Exam 2 review

B

A pathophysiological mechanism responsible for symptoms associated with laryngeal tracheal bronchitis (LTB) is: A) Inflammation of the bronchiole smooth muscle associated with bronchospasms B) Obstruction of the respiratory passages by edema and inflammation C) Narrowing of the respiratory airway associated with an allergic reaction D) Destruction of laryngeal tissues by thick tenacious mucous

D A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. Bronchoscopy, although helpful for identifying bacterial infection in children with CF, is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

D

Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestation is which of the following? A) Hyperactivity of sweat glands B) Hypoactivity of autonomic nervous system C) Atrophic changes in mucosal wall of intestines D) Mechanical obstruction caused by increased viscosity of mucous gland secretions

C Children with CF require a well-balanced, high-protein, high-caloric diet, with unrestricted fat (because of the impaired intestinal absorption).

In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind? a. Fats and proteins must be greatly curtailed. b. Most fruits and vegetables are not well tolerated. c. Diet should be high in calories, proteins, and unrestricted fats. d. Diet should be low fat but high in calories and proteins.

D

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent: A) Otitis media B) Diabetes insipidus C) Nephrotic syndrome D) Acute rheumatic fever

A

surgical closing of the ductus arteriosus would do which of the following: A. prevent the return of oxygenated blood to the lungs B. increase the oxygenation of blood C. decrease the edema in the legs and feet D. stop the loss of deoxygenated blood to the systemic circulation

C Should assess below

which of the following is NOT correct cardiac catheterization post procedure nursing care? A. assess temperature and color of the affected extremity B. monitor vital signs every 15 minutes with emphasis on heart rate and BP C. assess pulses above the catheterization site for equality and symmetry Dmonitor IV and oral fluid intake to ensure adequate hydration

A

assessment of a term neonate at 8 hours after birth reveals tachypnea, dyspnea, sternal retractions, diminished femoral pulses poor lower body perfusion and cyanosis of the lower body and extremities with a pink upper body. these symptoms are most likely associated with which of the following: A. coarction of the aorta B. pulmonary atresia C. transposition of the great arteriesatrio D. ventricular septal defectcoarctation

A. Weight gain of 1.8 kg- A 4lb weight gain indicates increased fluid and worsening of the child's heart failure; therefore, the nurse should report this finding to the provider.

a nurse is assessing a 2 month old infant who has a ventricular septal defect. Which of the following findings should the nurse report to the provider? A. Weight gain of 1.8 kg B. Heart rate of 125/min C. Soft, flat fontanel D. Systemic murmur

C

a nurse is caring for a child who has otitis media. the nurse should identify that which of the following is a manifestation of this condition: A. nasal congestion B. bulging fontanel C. elevated temp as high as 104F D. rash

B Children's response to the disruption of routine during hospitalization is demonstrated in eating, sleeping, and other activities of daily living. The lack of structure is allowing the child to sleep during the day, rather than at night. Most likely the lack of schedule is the problem. The nurse and child can plan a schedule that incorporates all necessary activities, including medications, mealtimes, homework, and patient care procedures. The schedule can then be posted, so the child has a ready reference. Sedatives are not usually used with children. The child has a chronic illness and most likely knows the importance of rest. The parents and child can be questioned about changes at home since the last hospitalization.

A 13-year-old child with cystic fibrosis (CF) is a frequent patient on the pediatric unit. This admission, she is sleeping during the daytime and unable to sleep at night. What should be a beneficial strategy for this child? a. Administer prescribed sedative at night to aid in sleep. b. Negotiate a daily schedule that incorporates hospital routine, therapy, and free time. c. Have the practitioner speak with the child about the need for rest when receiving therapy for CF. d. Arrange a consult with the social worker to determine whether issues at home are interfering with her care.

D Serum cholestreol level of 700mg/dL is above the expected reference range. A child with nephrotic syndrome will have high serum cholesterol because of increased plasma lipids.

A nurse is caring for a child who has suspected nephrotic syndrome. Which of the following laboratory values should the nurse expect? A. Platelets 120,000/mm3 B. Serum sodium 160 mEq/L C. Hgb 9 g/dL D. Serum cholesterol 700 mg/dL

A

A nurse is caring for a child who is 2 hr postoperative following a tonsillectomy. Which of the following fluid items should the nurse offer the child at this time? A. Crushed ice B. Cranberry juice C. Orange juice D. Vanilla milkshake

D Hematuria can be detected visually in clients who have acute post-streptococcal glomerulonephritis

A nurse is caring for a school age child who has acute poststreptococcal glomerulonephritis. Which of the following manifestation should the nurse expect? A. Hypotension B. Eleveated Serum Lipid Levels C. Decreased serum potassium levels D. Hematuria

A The nurse should recommend an increased protein intake for the child with cystic fibrosis. These children require up to 150% of the recommended daily allowance to meet their nutritional needs.

A nurse is providing dietary taeching to the parent if a child who has cystic fibrosis. Which of the following dietary recommendations should the nurse make? A. Increase the child's protein intake B. Decrease the child's calorie intake C. Increase the child's fiber intake D. Decrease the child's salt intake

C

A nurse is providing teaching to the parent of an infant who has gastroesophageal reflux. which of the following statements by the parent indicates an understanding of the teaching A. I should position my baby's side lying during sleep B. I will have to feed my baby formula rather than breast milk C. I will keep my baby in an upright position after feedings D. my baby formula can be thickened with oatmeal

D

A nurse is teaching a group of guardians about influenza. Which of the following information should the nurse include in the teaching? A. Amantadine will prevent the illness B. Rimantadine is administered IM C. Zanamivir can be given to children 1 year and older D. Oseltamivir should be given within 48 hours of onset of manifestations

A Rheumatic fever characteristically presents 2 to 6 weeks after an untreated or partially treated group A β-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child had a sore throat or an unexplained fever within the past 2 months. Options 2, 3, and 4 are unrelated to rheumatic fever.

A nurse receives a telephone call from the admitting office and is told that a child with rheumatic fever will be arriving in the nursing unit for admission. On admission, the nurse prepares to ask the mother which question to elicit assessment information specific to the development of rheumatic fever? A. "Did the child have a sore throat or an unexplained fever within the last 2 months?" B."Has the child had any nausea or vomiting?" C."Has the child complained of headaches?" D."Has the child complained of back pain?"

A (These are the insidious symptoms of bacterial endocarditis. Because the child is in a high-risk group for this disorder (VSD repair), immediate evaluation and treatment are indicated to prevent cardiac damage. With appropriate antibiotic therapy, bacterial endocarditis is successfully treated in approximately 80% of the cases. The child's complaints should not be dismissed. The low-grade fever is not a symptom that the child can fabricate.)

A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38 C (100.4 F), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother? a. Immediately bring the child to the clinic for evaluation. b. Come to the clinic next week on a scheduled appointment. c. Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness. d. Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.

C (Thickened feedings decrease the child's crying and increase the caloric density of the feeding. Although it does not decrease the pH, the number and volume of emesis are reduced. Surgical therapy is reserved for children who have failed to respond to medical therapy or who have an anatomic abnormality. The prone position is not recommended because of the risk of sudden infant death syndrome. Smaller, more frequent feedings are more effective than less frequent, larger volumes of formula.)

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent? a. Surgical therapy is indicated. b. Place in prone position for sleep after feeding. c. Thicken feedings and enlarge the nipple hole. d. Reduce the frequency of feeding by encouraging larger volumes of formula.

A Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which diagnosis? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

C, D

A nurse is caring for a child who has bronchiolitis. Which of the folloiwng actions should the nurse take? SATA A. Administer oral prednisone B. Initiate chest percussion and postural drainage. C. Administer humidified oxygen D. Suction as needed E. Administer oral penicillin

B (If a 1-minute apical pulse is less than 90 beats/min for an infant or young child, the digoxin is withheld. Sixty beats/min is the cut-off for holding the digoxin dose in an adult. One hundred to 120 beats/min is an acceptable pulse rate for the administration of digoxin.)

A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate? a. 60 beats/min b. 90 beats/min c. 100 beats/min d. 120 beats/min

C (The clinical manifestations of Hirschsprung disease in a 3-day-old infant include abdominal distention, vomiting, and failure to pass meconium stools. Pyloric stenosis would present with vomiting but not distention or failure to pass meconium stools. Intussusception presents with abdominal cramping and celiac disease presents with malabsorption.)

A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? a. Pyloric stenosis b. Intussusception c. Hirschsprung disease d. Celiac disease

A Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue. Therefore, IV fluids are preferred until the acute stage of bronchiolitis has passed. Infants with bronchiolitis may have paroxysmal coughing, but fluids by mouth would not be contraindicated. Irritability or fever would not be reasons for fluids by mouth to be contraindicated.

A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant's vital signs are T, 101.6° F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason? a. Tachypnea b. Paroxysmal cough c. Irritability d. Fever

D (The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. Preparing the family for imminent death or beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.)

A 3-month-old infant with Tetralogy of Fallot has a hypercyanotic spell. What should be the nurses first action? a. Assess for neurologic defects. b. Prepare the family for imminent death. c. Begin cardiopulmonary resuscitation. d. Place the child in the knee-chest position.

D This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.

A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner? a. Make her lie down and rest quietly. b. Examine her oral pharynx and report to the physician. c. Auscultate her lungs and prepare for placement in a mist tent. d. Notify the physician immediately and be prepared to assist with intubation.

D (Heart failure is common with ventricular septal defect that causes failure to thrive, respiratory infections, and increased exhaustion during feedings. There is a characteristic murmur. The other defects do not have left-to-right shunting.)

A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what? a. Tetralogy of Fallot b. Coarctation of the aorta c. Pulmonary stenosis d. Ventricular septal defect

B (Preoperative teaching should always be directed to the child's stage of development. The caregivers also benefit from these explanations. The parents may ask additionaDACE inhibitors act by interfering with the production of angiotensin II, which is a potent vasoconstrictor. Diuretics lower blood pressure by increasing fluid output. Vasodilators act on the vascular smooth muscle. By causing arterial dilation, blood pressure is lowered. Beta-blockers interfere with beta stimulation and depress renin output.l questions, which should be answered, but the child needs to receive the information based on developmental level. This age group will not understand in-depth descriptions. School-age children should be prepared close to the time of the cardiac catheterization.)

A 6-year-old child is scheduled for a cardiac catheterization. What consideration is most important in planning preoperative teaching? a. Preoperative teaching should be directed at his parents because he is too young to understand. b. Preoperative teaching should be adapted to his level of development so that he can understand. c. Preoperative teaching should be done several days before the procedure so he will be prepared. d. Preoperative teaching should provide details about the actual procedures so he will know what to expect.

A

A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggest which of the following? A) Asthma B) Pneumonia C) Bronchiolitis D) Foreign body in trachea

A Asthma presents with a nonproductive cough and wheezing. Pneumonia appears with an acute onset, fever, and general malaise. A productive cough and rales would be indicative of pneumonia. Stridor and substernal retractions are indicative of croup.

A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis? a. Nonproductive cough, wheezing b. Fever, general malaise c. Productive cough, rales d. Stridor, substernal retractions

A Nebulized epinephrine (racemic epinephrine) is now used in children with LTB that is not alleviated with cool mist. The beta-adrenergic effects cause mucosal vasoconstriction and subsequent decreased subglottic edema. The use of corticosteroids is beneficial because the anti-inflammatory effects decrease subglottic edema. Nebulizer treatments are not effective even though oxygen may be required. Antibiotics are not used because it is a viral infection. Chest physiotherapy would not be instituted.

A child is admitted with acute laryngotracheobronchitis (LTB). The child will most likely be treated with which? a. Racemic epinephrine and corticosteroids b. Nebulizer treatments and oxygen c. Antibiotics and albuterol d. Chest physiotherapy and humidity

C Amantadine hydrochloride may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

A child is diagnosed with influenza, probably type A disease. Management includes which recommendation? a. Clear liquid diet for hydration b. Aspirin to control fever c. Amantadine hydrochloride (Symmetrel) to reduce symptoms d. Antibiotics to prevent bacterial infection

A Peak expiratory flow rate monitoring is used to monitor the child's current pulmonary function. It can be used to manage exacerbations and for daily long-term management. The cause of asthma is known. Asthma is caused by a complex interaction among inflammatory cells, mediators, and the cells and tissues present in the airways. The triggers of asthma are determined through history taking and immunologic and other testing. The diagnosis of asthma is made through clinical manifestations, history, physical examination, and laboratory testing.

A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate? a. To assess severity of asthma. b. To determine cause of asthma. c. To identify "triggers" of asthma. d. To confirm diagnosis of asthma.

B One of the only adverse effects of DNase is voice alterations and laryngitis. DNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years. 2 agonists can cause tachycardia and jitteriness.

A child with cystic fibrosis (CF) is receiving recombinant human deoxyribonuclease (DNase). Which is an adverse effect of this medication? a. Mucus thickens b. Voice alters c. Tachycardia d. Jitteriness

B Bronchodilators should be given before CPT to open bronchi and make expectoration easier. These medications are not helpful when used after CPT. Oxygen is administered only in acute episodes, with caution, because of chronic carbon dioxide retention.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a. After chest physiotherapy (CPT) b. Before chest physiotherapy (CPT) c. After receiving 100% oxygen d. Before receiving 100% oxygen

B (A fall in the serum potassium level enhances the effects of digoxin, increasing the risk of digoxin toxicity. Increased serum potassium levels diminish digoxins effect. Therefore, serum potassium levels (normal range, 3.55.5 mmol/L) must be carefully monitored.)

A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which? a. Serum sodium b. Serum potassium c. Serum glucose d. Serum chloride

D (Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic alkalosis, not acidosis, is likely.)

A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication? a. Hyperkalemia b. Hyperchloremia c. Metabolic acidosis d. Metabolic alkalosis

B Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool extremities are clinical manifestations of impaired myocardial function.

A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is: a. Tachypnea. b. Peripheral edema. c. Tachycardia. d. Pale, cool extremities.

D Cardiac valve damage is the most significant complication of rheumatic fever. Seizures, cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic fever.

A common, serious complication of rheumatic fever is: a. Seizures. b. Cardiac arrhythmias. c. Pulmonary hypertension. d. Cardiac valve damage.

A Polyarthritis is swollen, hot, red, and painful joints. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. Osler's nodes, Janeway spots, and splinter hemorrhages are characteristic of infective endocarditis.

A major clinical manifestation of rheumatic fever is: a. Polyarthritis. b. Osler's nodes. c. Janeway spots. d. Splinter hemorrhages of distal third of nails.

C Epiglottitis is a disorder caused by an inflammation of the epiglottis. It results in rapid swelling of the epiglottis, which can obstruct breathing. Drooling is common finding due to the toddler's inability to swallow saliva.

A nurse in an emergency department is caring for a toddler who is in acute respiratory distress. Which of the following findings should alert the nurse to the possibility of epiglottitis?A. Lethargy B. Spontaneous coughing C. Drooling D. Hoarseness

B A VSD is an acyanotic heart deffect. A systolic murmur can be heard best at the lower left sternal border.

A nurse is assessing a child who has a ventricular septal defect. Which of the following findings should the nurse expect? A. Diastolic murmur B. Murmur at the left sternal border C. Cyanosis that increases with crying D. Widened pulse pressure

A, B, D, F Hoarseness, difficulty speaking, drooling, difficulty swallowing, high-grade (not low grade fever), and stridor are all manifestations of epiglottitis.

A nurse is assessing a child who has epiglottitis. Which of the following findings should the nurse expect? SATA A. Hoarseness and difficulty speaking B. Difficulty swallowing C. Low-grade fever D. Drooling E. Dry, barking cough F. Stridor

C A child with acute otitis media should take an antibiotic to help alleviate the infection. Children less than 6 months old should not take iboprofen.

A nurse is caring for a 4-month-old child with acute otitis media and fever of 38.3(101). Which of the following medications should the nurse administer? A. Diphenhydramine B. Furosemide C. Amoxicillin D. Ibuprofen

A

A nurse is caring for a 6 month old infant who has a prescription for clear liquids by mouth after a repair of an intussusception. Which fluid should a nurse select for the infant?. A. Oral electrolyte solution B. Half-strength infant formula C. Half-strength orange juice D. Sterile water

C

A nurse is caring for a 6 week old infant who has a pyloric stenosis. Which of the following clinical manifestations should the nurse expect? A. Red currant jelly stools. B. Distended neck veins C. Projectile vomiting D. Ridged Abdomen

B Beta-Adrenergic agonists and methylxanthines work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. Which describes their action? a. Liquefy secretions b. Dilate the bronchioles. c. Reduce inflammation of the lungs. d. Reduce infection.

C this is correct because it shows increase in respiratory effort (labored breathing)

An 11 year old child is admitted for treatment of an asthma attack. Which of the following indicates immediate intervention is needed? A. Thin, copious mucous secretion B. Productive cough C. Intercostal reactions D. Respiratory rate of 20 breaths per minute

C Clients with cystic fibrosis commonly die from respiratory problems. The mucus in the lungs is tenacious and difficult to expel, leading to lung infections and interference with oxygen and carbon dioxide exchange. The client will likely need supplemental oxygen and respiratory treatments to maintain adequate gas exchange, as identified by the oximeter reading. The child will be on bed rest due to respiratory distress. However, although blood gases will probably be prescribed, the oximeter readings will be used to determine oxygen deficit and are, therefore, more of a priority. A diet high in calories, proteins, and vitamins with pancreatic granules added to all foods ingested will increase nutrient absorption and help the malnutrition; however, this intervention is not the priority at this time. Inserting an IV to administer antibiotics is important, and can be done after ensuring adequate respiratory function.

An adolescent with cystic fibrosis has been hospitalized several times. On the latest admission, the client has labored respirations, fatigue, malnutrition, and failure to thrive. Which initial nursing actions are most important? a) inserting an IV line and initiating antibiotic therapy b) placing the client on bed rest and obtaining a prescription for a blood gas analysis c) applying an oximeter and initiating respiratory therapy d) implementing a high-calorie, high-protein, low-fat, vitamin-enriched diet and pancreatic granules

C RSV is transmitted through direct contact with respiratory secretions. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation? a. Reverse isolation b. Airborne isolation c. Contact Precautions d. Standard Precautions

B Respiratory hygiene/cough etiquette stresses the importance of source control measures to contain respiratory secretions to prevent droplet and fomite transmission of viral respiratory tract infections.

An infant with respiratory syncytial virus (RSV) is being admitted to the hospital. The nurse should stress the importance of: a. enteric precautions b. hygiene/cough etiquette c. the use of a respirator d. bloodborne disease precautions

B Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with potassiu

As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: A. chlorides. B. potassium. C. sodium. D. vitamins.

D

Children who have been treated for Rheumatic fever : A. Do not need additional prophylaxis against BE B. Are immune to rheumatic fever for the rest of their lives C. Will have transitory manifestation of chorea for the rest of their lives D. May need antibiotic therapy for years

D OME is characterized by feeling of fullness in the ear or other nonspecific complaints. Fever is a sign of AOM. OME does not cause severe pain. This may be a sign of AOM. Nausea and vomiting are associated with otitis media.

Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by: a. a fever as high as 40° C (104° F). b. severe pain in the ear. c. nausea and vomiting. d. a feeling of fullness in the ear

A Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a. Diet should be high in carbohydrates and protein. b. Diet should be high in easily digested carbohydrates and fats. c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

C After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours after beginning antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop.

It is generally recommended that a child with acute streptococcal pharyngitis can return to school: a. when sore throat is better. b. if no complications develop. c. after taking antibiotics for 24 hours. d. after taking antibiotics for 3 days.

D Group A hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute streptococcal pharyngitis.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition? A. Otitis media B. Diabetes insipidus (DI) C. Nephrotic syndrome D. Acute rheumatic fever

A (Patient irritability is a hallmark of Kawasaki disease and is the most challenging problem. A quiet environment is necessary to promote rest. The diagnosis is often difficult to make, and the course of the disease can be unpredictable. Intravenous gamma globulin and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to eat. Soft foods and fluids should be offered to prevent dehydration.)

Nursing care of the child with Kawasaki disease is challenging because of which occurrence? a. The child's irritability b. Predictable disease course c. Complex antibiotic therapy d. The child's ongoing requests for food

C

Of the following children, the one who is most likely to be hospitalized for treatment of croup is: A) A 2-year old child whose croupy cough worsens at night B) A 5-year old child whose croupy cough worsens at night C) A 2-year old child using accessory muscles to breathe D) A child with respiratory stridor during the physical examination

D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Pancreatic enzymes are not a contraindication for antibiotics. The dosage of enzymes should be increased if child is having frequent, bulky stools. Enzymes should be given just before meals and snacks.

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations should include to: a. not administer pancreatic enzymes if child is receiving antibiotics. b. decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. administer pancreatic enzymes between meals if at all possible. d. pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

D Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the association with Reye syndrome.

Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39° C (102.2° F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what medication? a. Decongestants to ease stuffy nose b. Antihistamines to help the child sleep c. Aspirin for pain and fever management d. Benzocaine ear drops for topical pain relief

D Parents have understood the teaching about preventing childhood otitis media if they respond they will keep childhood immunizations up to date. The child should be maintained upright during feedings and after. Otitis media can be prevented by exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position.

Parents have understood teaching about prevention of childhood otitis media if they make which statement? a. "We will only prop the bottle during the daytime feedings." b. "Breastfeeding will be discontinued after 4 months of age." c. "We will place the child flat right after feedings." d. "We will be sure to keep immunizations up to date."

C Rationale: If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place.

The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate what condition? A. Sore throat B. Inspiratory stridor C. Complete obstruction D. Respiratory tract infection

A, B, D The live attenuated influenza vaccine (LAIV) is an acceptable alternative to the IM vaccine (IIV) for ages 2 to 49 years. It is a live vaccine administered via nasal spray. Several groups are excluded from receiving it, including children with a chronic heart or lung disease (asthma or reactive airways disease), diabetes, or kidney failure; children who are immunocompromised or receiving immunosuppressants; children younger than 5 years of age with a history of recurrent wheezing; children receiving aspirin; patients who are pregnant; children who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components; or children with a history of Guillain-Barré Syndrome after a previous dose. A child with hemophilia A or gastroesophageal reflux disease would not be immunocompromised so they can receive the LAIV.

The clinic nurse is administering influenza vaccinations. Which children should not receive the live attenuated influenza vaccine (LAIV)? (Select all that apply.) a. A child with asthma b. A child with diabetes c. A child with hemophilia A d. A child with cancer receiving chemotherapy e. A child with gastroesophageal reflux disease

A Congenital heart defects with a large left-to-right shunt (e.g., in ventricular septal defect, patent ductus arteriosus, or complete AV canal), which cause increased pulmonary blood flow, may result in pulmonary hypertension. If these defects are not repaired early, the high pulmonary flow will cause changes in the pulmonary artery vessels, and the vessels will lose their elasticity. The blood does not shunt right to left, a pulmonary embolism is not a complication of ventricular septal defect, and the left ventricle does not hypertrophy.)

The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication? a. Pulmonary hypertension b. Right-to-left shunt of blood c. Pulmonary embolism d. Left ventricular hypertrophy

B Rationale: In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and comfort measures to minimize distress.

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which intervention? A. Admit to the hospital and observe for impending epiglottitis. B. Provide fluids that the child likes and use comfort measures. C. Control fever with acetaminophen and call if cough gets worse tonight. D. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.

A The mother needs sufficient rest and nutrition, so she can be effective as a caregiver. While the infant is hospitalized, the care is the responsibility of the nursing staff. The mother should be made comfortable with the care the staff provides in her absence. The mother has a right to provide care for the infant. The nursing staff and the mother should agree on the care division.

The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breastfeeding and provides all the care except for the medication administration. What should the nurse include in the plan of care? a. Ensuring that the mother has time away from the infant b. Making sure the mother is providing all of the infant's care c. Determining whether other family members can provide the necessary care so the mother can rest d. Contacting the social worker because of the mother's interference with the nursing care.

B The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt but this is not the best answer. The main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to stay at the bedside as much as possible. The nurse's rationale for this action is described primarily in which statement? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

B If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis. Epiglottitis is caused by H. influenzae in the respiratory tract.

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

B The American Academy of Pediatrics practice parameter recommends the use of supplemental oxygen if the infant fails to maintain a consistent oxygen saturation of at least 90%. The health care provider should be notified of the saturation reading of 88%. Withholding the feedings or placing the infant in an infant seat would not increase the saturation reading. The infant should be kept in the hood, but because the saturation reading is 88%, the health care provider should be notified to obtain orders to increase the oxygen concentration.

The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The child's SaO2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take? a. Withhold feedings. b. Notify the health care provider. c. Put the infant in an infant seat. d. Keep the infant in the plastic hood.

D, E, F Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

D

The nurse is caring for a 2 month old with transposition of the great vessels. which of the following interventions has higher priority? A. documenting vital signs B. encourage family visits C. maintaining proper caloric intake D. maintain adequate oxygenation

C

The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby.* Which is the nurse's best response A. we usually discourage breastfeeding babies with cleft lip and palate as it puts them at increased risk for aspiration B. it sounds like you are feeling discouraged. Would you like to talk about it? C. Sometimes breastfeeding is still an option for babies with a clef lip and palate. Would you like more information? D. "Although breastfeeding is not an option. you can pump your milk and then feed it to your baby with a special nipple.

D (When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified, and a new bandage with more pressure can be applied after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. Trendelenburg positioning would not be a helpful intervention. It would increase the drainage from the lower extremities.)

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is too wet. The nurse finds the bandage and bed soaked with blood. What nursing action is most appropriate to institute initially? a. Notify the physician. b. Place the child in Trendelenburg position. c. Apply a new bandage with more pressure. d. Apply direct pressure above the catheterization site.

B (Discharge instructions for a parent of a child who recently had a cardiac catheterization should include changing the bandage every day for the next 2 days. The child should avoid strenuous exercise but can go back to school. The child should avoid a tub bath, but an older child could take a shower the first day after the catheterization. The site should not have swelling or redness; if there is, it should be reported to the health care practitioner.)

The nurse is giving discharge instructions to the parent of a 6-year-old child who had a cardiac catheterization 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? a. My child should not attend school for the next 5 days. b. I should change the bandage every day for the next 2 days. c. My child can take a tub bath but should avoid taking a shower for the next 4 days. d. I should expect the site to be red and swollen for the next 3 days.

A, D, E (Clinical manifestations of hypertrophic pyloric stenosis include weight loss, projectile vomiting, and hunger after vomiting. The vomitus is nonbilious, and there is no evidence of pain or discomfort, just chronic hunger.)

The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a.Weight loss b.Bilious vomiting c.Abdominal pain d.Projectile vomiting e.The infant is hungry after vomiting

B, D, F (Intussusception occurs when a proximal segment of the bowel telescopes into a more distal segment, pulling the mesentery with it and leading to obstruction. Clinical manifestations of intussusception include the passage of red, currant jelly-like stools; a tender, distended abdomen; and sudden acute abdominal pain. Absent bowel sounds, anorexia, and hematemesis are clinical manifestations observed in other types of gastrointestinal dysfunction.)

The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Absent bowel sounds b. Passage of red, currant jelly-like stools c. Anorexia d. Tender, distended abdomen e. Hematemesis f. Sudden acute abdominal pain

A, C, D, E (Clinical manifestations of gastroesophageal reflux disease include spitting up, failure to thrive, excessive crying, and respiratory problems. Hematemesis, not bilious vomiting, is a manifestation.)

The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a.Spitting up b.Bilious vomiting c.Failure to thrive d.Excessive crying e.Respiratory problems

B (Infants rarely receive more than 1 ml (50 mcg, or 0.05 mg) of digoxin in one dose; a higher dose is an immediate warning of a dosage error. To ensure safety, compare the calculation with that of another staff member before giving digoxin.)

The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose and draws up 4 ml of the drug. The most appropriate nursing action is which? a. Mix the dose with juice to disguise its taste. b. Do not give the dose; suspect a dosage error. c. Check the heart rate; administer digoxin if the rate is greater than 100 beats/min. d. Check the heart rate; administer digoxin if the rate is greater than 80 beats/min.

B, E (Discharge instructions for an infant with GER should include the prone position (up on the shoulder or across the lap) after a feeding. Use of the prone position while the infant is sleeping is still controversial. The American Academy of Pediatrics recommends the supine position to decrease the risk of sudden infant death syndrome even in infants with GER. Prescribed cimetidine or another proton pump inhibitor should be given 30 minutes before the morning and evening feeding so that peak plasma concentrations occur with mealtime. The head of the bed in the crib does not need to be elevated. The mother may continue to breastfeed or express breast milk to add rice cereal if recommended by the health care provider; thickening breast milk or formula with cereal is not recommended by all practitioners. The Nissen fundoplication is only done on infants with GER in severe cases with complications.)

The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.) a. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping. b. Hold the infant in the prone position after a feeding. c. Discontinue breastfeeding so that a formula and rice cereal mixture can be used. d. The infant will require the Nissen fundoplication after 1 year of age. e. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

C A symptom of cystic fibrosis is a meconium ileus soon after birth. A murmur can be a sign of a congenital heart disease. Hypoglycemia can be a sign of Beckwith-Wiedemann syndrome. Muscle weakness can be a sign of myotonic dystrophy.

The nurse understands that which occurring soon after birth can indicate cystic fibrosis? a. Murmur b. Hypoglycemia c. Meconium ileus d. Muscle weakness

C

The nurse will soon receive a 4-month-old who has been diagnosed with intussusception. The infant is described as very lethargic with the following vital signs: T 101.8 F (38.8 C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. What is the most appropriate action for the receiving nurse? A. prepare to start a second iv line to administer fluids and antibiotics B. prepare to accompany the infant to a computed tomography scan to confirm the diagnosis C. prepare to get the infant ready for immediate surgical correction D. prepare to accompany the infant to the radiology department for a reducing enema

D (In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular congestion. Hypoxemia usually results from defects with mixed blood flow and decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure would stop this. There is increased workload on the left side of the heart with a PDA.)

The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication? a. Hypoxemia b. Right-to-left shunt of blood c. Decreased workload on the left side of the heart d. Pulmonary vascular congestion

C Antistreptolysin O (ASLO) titers measure the concentration of antibodies formed in the blood against this product. Normally, the titers begin to rise about 7 days after onset of the infection and reach maximum levels in 4 to 6 weeks. Therefore, a rising titer demonstrated by at least two ASLO tests is the most reliable evidence of recent streptococcal infection.

The test that provides the most reliable evidence of recent streptococcal infection is which? a. Throat culture b. Mantoux test c. Antistreptolysin O test (ASLO) d. Elevation of liver enzymes

B The opening in the septal wall allows for blood to flow from the higher pressure left ventricle into the lower pressure right ventricle. This left-to-right shunt creates increased pulmonary blood flow. The shunt is one way, from high pressure to lower pressure; oxygenated and unoxygenated blood do not mix. The outflow of blood from the ventricles is not affected by the septal defect.)

What blood flow pattern occurs in a ventricular septal defect? a. Mixed blood flow b. Increased pulmonary blood flow c. Decreased pulmonary blood flow d. Obstruction to blood flow from ventricles

A (Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Tricuspid atresia results in decreased pulmonary blood flow. The atrial septal defect results in increased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.)

What cardiovascular defect results in obstruction to blood flow? a. Aortic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

A Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Tricuspid atresia results in decreased pulmonary blood flow. The atrial septal defect results in increased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.)

What cardiovascular defect results in obstruction to blood flow? a. Aortic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

C (Hydrochlorothiazide is a diuretic. Captopril is an ACE inhibitor, digoxin is a digital glycoside, and carvedilol is a beta-blocker.)

What medication used to treat heart failure (HF) is a diuretic? a. Captopril (Capten) b. Digoxin (Lanoxin) c. Hydrochlorothiazide (Diuril) d. Carvedilol (Coreg)

A (Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.)

What structural defects constitute tetralogy of Fallot? a. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy d. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

D (Intussusception occurs when a proximal section of the bowel telescopes into a more distal segment, pulling the mesentery with it. The mesentery is compressed and angled, resulting in lymphatic and venous obstruction. Atresia is the absence or closure of a natural opening in the body. Stenosis is a narrowing or constriction of the diameter of a bodily passage or orifice. Herniation is the protrusion of an organ or part through connective tissue or through a wall of the cavity in which it is normally enclosed.)

What term describes invagination of one segment of bowel within another? a. Atresia b. Stenosis c. Herniation d. Intussusception

A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. Bronchoscopy, duodenal fluid analysis, stool tests for trypsin, and intestinal biopsy are not helpful in diagnosing CF. Gastric contents normally contain hydrochloride; it is not diagnostic.

What tests aid in the diagnosis of cystic fibrosis (CF)? a. Sweat test, stool for fat, chest radiography b. Sweat test, bronchoscopy, duodenal fluid analysis c. Sweat test, stool for trypsin, biopsy of intestinal mucosa d. Stool for fat, gastric contents for hydrochloride, radiography

A Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site. Gargling is discouraged because it could irritate the operative site. Ice compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen to facilitate drainage of secretions.

When caring for a child after a tonsillectomy, what intervention should the nurse do? a. Watch for continuous swallowing. b. Encourage gargling to reduce discomfort. c. Apply warm compresses to the throat. d. Position the child on the back for sleeping.

D (High-dose intravenous gamma globulin and salicylate therapy are indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. The fever of Kawasaki disease is unresponsive to antibiotics. It is responsive to anti-inflammatory doses of aspirin and antipyretics.)

When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care? a. Aspirin is contraindicated. b. The principal area of involvement is the joints. c. The child's fever is usually responsive to antibiotics within 48 hours. d. Therapeutic management includes administration of gamma globulin and salicylates.

B The etiology of Reye syndrome is not well understood, but most cases follow a common viral illness, typically influenza or varicella.

When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised if a week ago the child had recovered from what? a. Measles b. Influenza c. Meningitis d. Hepatitis

C Nurses have a role in prevention—primarily in screening school-age children for sore throats caused by group A -hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A -hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye's syndrome after viral illnesses.

Which action by the school nurse is important in the prevention of rheumatic fever? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.

A Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency. An excessive weight gain for an infant is an increase of more than 50 g/day. With fluid volume excess, skin will be edematous. The infant's position should be changed frequently to prevent undesirable pooling of fluid in certain areas. Lanoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid.

Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure? a. Weigh the infant every day on the same scale at the same time. b. Notify the physician when weight gain exceeds more than 20 g/day. c. Put the infant in a car seat to minimize movement. d. Administer digoxin (Lanoxin) as ordered by the physician.

C

Which is diagnostic for epiglottitis a. Blood test b. Throat swab c. lateral neck x-ray of the soft tissue d. signs and symptoms

A Osler's nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis. Subcutaneous nodules are nontender swellings located over bony prominences, commonly found in rheumatic fever. Aschoff's nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.

Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? a. Osler's nodes b. Janeway lesions c. Subcutaneous nodules d. Aschoff's nodules

B Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and URI symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.

Which type of croup is always considered a medical emergency? a. Laryngitis b. Acute Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)