EAQ

The parent of a 2-year-old child with just-diagnosed cystic fibrosis expresses concern about the child's frailty and low weight. Which is the most appropriate reply by the nurse? "Digestive enzymes will be given to help your child digest food." "Your child's appetite will improve once respiratory therapy is started." "Your child's coughing and shortness of breath prevent the adequate chewing of food." "I suggest that you offer baby foods to your child because they are more easily digested."

"Digestive enzymes will be given to help your child digest food." Because the pancreatic ducts are blocked and fibrotic, oral pancreatic enzymes must be given to make the nutrients digestible and absorbable. Children with cystic fibrosis have good, even voracious, appetites despite respiratory impairment. Chewing is adequate despite coughing and shortness of breath; undernourishment results from inadequate nutrient absorption. It is not the consistency of the foods that leads to inadequate digestion and absorption, but the lack of enzymes from the pancreatic duct.Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.

A child in respiratory distress is admitted to the hospital and diagnosed with acute spasmodic laryngitis (spasmodic croup). At the time of discharge, the mother asks how to handle another attack at home. Which would the nurse recommend? "Place him near a cool-mist humidifier." "Bring him to the emergency department." "Give him an over-the-counter cough syrup." "Offer him warm tea sweetened with honey."

"Place him near a cool-mist humidifier." During a spasmodic croup attack, cool humidified air to decrease inflammation is a fast home remedy. An attempt should be made to interrupt the attack at home first rather than going to the emergency department. Cough syrup is ineffective because it does not relieve laryngeal spasm. Tea with honey is an ineffective remedy for a spasmodic croup attack, and the tea may present a risk of aspiration.

Which parent education would the nurse provide as rationale for gavage feedings in an infant with congestive heart failure? "It limits the chance of vomiting." "It allows the feeding to be administered rapidly." "The energy that would have been expended on suckling is conserved." "The quantity of nutritional liquid can be regulated better than it can with a bottle."

"The energy that would have been expended on suckling is conserved." Gavage feeding is preferred for weak infants, those with respiratory distress or ineffective sucking-swallowing coordination, and those who are easily fatigued. It conserves energy and reduces the workload of the heart. Vomiting is not a reason to institute gavage feedings; however, vomiting may be lessened because the amount and rapidity of the feeding can be controlled. Feeding the infant quickly is not desirable; vomiting followed by aspiration may occur. The amount given can be regulated with oral formula feeding as well. Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess.

A toddler with a history of enlarged lymph nodes, prolonged fever, erythema of the extremities, and a rash is admitted to the pediatric unit with a diagnosis of Kawasaki disease. Which criteria would the nurse recognize as essential to confirming this diagnosis? An increased antistreptolysin O (ASO) titer A combination of signs A low-grade temperature An increased sedimentation rate

A combination of signs The diagnosis is based on the presence of five of six specific signs: fever, trunk rash, enlarged cervical lymph nodes, bilateral congestion of the conjunctiva, edema, and redness of the extremities. Increased ASO titer is associated with streptococcal infection. High, prolonged fever is a sign of Kawasaki disease. Increased sedimentation rate is not specific to Kawasaki disease; the sedimentation rate increases in the presence of inflammation.

A 37-year-old G3P2001 client with hypertension and type 1 diabetes with good glycemic control is seen in the antepartum testing unit for a nonstress test (NST) at 36 weeks. Her obstetric (OB) history includes an intrauterine fetal death at 38 weeks. What risk factors in the client's history indicate the need for an NST? Select all that apply. One, some, or all responses may be correct. Age older than 35 years The risk for placenta previa The risk for placental insufficiency A history of stillbirth from her last pregnancy Hypertension Type 1 diabetes

Age older than 35 years The risk for placental insufficiency A history of stillbirth from her last pregnancy Hypertension Type 1 diabetes This client has multiple risk factors that would indicate the need for an NST to evaluate fetal status. Maternal age over 35 is considered advanced maternal age and is associated with a slightly increased risk of stillbirth and fetal growth restriction. The history of a prior stillbirth increases her risk of stillbirth in the current pregnancy. This client also has diabetes and hypertension, both of which put her at risk for placental insufficiency. Although advanced maternal age increases the risk of placenta previa, it is not the primary reason for having an NST.

Which finding would the nurse be most concerned about when reviewing the chart of a client scheduled for an amniocentesis? Hepatitis B Prior uterine surgery Active genital herpes B negative blood type

B negative blood type Because of the possibility of fetomaternal hemorrhage, administering Rho D immune globulin to the woman who is Rh negative is standard practice after an amniocentesis. Hepatitis B, prior uterine surgery, or active genital herpes do not increase the risk for maternal or neonatal complications of amniocentesis.Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

Which nursing action would the nurse perform for an infant who develops mottling in the leg used for cardiac catheterization? Elevating the leg Covering the leg with a blanket Checking the pulse in the extremity Notifying the primary health care provider

Checking the pulse in the extremity Some mottling is expected because of circulatory disruption and arterial spasm. Further assessment (e.g., palpation of the pedal pulse) is performed to rule out arterial occlusion. Elevation of the leg is contraindicated; elevation may induce bleeding from the puncture site. A blanket will interfere with inspection. Other observations should be made before the primary health care provider is notified.

A 2-year-old child who is hospitalized for repair of tetralogy of Fallot is seen squatting in the playroom. In response to this behavior, which would the nurse do? Administer oxygen through a mask. Call the respiratory therapist for a nebulizer treatment. Continue to observe the child if there are no other signs of distress. Notify the health care provide that the child's condition is deteriorating.

Continue to observe the child if there are no other signs of distress. Squatting is a physiologic adaptation for children with tetralogy of Fallot. By squatting, the child decreases the amount of arterial blood that is flowing to the extremities, which in turn decreases venous return to the heart and reduces preload. Oxygen is not indicated. The child has a heart, not respiratory problem, so a nebulizer treatment is not indicated. The child's condition has not deteriorated; squatting is a physiologic adaptation.

Which iron-rich foods would the nurse encourage the client with mild anemia in early pregnancy to eat? Select all that apply. One, some, or all responses may be correct. Dark leafy green vegetables Legumes Dried fruits Yogurt Ground beef patty

Dark leafy green vegetables Legumes Yogurt Ground beef patty Excellent food sources of iron include liver, meats, whole grain or enriched breads, dark green leafy vegetables, legumes, and dried fruits. Yogurt is a good source of calcium, not iron.Test-Taking Tip: The night before the examination you may wish to review some key concepts that you believe need additional time, but then relax and get a good night's sleep. Remember to set your alarm, allowing yourself plenty of time to dress comfortably (preferably in layers, depending on the weather), have a good breakfast, and arrive at the testing site at least 15 to 30 minutes early.

The nurse is caring for a 4-year-old child who has been hospitalized with an acute asthma exacerbation. Which assessment finding would require immediate action by the nurse? Diminished breath sounds Pulse rate of 110 beats per minute Pulse oximetry reading of 95% Respiratory rate of 24 breaths per minute

Diminished breath sounds At the beginning of an asthma exacerbation, wheezing may be heard only with a stethoscope. As the severity of the episode increases, wheezing may become audible to the unaided ear. Children in severe respiratory distress may not demonstrate wheezing because of decreased air movement; diminished breath sounds in a child may signal an inability to move air, so this finding requires immediate action to prevent respiratory failure. The normal pulse range for a 4-year-old is 80 to 125 beats per minute; a pulse of 110 beats per minute does not require action. The normal respiratory range for a 4-year-old is 20 to 30 breaths per minute, so a respiratory rate of 24 breaths per minute does not require action. A pulse oximetry reading of 95% is acceptable. Once the child has been hospitalized with an acute asthma attack, oxygen saturation should be kept at 95% or higher.

During their initial visit to the prenatal clinic, a couple asks the nurse whether the woman should have an amniocentesis for genetic studies. Which factor indicates that an amniocentesis may be indicated? Recent history of drug abuse Family history of genetic abnormalities Maternal age older than 30 years at the time of the first pregnancy Request by client to determine sex of fetus

Family history of genetic abnormalities The main reason for performing amniocentesis is the diagnosis of genetic problems. Some genetic conditions are inherited, so a family history of genetic abnormalities could be an indication to offer amniocentesis. The decision to have an amniocentesis is made by the parents after detailed discussion of the risks, benefits, and alternatives. There are now other, less invasive screening tests for genetic abnormalities, but amniocentesis and chorionic villi sampling remain the diagnostic tests. Even though a recent history of drug abuse may increase the risk of the development of the fetus, it is not a genetic issue. A 30-year-old pregnant client would be routinely offered less invasive serum genetic screening as a first step, with amniocentesis only if the preliminary screening suggested an increased risk of genetic abnormality. Using amniocentesis to determine the fetal sex only for the reason of parental curiosity is not appropriate because of the risks of amniocentesis. Other, less invasive procedures can be done to determine the sex of the fetus.

A child has a respiratory tract infection with a low-grade fever. When teaching the parents, which intervention would the nurse emphasize? Encouraging high-calorie snacks to prevent weight loss Keeping the toddler wrapped in blankets to prevent shivering Giving small amounts of clear liquids frequently to prevent dehydration Using cool-water baths to prevent the child's fever from increasing further

Giving small amounts of clear liquids frequently to prevent dehydration Fluid is lost through perspiration and the increased metabolic rate associated with a fever; an intake of small, frequent amounts of fluids will replenish lost fluid and prevent dehydration. Although caloric intake is important, it is not the priority. Keeping the toddler wrapped in blankets to prevent shivering interferes with the radiation of heat from the body; dressing the toddler in light clothing will help reduce the fever. Cool baths may produce shivering; this will increase the fever; a low-grade fever is part of the body's adaptive mechanism that limits the multiplication of microorganisms.Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely.

Which parent education would the nurse provide to decrease the workload of a baby's heart for an infant with a cardiac defect? How to organize care to support periods of rest Reasons that the infant should not be held or cuddled Reasons that a regular feeding schedule should be maintained How to stimulate the infant periodically to promote respiratory excursion

How to organize care to support periods of rest Long periods of rest must be promoted; activities should be organized to minimize interruptions. Parents should be encouraged to cuddle their infants, both for emotional development and to induce sleep. The feeding plan should be flexible to accommodate the infant's sleep and wake needs and patterns. Stimulation should be minimized to decrease the workload of the heart.

Which early sign of heart failure would the nurse recognize in an infant who has a congenital heart defect with left-to-right shunting of blood? Cyanosis Restlessness Decreased heart rate Increased respiratory rate

Increased respiratory rate Because the lungs are stressed by pulmonary edema, a quicker respiratory rate is the first and most reliable indicator of early heart failure in infants. Cyanosis is a late sign of heart failure; with early failure there is still adequate perfusion of blood. Infants with early heart failure do not move about; they become fatigued quickly, especially when feeding, because of a decrease of oxygen to body cells. The heart rate of an infant in early heart failure increases, not decreases, in an attempt to increase oxygen to body cells.

A 3-month-old infant with tetralogy of Fallot suddenly becomes cyanotic and begins breathing rapidly. In which position would the nurse immediately place the infant? Supine Lateral Knee-chest Semi-Fowler

Knee-chest The infant is experiencing a hypercyanotic ("tet" spell) episode caused by a sudden decrease in pulmonary blood flow and an increase in right-to-left shunting. It usually occurs after increased activity. The knee-chest position decreases venous return from the legs, which increases systemic vascular resistance, thereby increasing pulmonary blood flow. The supine and lateral positions increase venous return, which exacerbates the problem. Although the semi-Fowler position is recommended for infants with cardiac disease, it is not adequate for an infant experiencing a tet spell.

Which position increases cardiac output in the obstetrical client with cardiac disease? Trendelenburg Low semi-Fowler Lateral positioning Supine with legs elevated

Lateral positioning Lateral positioning improves the cardiac output of an obstetrical client with cardiac disease. Trendelenburg, low semi-Fowler, and the supine position are not appropriate positions to improve the cardiac output of an obstetrical client with cardiac disease. Placing the client in these positions allows the weight of the uterus to remain on the vena cava, impeding the blood flow.Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer.

When preparing a child with asthma for discharge, which instructions would the nurse emphasize to the family? Select all that apply. One, some, or all responses may be correct. Limit allergens in the home. Maintain a dry home environment. Avoid placing limits on the child's behavior expectations. Continue the medications even if the child is asymptomatic. Prevent exposure to infection by having the child tutored at home.

Limit allergens in the home. Continue the medications even if the child is asymptomatic. Parents should be taught to limit allergens in the home that can precipitate asthma attacks (e.g., no carpets, no down pillows, no scented products; wet-mopping floors, vacuuming when the child is not in the home). Medications to control inflammation, including inhaled corticosteroids and long-acting β2-agonists, must be continued to suppress exacerbations of asthma. Environmental moisture is necessary for these children; in addition, cold environments should be avoided. Consistent limits should be placed on the child's behavior, regardless of the illness; a chronic illness does not eliminate the need for limit setting. The child should return to school and continue to interact with schoolmates and friends.Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.

Which medication would be administered to prevent symptoms of withdrawal in a laboring client who routinely uses heroin? Butorphanol Pentazocine Nalbuphine Methadone

Methadone Methadone is a narcotic analgesic used to prevent withdrawal symptoms in pregnant women who have stopped using heroin or other opioid drugs. Butorphanol, pentazocine, and nalbuphine are all narcotic agonist-antagonists and may cause acute withdrawal symptoms in the woman and fetus.

For a pregnant client with type 1 diabetes, which action is most likely to reduce the risks of disease-related complications? Monitor and control blood glucose levels. Limit pregnancy weight gain to an average of 25 pounds. Preplan for a cesarean section. Attend all prenatal office visits.

Monitor and control blood glucose levels. In a pregnant client with type 1 diabetes, monitoring and controlling blood glucose levels are the most important interventions to optimize maternal and fetal health. Uncontrolled glucose levels in pregnancy are associated with fetal malformations, macrosomia, difficult deliveries with increased risk of hemorrhage, and fetal death. A woman who is average weight before getting pregnant can gain 25 to 35 pounds after becoming pregnant. Underweight women can gain 28 to 40 pounds. Overweight women should gain no more than 15 to 25 pounds during pregnancy, and obese women can gain 11 to 20 pounds. Preplanning for a cesarean section may be appropriate in some cases, but is not a risk-reducing factor during the pregnancy. Prenatal office visits will help the mother monitor and identify early interventions that can be implemented to maintain blood glucose control.Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.

The nurse is caring for a toddler in acute respiratory distress precipitated by laryngotracheobronchitis. The child has a temperature of 103°F (39.4°C). Which is the priority nursing intervention? Delivering humidified oxygen Initiating measures to reduce fever Monitoring respiratory status continuously Providing support to diminish apprehension

Monitoring respiratory status continuously Laryngeal spasms can occur abruptly; patency of the airway is determined through continuous monitoring for signs of respiratory distress. Providing oxygen is important, but maintenance of respiration is the priority. The fever should be treated, but it is not critical at 103°F (39.4°C); maintenance of respiration is the priority. Offering support is important, but maintenance of respiration is the priority.

Which clinical condition concerns the nurse the most for an obstetrical client with heart disease? Select all that apply. One, some, or all responses may be correct. Obesity Anemia Hypertension Hypothyroidism Emotional distress

Obesity Anemia Hypertension Emotional distress The effects of factors that increase the workload of the cardiovascular system can be reduced by appropriate treatment of coexisting conditions that increase the risk of cardiac decompensation. Conditions such as obesity, anemia, hypertension, and emotional stress should be reduced. Hypothyroidism is not a condition that increases the workload of the cardiovascular system; however, hyperthyroidism does.

Which intervention is important in the care of a hospitalized toddler with cystic fibrosis? Discouraging coughing Performing postural drainage Encouraging active exercise Providing small, frequent feedings

Performing postural drainage Because the mucus glands secrete thick mucoid secretions that accumulate, reducing ciliary action and mucus flow, the nurse would perform postural drainage, which promotes the removal of mucopurulent secretions by means of gravity. Coughing should be encouraged; it helps bring up secretions from the respiratory tract. Although the nurse would encourage activities that are appropriate for the child's physical capacity, the child's energy should be conserved during acute phases of illness. Providing small, frequent feedings is not necessary; the child with cystic fibrosis may eat regular meals at the usual times.

Which would the nurse avoid in an infant with a congenital heart defect after cardiac catheterization? Offering fluids as tolerated Performing range-of-motion exercises Monitoring the apical pulse for rate and rhythm Assessing the pulses distal to the catheterization site

Performing range-of-motion exercises Range-of-motion exercises of the limb bearing the catheterization site might cause the dislodgment of a clot and result in hemorrhage. Intake should start with fluids and progress as tolerated. The apical pulse is monitored because a common complication after cardiac catheterization involves disturbances of cardiac rate and rhythm. The peripheral pulses are assessed because formation of thrombi is a complication of cardiac catheterization.

Which intervention would the nurse implement for a 4-month-old infant with tetralogy of Fallot and heart failure? Providing small, frequent feedings Positioning the child flat on the back Encouraging frequent nutritional fluids Measuring the head circumference dail

Providing small, frequent feedings Small, frequent feedings with adequate rest periods in between may improve the infant's intake at each feeding; infants with tetralogy of Fallot become extremely fatigued while feeding. Positioning the child with the head elevated, not flat on the back, facilitates respiration; an infant cardiac seat, similar to a car seat, helps maintain the child in the semi-Fowler position. As a means of reducing the cardiac workload, excessive fluids usually are not offered, and fluids may even be restricted. The head circumference is not an important assessment for infants with congenital heart disease; daily head measurements should be taken for infants with hydrocephaly.Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.

In which part of the cardiovascular system would the nurse expect an increase in pressure in a toddler with pulmonic stenosis? Left atrium Right ventricle Pulmonary vein Pulmonary artery

Right ventricle Pulmonic stenosis increases resistance to blood flow, causing right ventricular hypertrophy; with right ventricular failure there is an increase in pressure on the right side of the heart. Pressure in the left side of the heart is decreased with pulmonic stenosis. Pressure in the pulmonary vein is decreased with pulmonic stenosis. Pressure in the pulmonary artery is decreased with pulmonic stenosis.

Which behavior would the nurse know is important to avoid in a 5-month-old child who had heart surgery to repair the defects associated with tetralogy of Fallot? Crying Coughing Straining at stool Unnecessary movement

Straining at stool Forceful evacuation involves taking a deep breath, holding it, and straining (Valsalva maneuver). This increases intrathoracic pressure, which puts excessive strain on the heart sutures. Crying is not a problem after cardiac surgery; it may, in fact, help prevent respiratory complications. Coughing and deep breathing are essential for the prevention of postoperative respiratory complications. Activity is gradually increased.

Which anatomic abnormalities are found in tetralogy of Fallot? Overriding aorta, aortic stenosis, patent ductus arteriosus, and mitral insufficiency are the components of this defect. Tricuspid atresia, ventricular septal defect, atrioventricular canal, and coarctation of the aorta are the components of this defect. The disorder consists of right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta. The disorder consists of right ventricular hypertrophy, atrial septal defect, patent ductus arteriosus, and mitral insufficiency.

The disorder consists of right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta. Tetralogy of Fallot consists of right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and an overriding aorta.

The nurse is reviewing the laboratory report of an infant with tetralogy of Fallot that shows an increased red blood cell (RBC) count. Which would the nurse identify as the cause of the polycythemia? Low blood pressure Diminished iron level Tissue oxygen needs Hypertrophic cardiac muscle

Tissue oxygen needs Decreased tissue oxygenation stimulates erythropoiesis, resulting in excessive production of RBCs. Low blood pressure and hypertrophic cardiac muscle are not direct causes of polycythemia. Diminished iron level may or may not affect the production of RBCs.

Which problem is indicated by a positive contraction stress test (CST)? Preeclampsia Placenta previa Fetal prematurity Uteroplacental insufficiency

Uteroplacental insufficiency A CST is positive when late decelerations occur with 50% or more of contractions. A positive CST indicates uteroplacental insufficiency and a compromised fetus. Preeclampsia does not cause a positive CST result. A CST is contraindicated for a client with a suspected placenta previa, because the contractions may cause bleeding. A CST is contraindicated for a client with a suspected preterm birth or a gestation less than 33 weeks' duration, because the contractions may induce true labor.

A toddler is found to have coarctation of the aorta. Which would the nurse expect to identify when taking the child's vital signs? Irregular heartbeat Weak femoral pulse Thready radial pulses Increased temperature

Weak femoral pulse Coarctation of the aorta is a narrowing of the aorta, usually in the thoracic segment, resulting in decreased blood flow below the constriction and increased blood volume above it. The femoral pulses are weak or absent. An irregular heartbeat and increased temperature are not related to coarctation of the aorta. The radial pulses are bounding in coarctation of the aorta.