children who are immunosuppressed should not receive any live attenuated vaccines. Clients who are immunosuppressed and are given live attenuated vaccines such as measles, mumps, rubella, and oral polio vaccine can develop severe forms of the diseases for which they are being immunized, which can result in death. Inactivated vaccines may be given if necessary, but the client is not able to adequately produce needed antibodies, and it is recommended that immunizations be delayed for 3 months after the immunosuppressive drugs have been discontinued. It is unnecessary to monitor the child's temperature at school unless the child shows symptoms of an illness. Vitamin and mineral supplements are not normally given in conjunction with immunosuppressive drugs. When the client is immunosuppressed, the client should avoid only persons who have an infection. CN: Health promotion and maintenance; CL: Synthesize

55. A nurse is proving anticipatory guidance to the family of a school-age child with acute lymphocytic leukemia. Which recommendation should the nurse make? □ 1. home schooling for 2 years □ 2. avoiding all athletic activities □ 3. encouraging trips to the shopping mall □ 4. being treated as "normal" as much as possible

55. 4. Any child with a chronic illness should be treated as normally as possible. Unless the child has severe bone marrow depression, he or she should be allowed to go to school with others and can go to the mall. If the child is in remission, athletic activities are allowed. CN: Health promotion and maintenance; CL: Synthesize

56. Which signs and symptoms of leukemia would lead the nurse to suspect the client has thrombocytopenia? Select all that apply. □ 1. fever □ 2. petechiae □ 3. epistaxis □ 4. anorexia □ 5. bone pain □ 6. dyspnea Managing Care, Quality, and Safety of Children with Cardiovascular and Hematologic Health Problems

56. 2, 3. Children with acute lymphocytic leukemia have a reduced platelet count (thrombocytopenia), reduced red blood cell count (anemia), and reduced white blood cell count (neutropenia) because of unrestricted proliferation of immature white blood cell. Chemotherapy is used to treat leukemia and contributes to thrombocytopenia, neutropenia, and anemia. Clients with thrombocytopenia are at risk for bleeding. Petechiae (small red or purple spots on the skin) and epistaxis (nose bleeds) are both signs of bleeding. A fever is a result of a decreased white blood cell count. Anorexia and dyspnea (shortness of breath) are a result of a decreased red blood cell count. Bone pain is a result of stress on the bone related to the unrestricted proliferation of the leukemic blast cells. CN: Physiological adaptation; CL: Analyze Managing Care, Quality, and Safety of Children with Cardiovascular and Hematologic Health Problems

57. A transfusion of packed red blood cells has been prescribed for a 1-year-old with sickle cell anemia. The infant has a 25-gauge IV infusing dextrose with sodium and potassium. Using the situation, background, assessment, and recommendation (SBAR) method of communication, the nurse contacts the health care provider (HCP) and makes which recommendation? □ 1. starting a second IV with a 22-gauge catheter to infuse normal saline with the blood □ 2. using the existing IV, but changing the fluids to normal saline for the transfusion □ 3. replacing the IV with a 22-gauge catheter to infuse the prescribed fluids □ 4. starting a second IV with a 25-gauge catheter to infuse normal saline with the transfusion lk.

57. 2. The best evidence indicates that a catheter as small as 27 gauge may safely be used for transfusion in children, but blood must be infused with normal saline, not dextrose. A 1-year-old should be able to maintain his or her blood glucose for the 2-hour duration of the infusion without the need for a second IV. CN: Management of care; CL: Synthesize

58. An infant has been transferred from the ICU to the pediatric floor after undergoing surgery to correct a heart defect. Which tasks can the nurse delegate to the licensed practical/vocational nurse (LPN/VN)? Select all that apply. □ 1. administering oral medications □ 2. administering IV push morphine □ 3. obtaining vital signs □ 4. providing morning hygiene □ 5. obtaining circulation checks □ 6. providing discharge teaching

58. 1, 3, 4. The RN's scope of practice includes assessment, planning, implementing, and evaluation. Only aspects of care implementation may be delegated to the LPN/VN , and the exact skills that may be delegated vary by state and institution. In general, LPN/VNs have been trained to perform the tasks of administering oral medications, performing hygiene, and recording the intake and output. LPN/VNs may also take vital signs to gather data, but the nurse must interpret the data. Administering IV morphine requires assessment of the client's respiratory status before, during, and after the procedure. Circulation checks are assessments the RN should complete. CN: Management of care; CL: Synthesize

62. A school-age client with hemophilia A has fallen and badly bruised his knee. Which action should the nurse do first to manage the client's hemarthrosis? □ 1. Use active range of motion to prevent immobility. □ 2. Apply cold packs to promote vasoconstriction. □ 3. Apply pressure and immobilize the joint. □ 4. Notify the health care provider (HCP) of the injury.

62. 3. Application of pressure and immobilization of the affected limb are the first priority. Pressure is required to stop the bleeding, and immobilization aids in reducing swelling and pain. Active range of motion is recommended after the bleeding is controlled. The application of cold packs can be helpful in diminishing swelling and pain. Cold packs will also promote vasoconstriction, which can help reduce the bleeding. The health care provider (HCP) should be informed of the bleeding episode after initial measures to control the bleeding are implemented. CN: Management of care; CL: Synthesize

63. The nurse completes discharge teaching with the family of an 8-week-old infant with congenital heart disease. What is the most important information for the nurse to convey regarding feeding? □ 1. Allow the infant 1 hour to complete each feeding. □ 2. Position the infant in an upright position after each feeding. □ 3. Give feedings per nasogastric tube to conserve energy. □ 4. Provide a higher calorie formula or fortified breast milk

63. 4. Infants with congenital heart disease often have difficulty feeding and gaining weight. They will tire quickly during the feeding. Most will do well with smaller, more frequent feedings. The infant with a congenital heart defect should not be given more than 20 minutes per feeding. Fortified breast milk or a high-calorie formula will help the infant gain weight and conserve energy. Prolonging the feeding to an hour will merely tire the infant. Positioning the infant in an upright position is recommended for infants with gastrointestinal reflux. Some infants with a congenital heart defect may not consume adequate amounts of calories through breast- or bottle-feeding and may require supplemental feeding through a nasogastric tube; however, nasogastric tube feedings are not necessary for all infants with congenital heart defects. CN: Management of care; CL: Synthesize