Test #6 Pediatrics Chapters 25, 26, 27

Which statement by a mother may indicate a cause for her 9-month-old's iron deficiency anemia?

"Formula is so expensive. We switched to regular milk right away." RATIONALE: Because cow's milk contains very little iron, infants should drink iron-fortified formula for the first year of life.

Which comment made by a parent of a 1-month-old would alert the nurse about the presence of a congenital heart defect?

"He tires out during feedings." RATIONALE: Fatigue during feeding or activity is common to most infants with congenital cardiac problems.

The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions?

"If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest." RATIONALE: In the event of a paroxysmal hypercyanotic or "tet" spell, the infant should be placed in a knee-chest position.

Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease?

"It is important for my child to drink plenty of fluids." RATIONALE: Prevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.

When auscultating breath sounds of an infant with respiratory syncytial virus, which assessment would the nurse immediately report?

"Quiet chest" from previous assessment of wheezing RATIONALE: A "quiet chest" after assessment of wheezing indicates occlusion of air pathways and impending respiratory arrest.

The nurse finds an adolescent with Hodgkin's disease crying. The adolescent says, "I am so scared." What is the most appropriate nursing response to this comment?

"Tell me what's got you scared." RATIONALE: The nurse should encourage the adolescent to express her feelings and concerns.

Which statement indicates that the child's parents understand how to perform respiratory therapy?

"We give the aerosol followed by postural drainage before meals." RATIONALE: Postural drainage for the child with CF is done following nebulization. Therapy is best scheduled before meals or at least 1 hour after eating to prevent vomiting.

A 6-year-old with leukemia asks, "Who will take care of me in heaven?" What is the best response by the nurse?

"Who do you think will take care of you?" RATIONALE: This response gives the child an opportunity to verbalize his or her feelings and concerns, whereas closed responses shut off communication. The asking of a "why" question is not therapeutic as it calls for justification.

Which assessment suggests a meconium ileus in a newborn?

- Abdominal distention - Vomiting - Absence of stool

What should be included in the nursing care of a 12 year old receiving radiation therapy for Hodgkin's disease?

- Application of sunblock - Appetite stimulation - Conservation of energy - Provision for expressions of anger

Which congenital cardiac defect(s) cause(s) increased pulmonary blood flow?

- Atrial septal defects (ASDs) - Patent ductus arteriosus - Ventricular septal defects (VSDs)

You suspect a child has sinusitis. Which symptoms lead to this suspicion?

- Child reports tooth pain - Child reports, I have had a cold for 2 weeks - Nurse observes periorbital swelling - Halitosis is present

A toddler has to stay on bedrest for pneumonia. What actions will you implement?

- Consider age - Assess developmental level - Implement light play activities

Place the stages of dying in the usual order as detailed by Kubler-Ross

- Denial - Anger - Bargaining - Depression - Acceptance

How has synthetic recombinant anti-hemophilic factor improved how hemophilia is managed?

- Eliminates the need for frequent transfusion - Can be administered by family at home - Reduces cost of care of the hemophiliac - Reduces risk of HIV and hepatitis A and B transmission

How would you modify feeding techniques when caring for a child with CHF?

- Feeding more frequently with smaller feedings - Using soft nipple with enlarged holes - Holding and cuddling the child during feedings - Offering high-caloric formula

What are the classic symptoms of thalassemia major (Cooley's anemia)?

- Hepatomegaly - Jaundice - Protruding teeth - Pathological fractures

A 16 year old is diagnosed with primary hypertension. What risk factors will you mention when providing education to the child and the parents?

- Heredity - Stress - Obesity - Poor diet

What are the 4 structural heart anomalies that make up tetralogy of fallot?

- Hypertrophied right ventricle - Patent ductus arteriosus - Narrowing of pulmonary artery - Dextroposition of aorta

How does chronic illnesses effect growth and development of a school aged child?

- Impaired sense of belonging - Decreased feelings of independence

What would you include when teaching an asthmatic child about purse lip breathing?

- Inhale deeply through nose with mouth closed - Make exhalation twice as long as inhalation - Exhale through mouth as if whistling

The "allergic salute" is a cluster of what signs related to chronic allergy?

- Mouth breathing - Transverse nasal crease - Dark circles under the eyes - Reddened conjunctiva

If a child has a low platelet count. What skin assessments would alert you to bleeding?

- Petichiae - Purpura - Ecchymosis - Hematoma

A 4 year old has H. influenza type B. Which signs and symptoms would make you suspect epiglottitis?

- Restlessness - Edematous epiglottis - Drooling

Why would you urge the family of a dying 12 year old to include his 8 year old sibling in his care?

- She will feel less neglected by the parents - She can make amends for past hostilities to her brother - She can express her feelings through care - She can experience being supportive of her parents and brother

What assessment in a child with tetralogy of fallot would indicate the child is experiencing a paroxysmal hyper-cyanotic episode?

- Spontaneous cyanosis - Dyspnea - Weakness - Syncope

What will you discourage when teaching parents of an asthmatic child

- Stuffed toys - Basketball

Which sport would you encourage an asthmatic child to participate in?

- Swimming - Gymnastics - Baseball

The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspects of care?

- Using a support group - Stimulating appetite - Continuing with scheduled immunizations - Reporting exposure to infectious diseases

Which combination of drugs does the COPP medical regimen use for treatment of Hodgkin's disease?

- Vincristine - Cyclophosphamide - Prednisone - Procarbazine hydrochloride

How long should a 4-year-old child recovering from rheumatic fever need to receive monthly injections of penicillin G?

5 years RATIONALE: Children who recover from rheumatic fever should have a chemoprophylaxis protocol of penicillin G injections (about 200,000 units per dose) for a minimum of 5 years or up to the age of 18 to prevent further bouts of rheumatic fever.

The nurse is caring for a 3-year-old who suffered a smoke inhalation injury. How long is this patient at the highest risk for pulmonary edema after exposure?

72 hours RATIONALE: Pulmonary edema appears in a child with smoke inhalation injury 6 to 72 hours after exposure.

What should the school nurse recommend when encouraging a heart-healthy diet for a child with high cholesterol?

A fat intake reduction of 25-35% of total calories RATIONALE: For a child with increased cholesterol a fat reduction of 25-35% of total calories with less than 75 saturated fat and less than 200 mg of cholesterol per day is advised.

Which assessment would lead the nurse to suspect that a newborn infant has a ventricular septal defect?

A loud, harsh murmur with a systolic thrill RATIONALE: A loud, harsh murmur combined with a systolic thrill is characteristic of a ventricular septal defect.

What is the best choice for fluid replacement that the nurse can offer a child who has just had a tonsillectomy?

A popsicle RATIONALE: Small amounts of clear liquids can be offered to the child. Synthetic fruit juices are not as irritating as natural juices. A popsicle is usually well-tolerated.

Through what does the infant born with hypoplastic left heart syndrome acquire oxygenated blood?

An atrial septal defect RATIONALE: Because the right side of the heart must take over pumping blood to both the lungs and systemic circulation, the ductus arteriosus must remain open to shunt the oxygenated blood from the lungs.

What will the nurse teach the parents of a child with a low platelet count to avoid?

Aspirin RATIONALE: Aspirin interferes with platelet function and should be avoided to prevent the risk of prolonged bleeding.

On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention?

Assessing neurological status RATIONALE: When platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.

What should the nurse explain to the parent of a child with exercise-induced asthma about when to inhale Cromolyn?

Before exercise to prevent attacks RATIONALE: Anti-inflammatory inhalants are taken before exercise to prevent attacks. These drugs can do nothing for the attack in progress. They are meant to be used as prophylactic therapies.

The nurse would observe a child for frequent swallowing after a tonsillectomy and adenoidectomy (T&A). What might this indicate?

Bleeding from the surgical site RATIONALE: Hemorrhage is the most common postoperative complication. Blood trickling down the back of the child's throat could cause frequent swallowing.

An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). What does the nurse understand regarding why dyspnea occurs?

Blood is circulated through the lungs again, causing pulmonary circulatory congestion. RATIONALE: When PDA is present, oxygenated blood recycles through the lungs, overburdening the pulmonary circulation.

What finding would the nurse expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta?

Blood pressure lower in the legs than in the arms RATIONALE: The characteristic symptoms of coarctation (narrowing) of the aorta are a marked difference in blood pressure and pulses between the upper and lower extremities. Pressure is increased proximal to the defect (upper extremities) and decreased distal to the coarctation (lower extremities).

What does the nurse explain that a ventricular septal defect will allow?

Blood to shunt left to right, causing increased pulmonary flow and no cyanosis RATIONALE: Pulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis.

The parents of a 3-month-old infant with cystic fibrosis (CF) want to know how their child got this disease, because no one in either of their families has CF. What is the nurse's best response based on the understanding of CF?

Both parents are carriers of the CF gene. RATIONALE: Cystic fibrosis is an inherited disease. Both parents must be carriers of the CF gene for the child to have the disease.

The teaching plan for the use of a dry powder inhaler for the treatment of asthma should include the warning to rinse the mouth after inhaling the powder. What does this prevent?

Candidiasis RATIONALE: Inhalant powders can cause candidiasis (yeast) infection of the mouth.

To prevent _____ you warm the blood prior to a transfusion

Cardiac dysrhythmias

What can sense the oxygen concentration in the blood and signal the brainstem to increase respiration?

Chemoreceptors

What is the result of a deficiency of factor IX?

Christmas disease RATIONALE: Christmas disease, or hemophilia B, is caused by the deficiency of factor IX.

The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse?

Clamp off blood and keep line open with normal saline. RATIONALE: If a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.

What would the nurse include in a teaching plan about mouth care of a child receiving chemotherapy?

Clean teeth with a soft toothbrush. RATIONALE: A soft toothbrush reduces capillary damage and mucous membrane breakdown and prevents bleeding and infection. Commercial mouthwashes may kill oral flora that combat infection. Water-Pik is useful for toughening gums.

The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, "Why do my child's fingertips look like that?" On what understanding does the nurse base a response?

Clubbing occurs as a result of chronic hypoxia.

The nurse is teaching the parents of a young child with iron deficiency anemia about nutrition. What food would the nurse emphasize as being a rich source of iron?

Cream of Wheat RATIONALE: Good nutritional sources of iron include boiled egg yolk, liver, green leafy vegetables, Cream of Wheat, dried fruits, beans, nuts, and whole-grain breads.

The asthmatic child who has been taking theophylline complains of stomachache and tachycardia and is sweating profusely. What does the nurse recognize as the cause of these symptoms?

Drug toxicity RATIONALE: The symptoms described are the signs of theophylline toxicity.

A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the children's risk of inheriting this disease?

Each child has a one in four chance of having the disease and a two in four chance of being a carrier. RATIONALE: The sickle cell gene is inherited from both parents; therefore each offspring has a one in four chance of inheriting the disease.

A pediatric patient is scheduled for a noninvasive procedure to determine if his heart is structurally normal and to localize a murmur. What diagnostic test does the nurse anticipate?

Echocardiogram RATIONALE: Echocardiography is a noninvasive procedure that localizes murmurs and determines if theheart is structurally normal.

Which is the most appropriate nursing action when planning care for a child with cystic fibrosis?

Ensure high-protein, high-calorie diet. RATIONALE: The maintenance of adequate nutrition is essential. The diet is high in protein and calories. Chest physiotherapy should be done between meals. Pancreatic enzyme powder should be given with applesauce or other nonstarch, nonfat, nonprotein food. Children with cystic fibrosis should be weighed daily.

The rate of RBC production is regulated by _____.

Erythropoietin

What classic sign would the nurse, auscultating the breath sounds of a child hospitalized for an acute asthma attack, expect to find?

Expiratory wheezing RATIONALE: The child experiencing an acute asthma attack wheezes as air moves in and out of the narrowed airways. The expiratory wheeze is most pronounced.

What important focus of nursing care for the dying child and the family should the nurse implement?

Families should be made aware that hearing is the last sense to stop functioning before death. RATIONALE: Hearing is intact even when there is a loss of consciousness.

_____ is designed to serve the metabolic needs during intrauterine life and to permit safe transition to life outside the womb.

Fetal Circulation

What should the nurse closely assess in a child receiving a transfusion?

Fever RATIONALE: The child receiving a blood transfusion is observed for signs of a transfusion reaction including chills, itching, fever, rash, headache, and back pain.

A child is diagnosed with iron deficiency anemia. What will the nurse explain can occur if this disorder goes untreated?

Heart failure RATIONALE: Untreated iron deficiency anemias progress slowly, and in severe cases the heart muscle becomes too weak to function. If this happens, heart failure follows.

A child develops carditis from rheumatic fever. Which areas of the heart are affected by carditis?

Heart muscle and the mitral valve RATIONALE: The tissues that cover the heart and heart valves are affected. The heart muscle may be involved and the mitral valve is frequently involved.

Systemic BP increases with age and correlates with _____ and _____ throughout childhood and adolescence

Height and Weight

In addition to their sickle shape, sickle cells contain the abnormal element of _____.

Hemoglobin S

Sickle cell trait can be distinguished from sickle cell disease by a lab test called _____.

Hemoglobin electrophoresis

A child with thalassemia major receives blood transfusions frequently. What is a complication of repeated blood transfusions?

Hemosiderosis RATIONALE: As a result of repeated blood transfusions, excessive deposits of iron (hemosiderosis) are stored in tissues.

An adolescent is diagnosed with Hodgkin's disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. Which disease stage is this?

III (3) RATIONALE: Lymph node regions on both sides of the diaphragm are consistent with a diagnosis of stage III Hodgkin's disease.

A 2-year-old child has been diagnosed with hemophilia A. What information should the nurse include in a teaching plan about home care?

If bleeding occurs, apply pressure, ice, elevate, and rest the extremity. RATIONALE: When bleeding occurs, the traditional approach is to follow RICE—rest, ice, compression, and elevation.

A child has just been diagnosed with acute lymphoblastic leukemia (ALL). What is the result of an overproduction of immature white blood cells in the bone marrow?

Increased susceptibility to infection RATIONALE: An overproduction of immature white blood cells increases the child's susceptibility to infection.

An infant is hospitalized with RSV bronchiolitis. What is the priority nursing diagnosis?

Ineffective breathing pattern related to airway inflammation and increased secretions

The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, "How does Kawasaki disease affect my child's heart and blood vessels?" On what understanding is the nurse's response based?

Inflammation weakens blood vessels, leading to aneurysm. RATIONALE: Inflammation of vessels weakens the walls of the vessels and often results in aneurysm.

The nurse is presenting information on the congentital disorder of hemophilia A. What fact will the nurse include?

It is transmitted by symptom-free females. RATIONALE: Hemophilia A affects mostly males who received the sex-linked recessive trait from a symptom-free female. The defective gene is on the X chromosome.

The _____ used in the diagnosing of rheumatic fever because it is so difficult.

Jones Criteria

What will the nurse tell parents of a child with a positive throat culture for group A hemolytic streptococcus that the treatment is most likely to be?

Oral penicillin for 10 days RATIONALE: When a throat culture is positive for group A beta-hemolytic streptococcus, penicillin is administered for 10 days even if symptoms are alleviated before the medication is finished.

A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever?

Painful, tender joints and carditis RATIONALE: The presence of two major Jones criteria would indicate a high probability of rheumatic fever.

What will the nurse teach the child with cystic fibrosis to take in order to facilitate digestion and absorption of nutrients?

Pancreatic enzymes RATIONALE: An oral pancreatic enzyme is given to the child with every meal and with snacks to replace the pancreatic enzymes that the child's body cannot produce.

The nurse is planning a hypertension-prevention program. What should be the main focus of the nurse when presenting information?

Patient education RATIONALE: The main focus of a hypertension-prevention program is patient education.

The nurse, caring for a child receiving chemotherapy, notes that the child's abdomen is firm and slightly distended. There is no record of a bowel movement for the last 2 days. What do these assessment findings suggest?

Peripheral neuropathy RATIONALE: Peripheral neuropathy may be signaled by severe constipation resulting from decreased nerve sensations in the bowel.

The nurse is planning to teach parents about preventing sudden infant death syndrome (SIDS). What significant information would the nurse include?

Placing infants on their backs or sides for sleep RATIONALE: The American Academy of Pediatrics recommends that all healthy infants be placed in the supine or side-lying position on a firm mattress to prevent SIDS.

The nurse notes that a 4-year-old child's gums bleed easily and he has bruising and petechiae on his extremities. Which lab value is consistent with these symptoms?

Platelet count of 25,000/mm3 RATIONALE: The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential.

What is the best intervention for the nurse caring for a child experiencing an acute asthma attack?

Position the child with arms resting on the overbed table. RATIONALE: This position is comfortable and allows maximum use of the accessory muscles for breathing. Sedatives would mask symptoms of increasing air hunger. Carbonated beverages are contraindicated in persons with dyspnea.

The first child of a couple is being treated for bronchopulmonary dysplasia (BPD). They ask how to prevent this from happening with the child they are currently expecting. What will the nurse explain as the best way to prevent BPD?

Prevention of preterm birth RATIONALE: Bronchopulmonary dysplasia (BPD) is a fibrosis, or thickening, of the alveolar walls and the bronchiolar epithelium. It occurs in premature infants (less than 32 weeks) who have abnormal or arrested lung development and receive ventilation and oxygen for more than 28 days to survive. Respiratory distress in the newborn is the major reason why oxygen and ventilators are used for prolonged periods. The main cause of respiratory distress in the newborn is prematurity. Therefore the prevention of preterm births is the best way to prevent BPD.

The difference between the systolic BP and the diastolic BP is called the _____.

Pulse Pressure

How would the nurse advise a mother to clear the nostrils when her infant has a cold?

Remove nasal secretions with a bulb syringe. RATIONALE: The nasal passages can be cleared by instilling a few drops of saline into the nose and then suctioning the secretions with a bulb syringe.

The nurse is caring for a toddler with acute laryngotracheobronchitis. Which assessment finding would indicate the child is experiencing increased respiratory obstruction?

Restlessness RATIONALE: Restlessness is a primary sign of increased respiratory obstruction.

_____ is a systemic disease involving the joints, heart, CNS, skin, and subcutaneous tissues

Rheumatic Fever

The most recent blood count for a child who received chemotherapy last week shows neutropenia. What is the priority nursing diagnosis for this child?

Risk for infection

The nurse offers a variety of fluids to a 5-year-old asthmatic child to compensate for the fluid loss through dyspnea. Which fluids are most appropriate?

Room temperature water RATIONALE: Room temperature fluids are the best. Carbonated and iced beverages increase spasm. Milk stimulates mucus production.

A father asks why his child with tetralogy of Fallot seems to favor a squatting position. What is the nurse's best response?

Squatting increases the return of venous blood back to the heart. RATIONALE: The squatting position allows the child to breathe more easily because systemic venous return is increased.

A child with rheumatic fever begins involuntary, purposeless movements of her limbs. What does the nurse recognize that this indicates?

Sydenham's chorea RATIONALE: As the effects of rheumatic fever affect the central nervous system, the child may develop Sydenham's chorea, manifested by involuntary, purposeless movements of the limbs.

Which initial intervention will the nurse suggest to the parents of a child experiencing laryngeal spasm?

Take the child to the bathroom and turn on a hot shower. RATIONALE:

The nurse is dealing with a preschool-age child with a life-threatening illness. What should the nurse remember the child's concept of death is at this age?

That a person becomes alive again soon after death RATIONALE: The preschooler views death as reversible and temporary.

What is accurate about the characteristics of high-density lipoproteins (HDLs)?

They have little cholesterol. RATIONALE: HDLs have low amounts of triglycerides, large amounts of proteins, low amount of cholesterol, and are excreted via the liver. They have no role in the production of steroids.

A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing?

Vaso-occlusive RATIONALE: Vaso-occlusive crisis, or painful crisis, is caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.

The most common congenital heart defect is _____ defect

Ventricular septal

An infant with congestive heart failure is receiving digoxin (Lanoxin). What does the nurse recognize as a sign of digoxin toxicity?

Vomiting RATIONALE: Symptoms of digoxin toxicity include: nausea, vomiting, anorexia, irregularity in pulse rate and rhythm, and a sudden change in pulse.

What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit?

With orange juice RATIONALE: Vitamin C aids in the absorption of iron, whereas food and milk interfere with the absorption of iron.

Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant?

Withholding a dose if the apical heart rate is less than 100 beats/min RATIONALE: As a rule, if the pulse rate of an infant is below 100 beats/min, the medication is withheld and the physician is notified.

You review Accolate and Zyflo, which are _____; They are capable of blocking the inflammatory response as well as providing bronchodilation

leukotriene modifiers