Exam 3
Cystic Fibrosis is an __________ ___________ disorder, and most carriers of the gene are _____________.
Autosomal recessive , asymptomatic
Cystic fibrosis is an ____________ __________ disease caused by defects in the ___________ ___________, which encodes for a protein that functions as a chloride channel
Autosomal recessive, CFTR mutation
Acute Nasopharyngitis (Common Cold) virus?
*Rhinovirus RSV Influenza Parainfluenza
A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure? A. Immediately before a meal B. At least 2 hours after a meal C. When bronchospasms occur D. When secretions have mobilized
Answer B. The nurse should perform chest physiotherapy at least 2 hours after a meal to reduce the risk of vomiting and aspiration. Performing it immediately before a meal may tire the client and impair the ability to eat. Percussion and vibration, components of chest physiotherapy, may worsen bronchospasms; therefore, the procedure is contraindicated in clients with bronchospasms. Secretions that have mobilized (especially when suction equipment isn't available) are a contraindication for postural drainage, another component of chest physiotherapy.
Bryce is a child diagnosed with coarctation of aorta. While assessing him, Nurse Zach would expect to find which of the following? A. Squatting posture B. Absent or diminished femoral pulses C. Severe cyanosis at birth D. Cyanotic ("tet") episodes
B. Absent or diminished femoral pulse is a classic characteristic of coarctation of aorta
Which finding is the best indication that a client with ineffective airway clearance needs suctioning? A. Oxygen saturation. B. Respiratory rate. C. Breath sounds. D. Arterial blood gases.
C: Changes in breath sounds are the best indication of the need for suctioning in the client with ineffective airway clearance.
Isaiah is diagnosed with "strep throat." Which clinical manifestation would the nurse expect to the client? A. A fiery red pharyngeal membrane and fever. B. Pain over the sinus area and purulent nasal secretions. C. Foul-smelling breath and noisy respirations. D. Weak cough and high-pitched noise on respirations.
Option A: Strep throat, or acute pharyngitis, results in a red throat, edematous lymphoid tissues, enlarged lymph nodes, fever, and sore throat.
The nurse should observe for side effects associated with the use of bronchodilators. A common side effect of bronchodilators is: A. Tinnitus B. Nausea C. Ataxia D. Hypotension
Option B: A side effect of bronchodilators is nausea.
Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation? A. Aortic stenosis (AS) B. Coarctation of aorta C. Patent ductus arteriosus (PDA) D. Tetralogy of Fallot
D. Tetralogy of Fallot consists of four major anomalies: ventricular septal defect, right ventricular hypertrophy, pulmonic stenosis (PS), aorta overriding the ventricular septal defect.
The procedure that has to be performed in order to shift the high pressure from the right ventricle to the left ventricle in Transposition of the Great Arteries (TGA) is: A Rashkind Procedure B Rastelli Procedure C Pulmonary Artery Banding D Jatene Procedure
D. The Jatene procedure, arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries.
When administering pancrelipase (Pancreases capsules) to child with cystic fibrosis, nurse Faith knows they should be given: A. Every three hours while awake B. On awakening, following meals, and at bedtime C. After each bowel movement and after postural drainage D. With meals and snacks
D. Pancreases capsules must be taken with food and snacks because it acts on the nutrients and readies them for absorption.
A premature baby might have the option of medical treatment of a PDA by way of administration of: A. Fluconazole. B. Tramadol. C. Warfarin. D. Indomethacin.
D: Indomethacin is a prostaglandin inhibitor that's an alternative to surgery in premature neonates and induces ductus spasm and closure.
A nurse reinforces instructions to the mother of a child who has been hospitalized with croup. Which of the following statements, if made by the mother, would indicate the need for further instruction? A. "I will give my child cough syrup if a cough develops." B. "During an attack, I will take my child to a cool location." C. "I will give acetaminophen (Tylenol) if my child develops a fever." D. "I will be sure that my child drinks at least three to four glasses of fluids every day."
Option A: Cough syrups and cold medicines are not to be given, because they may dry and thicken secretions.
For Mikael who is diagnosed of having allergic rhinitis, which nursing intervention is the most appropriate? A. Encouraging the client to use nasal saline sprays. B. Discouraging nose blowing before administering nasal medication. C. Advising use of bronchodilator regularly, even if having no symptoms. D. Instructing the client to carry epinephrine with him at all times.
Option A: For the client with allergic rhinitis, saline nasal sprays may be helpful in soothing mucous membranes, softening crusted secretions, and removing irritants.
epiglottis caused by
-Haemophilus influenzae type B
An infant is being treated at home for bronchiolitis. What should the nurse teach the parent about home care. SATA 1. Offering small amounts of fluids frequently 2. Allowing the infant to sleep prone. 3. Calling the clinic if the infant vomits 4. Writing down how much the infant drinks 5. Performing chest physiotherapy every 4 hrs. 6. Watching for difficulty breathing.
1 , 6
A child has viral pharyngitis. What should the nurse advise the parents to do? Select all that apply. 1. use a cool mist vaporizer 2. offer a soft-to-liquid diet 3. administer amoxicillin 4. administer acetaminophen 5. place the child on secretion precautions
1, 2, 4 NOT 3 and 5: ABX does not work on viruses and child does not need to be on secretion precautions because viral pharyngitis is NOT contagious.
Which signs and symptoms would lead the nurse to suspect a child has tetralogy of Fallot? SATA 1. Murmur 2. History of squatting 3. Bounding pulses 4. Cyanosis 5. Faint pulse 6. Tachypnea
1, 2, 4,6 Systolic murmur, cyanosis, and tachypnea plus squatting
A teaching care plan to prevent the transmission of RSV should include what information. SATA 1. The virus can be spread by direct contact 2. The virus can be spread by indirect contact 3. Palivizumab is recommended to prevent RSV for all toddlers in daycare 4. The virus is typically contagious for 3 wks 5. Older children seldom spread RSV 6. Frequent hand washing helps reduce the spread of RSV
1, 2, 6
A child with cystic fibrosis is receiving gentamicin. Which nursing action is MOST important? 1. Monitoring intake and output 2. Obtaining daily weights 3. Monitoring the client for indications of constipation 4. Obtaining stool samples to test for occult blood.
1. Because a decrease in output is an early sign of renal damage
The parent of a 16 mth old. Child calls the clinic because the child has a low-grade fever, cold sym, and a hoarse cough. What should the nurse suggest that the parent do? 1. Offer extra fluids frequently 2. Bring the child to the clinic immediately 3. Count the child's respiratory rate 4. Use a hot air vaporizer
1. Toddler is exhibiting cold sym. A hoarse cough may be part of the URI. The best suggestion is to offer the child additional fluids. To help keep secretions loose and membranes moist .
A school- age client with rheumatic fever is on longe-term aspirin therapy. Which client statement most indicates that the clients is experiencing serious adverse reaction to aspirin? 1. I hear ringing in my ears. 2. I put lotion on my itchy skin 3. My stomach hurts after i take that medication 4. These pills make me cough
1. Tinnitus is an adverse effect of prolong aspirin therapy and the child should be examined by a HCP for hearing loss.
The nurse assess the results of a gentamicin trough blood level for an teen with cystic fibrosis who has had been treated with gentamicin several time over the past year. The drug level is HIGH. What is the nurse's primary concern? 1. The child may develop liver dysfunction 2. The child may suffer hearing loss 3. The medication may have been administered incorrectly 4. The child may need to have a different ABX.
2. Aminoglycoside ABX can cause permanent hearing loss.
A 21 mth old child admitted with the diagnosis of croup now has a respiratory rate of 48 bpm , heart rate of 120 bpm, and a temp of 100.8 rectally. The nurse is having difficulty calming the child. What should the nurse do next? 1. Administer acetaminophen 2. Notify the HCP immediately 3. Allow the toddler to continue to cry 4. Offer clear fluids every few minutes
2. The child is experiencing increasing respiratory distress. The norm RR for a 21 mth old is 25 - 30 breaths /min
The nurse assesses a child after heart surgery to correct tetralogy of Fallot. Which finding would the nurse report to the HCP as an indication that the client has low cardiac output? 1. Bounding pulses and mottled skin 2. Altered level of consciousness and thready pulses 3. Cap refill of 2 sec and blood pressure of 96/67 4. Extremities warm to the touch and pale skin
2. With low cardiac output and subsequent poor tissue perfusion, s/s would include pale, cool extremities, cyanosis, weak, thready pulses, delayed cap refill and decrease in level of consciousness.
A charge nurse is making assignments for a group of children on a pediatric unit. Which client should the nurse MOST avoid assigning the same nurse caring for a 2 yr old with RSV? 1. 18 mth old with RSV 2. 9 yr old, 8 hrs post appendectomy 3. 1 yr old with a heart defect 4. 6 yr old with sickle cell crisis
3.
The nurse is monitoring an infant with congenial heart disease closely for signs of HF. The nurse should assess the infant for which early sign of HF? 1. Pallor 2. Cough 3. Tachycardia 4. Slow and shallow breathing
3. Inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body.
The nurse is caring for a newborn with large ventricular sepal defect. The client has undergone pulmonary artery banding. Which assessment finding best indicates that the pulmonary artery band is functioning effectively? 1. Cap refill is < 3 sec 2. Urine output is > 1 ml/kg/h 3. Breath sounds are clean and equal bilaterally 4. Radial pulses are bounding
3. When the band is working properly, the lungs should no longer be receiving an increased amount of blood flow, which would reflected in clean and equal breath sounds.
The mother of an 8 yr old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen is not effective. Which instructions should the nurse provide to the mother? 1. Increase the dose of ibuprofen 2. Increase the frequency of ibuprofen 3. Encourage the child to lie on the left side 4. Encourage the child to lie on the right side
4. Splinting of the affected side by lying on that side may decrease comfort.
Which intervention is the HIGHEST priority for the therapeutic management of the child with CHF caused by pulmonary stenosis? 1. Educating the family about the s/s of infection 2. Administering exnoxaparin to improve left ventricular contraction Ty 3. Assessing heart rate and blood pressure every 2 hrs. 4. Administrating furosemide to decreased systemic venous congestion
4. Administrating furosemide
Virus for Rheumatic Fever?
A beta-hemolytic streptococcal
A child with Kawasaki disease is admitted to the pediatric ward. Which of the following medications will you expect to be a part of the treatment? Select all that apply: A. Gamma Globulin B. Warfarin C. Acetaminophen D. Aspirin E. Atenolol
A, B, D: The principal goal of treatment for Kawasaki disease is to prevent coronary artery disease and to relieve symptoms such as fever and joint pain so an antipyretic, antiplatelet, and gamma globulin is used.
Wha instructions should he nurse include in he discharge teaching for a 3 mth old infant with a cardiac defect who is to receive digoxin? SATA A. Give the medication at regular intervals B. Mix the medication with a small volume of breast milk or formula C. Repeat the dose one time if the child vomits immediately after the administration D. Notify the HCP of poor feeding and vomiting E. Make up any missed doses as soon as realized F. Notify the HCP if more than two consecutive doses are missed.
A, D, F To achieve optimal therapeutic levels, dig should be given at regular intervals without variation, usually every 12 hrs. Vomiting and poor feeding are signs of tox. If more than two consecutive doses are missed, interventions may be needed to assure therapeutic levels.
Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child? A. Pulmonary secretions are abnormally thick. B. Elevated levels of potassium are found in the sweat. C. CF is an autosomal dominant hereditary disorder. D. Obstruction of the endocrine glands occurs.
A. CF is identified by abnormally thick pulmonary secretions.
Which of the following instructions would Nurse Courtney include in a teaching plan that focuses on initial prevention for Sheri who is diagnosed with rheumatic fever? A. Treating streptococcal throat infections with an antibiotic B. Giving penicillin to patients with rheumatic fever C. Using corticosteroid to reduce inflammation D. Providing an antibiotic before dental work
A. Rheumatoid fever results from improperly treated group beta-hemolytic streptococcal infections, usually pharyngitis. Therefore, prompt treatment of streptococcal throat infections with an antibiotic is a key preventive measure.
Mr. and Mrs. Baker's only daughter is diagnosed with heart failure. Which of the following interventions would be appropriate to promote optimal nutrition for the infant? Replacing regular nipples with easy-to-suck ones A. Replacing regular nipples with easy-to-suck ones B. Allowing the infant to feed for at least 1 hour C. Providing large feedings evenly spaced every 4 hours D. Offering formula that is high in sodium and calories
A. The nurse should replace regular nipples with easy-to-suck-ones because the infant may tire instantly with regular nipples and thus would not be able to suck sufficiently.
Cystic fibrosis is diagnosed by: A. Sweat test B. Echocardiogram C. Complete blood panel D. Chest X-ray
A. A small electrode is placed on the skin, which stimulates the sweat glands. Sweat is collected for a period of time and then analyzed. People with cystic fibrosis have an increased amount of chloride in their sweat, due to the abnormal protein manufactured by the cystic fibrosis gene.
A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is performing an assessment. Which later finding of this disease would the nurse not expect to see at this time? A. Moist, productive cough B. Positive sweat test C. Bulky greasy stools D. Meconium ileus
A. Moist, productive cough, Noisy respirations and a dry non-productive cough are commonly the first of the respiratory signs to appear in a newly diagnosed client with cystic fibrosis (CF). The other options are the earliest findings. CF is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva and digestive juices. Normally, these secretions are thin and slippery, but in CF, a defective gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts and passageways, especially in the pancreas and lungs. Respiratory failure is the most dangerous consequence of CF.
When assessing a newborn diagnosed with patent ductus arteriosus, Nurse Olivia should expect that the child most likely would have an: A. Loud, machinery-like murmur. B. Bluish color to the lips. C. Decreased BP reading in the upper extremities. D. Increased BP reading in the upper extremities.
A: A loud, machinery-like murmur is a characteristic finding associated with patent ductus arteriosus.
A 16-year old patient with cystic fibrosis is admitted with increased shortness of breath and possible pneumonia. Which nursing activity is most important to include in the patient's care? A. Perform postural drainage and chest physiotherapy every 4 hours. B. Allow the patient to decide whether she needs aerosolized medications. C. Place the patient in a private room to decrease the risk of further infection. D. Plan activities to allow at least 8 hours of uninterrupted sleep.
A: Airway clearance techniques are critical for patients with cystic fibrosis and should take priority over the other activities.
Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child? A. Pulmonary secretions are abnormally thick. B. Elevated levels of potassium are found in the sweat. C. CF is an autosomal dominant hereditary disorder. D. Obstruction of the endocrine glands occurs.
A: CF is identified by abnormally thick pulmonary secretions.
An appropriate nursing diagnosis for clients who are taking anticoagulants would be which of the following? A. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI. B. Potential for injury related to GI toxicity and decrease in bleeding time. C. Altered protection related to GI bleeding and increasing platelet aggregation. D. Risk for injury related to thrombocytosis prolonged prothrombin time.
A: The nursing diagnosis addresses all the interactions that pose a threat to the client taking both these drugs.
A 2-year-old client with cystic fibrosis is confined to bed and is not allowed to go to the playroom. Which of the following is an appropriate toy would the nurse select for the child: A. Arranging stickers in the album B. Musical automobile C. Pounding board and hammer D. Puzzle
C. The autonomous toddler would be frustrated by being confined to be. The pounding board and hammer is developmentally appropriate and an excellent way for the toddler to release frustration.
Cystic fibrosis is treated by: A. Taking pancreatic enzymes to help digest food B. All of these C. Taking special vitamins D. Airway clearance techniques that aim to move the thick mucus from the lungs
B. All of these are treatments for cystic fibrosis. Airway clearance techniques help people with cystic fibrosis move thickened mucus from the lungs. Pancreatic enzymes are taken to help digest the food. Special vitamins are needed to help replace vitamins A, D, and K which may not be absorbed well by the CF patient. There are more treatments, of course, but these are the main ones to help keep the person with cystic fibrosis healthy.
The ductus arteriosus is another fetal structure that is important in the intrauterine life. It functions to: A. Shunts the combined cardiac output from the pulmonary artery to the aorta going to the lungs B. Shunts the combined cardiac output from the pulmonary artery to the systemic circulation C Shunts the combined cardiac output from the aorta to the pulmonary artery and later to the pulmonary veins D Shunts the combined cardiac output from the aorta to the pulmonary artery to the right ventricle
B. In the developing fetus, the ductus arteriosus, also called the ductus Botalli, is a blood vessel connecting the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus's fluid-filled non-functioning lungs.
The nurse is providing a health teaching to the mother of an 8-year-old child with cystic fibrosis. Which of the following statement if made by the mother would indicate to the nurse the need for further teaching about the medication regimen of the child? A. "My child might need an extra capsule if the meal is high in fat" B. "My child hates to take pills, so I'll mix the capsule into a cup of hot chocolate C. "I'll give the enzyme capsule before every meal" D. "I'll give the enzyme capsule before every snack"
B. The pancreatic capsules contain pancreatic enzyme that should be administered in a cold, not a hot, medium (example: chilled applesauce versus hot chocolate) to maintain the medication's integrity.
The mother of a child with cystic fibrosis tells the nurse that her child makes "snoring" sounds when breathing. The nurse is aware that many children with cystic fibrosis have: A. Choanal atresia. B. Nasal polyps. C. Septal deviations. D. Enlarged adenoids.
B: Children with cystic fibrosis are susceptible to chronic sinusitis and nasal polyps, which might require surgical removal.
The Foley Family is caring for their youngest child, Justin, who is suffering from tetralogy of Fallot. Which of the following are defects associated with this congenital heart condition? A Aorta exits from the right ventricle, pulmonary artery exits from the left ventricle, and two noncommunicating circulations B. Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy C Coarctation of aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus D Tricuspid valve atresia, atrial septal defect, ventricular septal defect, and hypoplastic right ventricle
B: The defects associated with tetralogy of Fallot include ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy.
An infant with a patent ductus arteriosus is admitted to the pediatric unit ward. The nurse anticipates which of the following medications will be given to the infant? A. Prednisone. B. Ibuprofen. C. Penicillin. D. Albuterol.
B: When surgical ligation is not indicated, prostaglandin inhibitors (e.g., nonsteroid anti-inflammatory drugs [NSAIDs]) are used to close the ductus arteriosus.
The structure that connects the aorta to the pulmonary artery in utero is known as the: A. Pulmonary vein. B. Left ventricle. C. Ligamentam arteriosum. D. Ductus arteriosus.
D: The ductus arteriosus is a fetal blood vessel that connects the pulmonary artery to the descending aorta.
Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions? A. Bronchiolitis B. Laryngotracheobronchitis (LTB) C. Epiglottitis D. Pneumonia
C. Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis.
Which of the following would Nurse Tony suppose to regard as a cardinal manifestation or symptom of digoxin toxicity to his patient Clay diagnosed with heart failure? A Headache B Respiratory distress C Extreme bradycardia D Constipation
C. Extreme bradycardia is a cardinal sign of dig tox.
The foul-smelling, frothy characteristic of the stool in cystic fibrosis results from the presence of large amounts of which of the following: A. Lipase, trypsin and amylase B. Sodium and chloride C. Undigested fat D. Semi-digested carbohydrates
C. The client with cystic fibrosis absorbs fat poorly because of the think secretions blocking the pancreatic duct. The lack of natural pancreatic enzyme leads to poor absorption of predominantly fats in the duodenum. Foul-smelling, frothy stool is termed steatorrhea.
Clay is an 8-year-old boy diagnosed with heart failure. Which of the following shows that he is strictly following the directed therapeutic regimen? A Daily use of an antibiotic B Pulse rate less than 50 beats/minute C. Normal weight for age D Elevation in red blood cell (RBC) count
C. Adequate weight for height demonstrates adequate nutritional intake and lack of edema.
Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would Nurse Nica expect to assess? A. Mild cough B. Slight fever C. Chest pain D. Bulging fontanel
C. Older children with pneumococcal pneumonia may complain of chest pain.
Appropriate intervention is vital for many children with heart disease in order to go on to live active, full lives. Which of the following outlines an effective nursing intervention to decrease cardiac demands and minimize cardiac workload? A. Feeding the infant over long periods B. Allowing the infant to have her way to avoid conflict C. Scheduling care to provide for uninterrupted rest periods D. Developing and implementing a consistent care pla
C. Organizing nursing care to provide for uninterrupted periods of sleep reduces cardiac demand.
The nurse is teaching the mother of a child with cystic fibrosis how to do postural drainage. The nurse should tell the mother to: A. Use the heel of her hand during percussion. B. Change the child's position every 20 minutes. C. Do percussion after the child eats and at bedtime. D. Use cupped hands during percussion.
D: The nurse or parent should use a cupped hand when performing chest percussion.
Which of the following respiratory conditions is always considered a medical emergency? A. Asthma B. Cystic fibrosis (CF) C. Epiglottiditis D. Laryngotracheobronchitis (LTB)
C: Epiglottiditis, acute and severe inflammation of the epiglottis, is always considered an acute medical emergency because it can lead to acute, life-threatening airway obstruction.
When creating a teaching program for the parents of Jessica who is diagnosed with pulmonic stenosis (PS), Nurse Alex would keep in mind that this disorder involves which of the following? A. single vessel arising from both ventricles B. Obstruction of blood flow from the left ventricle C. Obstruction of blood flow from the right ventricle D. Return of blood to the heart without entry to the left atrium
C: Obstruction of blood flow from the right ventricle
Veronica's parents were told that their daughter needs ribavirin (Virazole). This drug is used to treat which of the following? A. Cystic fibrosis B. Otitis media C. Respiratory syncytial virus (RSV) D. Bronchitis
C: Ribavirin is an antiviral medication used for treating RSV infection and for children with RSV who are compromised (such as children with bronchopulmonary dysplasia or heart disease).
Which of the following is the best method for performing a physical examination on a toddler? A. From head to toe B. Distally to proximally C. From abdomen to toes, the to head D. From least to most intrusive
D: When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive.
An 8-year-old client with cystic fibrosis is admitted to the hospital and will undergo a chest physiotherapy treatment. The therapy should be properly coordinated by the nurse with the respiratory therapy department so that treatments occur during: A. Around the child's play schedule B. After medication C. After meals D. Between meals
D. Chest physiotherapy treatments are scheduled between meals to prevent aspiration of stomach contents, because the child is placed in a variety of positions during the treatment process.
A child with cystic fibrosis is being treated with inhalation therapy with Pulmozyme (dornasa Alfa). A side effect of the medication is? A. Hair loss B. Brittle nails C. Wt gain D. Sore throat
D. Sore throat, hoarseness, and laryngitis
A child diagnosed with tetralogy of fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and respiratory rate increases to 44 bpm. Which of the following actions would the nurse do first? a) obtain an order for sedation for the child b) assess for an irregular heart rate and rhythm c) explain to the child that it will only hurt for a short time d) place the child in knee-to-chest position
D. Place the child in the knee-chest position.
The nursing care plan for a toddler diagnosed with Kawasaki Disease (mucocutaneous lymph node syndrome) should be based on the high risk for development of which problem? A. Chronic vessel plaque formation B. Pulmonary embolism C. Occlusions at the vessel bifurcations D. Coronary artery aneurysms
D: Kawasaki Disease involves all the small and medium-sized blood vessels. There is progressive inflammation of the small vessels which progresses to the medium-sized muscular arteries, potentially damaging the walls and leading to coronary artery aneurysms.
A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart from the identified symptoms of the disease, she may also likely develop which of the following? A. Sepsis B. Meningitis C. Mitral valve disease D. Aneurysm formation
D: Kawasaki disease is a rare childhood illness that affects the blood vessels. 20% to 25% of children can develop aneurysm formation if not intervened.
A patent ductus arteriosus can lead to: A. Cyanosis. B. Left-sided heart failure. C. Right-sided heart failure. D. A&B
D: PDA could cause both cyanosis and left-sided heart failure as the left-to-right shunting of the blood renders the cardiac muscles of the left chamber overworked and leads to heart failure and cyanosis.
CF is a disease of ___________ gland functions that involves multiple organ systems but chiefly results in chronic ____________ infections, pancreatic ______________ insufficiency.
Exocrine , respiratory, enzyme
You have obtained the following assessment information about a 3-year old who has just returned to the pediatric unit after having a tonsillectomy. Which finding requires the most immediate follow-up? A. Frequent swallowing. B. Hypotonic bowel sounds. C. Complaints of a sore throat. D. Heart rate of 112 beats/min.
Option A: Frequent swallowing after a tonsillectomy may indicate bleeding. You should inspect the back of the throat for evidence of bleeding.
A 3-year-old arrives in the ER. The child has a temperature of 102.4°F and is agitated. The child is diagnosed with epiglottitis. You note the child is sitting up, positioned forward with chin in the air and the tongue is protruding with the mouth open. Which nursing intervention below is not appropriate for this patient? A. Assist the patient in a supine position. B. Keep the child on the parent's lap during treatments. C. Keep the child nothing by mouth. D. Avoid taking a temperature on the patient orally.
Option A: Placing the child on a supine position is contraindicated because it impedes respiratory effort.
Which of the following organisms is responsible for the development of rheumatic fever? A. Group A β-hemolytic streptococcus. B. Staphylococcus aureus. C. Streptococcal pneumonia. D. Haemophilus influenza.
Option A: Rheumatic fever results from a delayed reaction to inadequately treated group A β-hemolytic streptococcal infection.
Inigo is diagnosed with "strep throat." Which clinical manifestation would the nurse expect to the client? A. A fiery red pharyngeal membrane and fever. B. Pain over the sinus area and purulent nasal secretions. C. Foul-smelling breath and noisy respirations. D. Weak cough and high-pitched noise on respiration.
Option A: Strep throat, or acute pharyngitis, results in a red throat, edematous lymphoid tissues, enlarged lymph nodes, fever, and sore throat.
A hospitalized 8-year-old client who has been receiving antibiotics for 10 days tells you that he is having frequent watery stools. Which action will you take first? A. Place the client on contact precaution. B. Instruct the client about correct handwashing. C. Obtain stool specimens for culture. D. Notify the physician about the loose stools.
Option A: The client's age, history of antibiotic therapy, and watery stools suggest that he may have Clostridium difficile infection.
A 4-year-old female client is brought to the emergency room after waking up with bark-like cough and stridor. On arrival to the ER, she has respiratory distress and is afebrile. The diagnosis is croup. What instruction should you give the parents? A. Perform percussion and postural drainage before putting the child to bed and before meals. B. Run a cool mist vaporizer in patient's room during the day. C. Encourage the child to do coughing and deep breathing exercises. D. Bring the child to the bathroom and have the tap run with warm water during acute episodes of cough.
Option B: Cool mist vaporizer will relieve spasm of airways. This will promote easy breathing of the child with croup.
A nurse has taught a client taking a xanthine bronchodilator about beverages to avoid. The nurse determines that the client understands the information if the client chooses which of the following beverages from the dietary menu? A. Chocolate milk B. Cranberry juice C. Coffee D. Cola
Option B: Cranberry juice does not contain xanthine and is appropriate for the client.
A newly admitted client with pharyngitis has been placed on droplet precaution. Which of the following statements indicates the best understanding of this type of isolation? A. The client can be placed in a room with another client with measles (rubeola). B. Must maintain a spatial distance of 3 feet. C. A special mask (N95) should be worn when working with the client. D. Gloves should be only worn when giving direct care.
Option B: Droplets can travel no more than 3ft so precautions should be maintained when there is a possibility of entering this distance.
After the first injection of an immunotherapy program, the nurse notices a large, red wheal on the client's arm, coughing, and expiratory wheezing. Which intervention should the nurse implement first? A. Notifying the health care provider immediately. B. Administering I.M. epinephrine per protocol. C. Beginning oxygen by way of nasal cannula. D. Starting an I.V. line for medication administration.
Option B: Immediately on noticing the client's sign and symptoms, the nurse would determine that the client is experiencing anaphylaxis to the injection; the first action is to give 0.2 to 0.5 ml of 1:1,000 epinephrine I.M.
An 8-year-old boy is returned to his room following a tonsillectomy. He remains sleepy from the anesthesia but is easily awakened. The nurse should place the child in which of the following positions? A. Sims'. B. Side-lying. C. Supine. D. Prone.
Option B: Side-lying position is most effective to facilitate drainage of secretions from the mouth and pharynx; reduces possibility of airway obstruction.
The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered, and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic to penicillin. Legal responsibility for the error is: A. Only the nurse's—she should have checked the allergies before administering the medication. B. The pharmacist, physician, and nurse are all liable for the mistake. C. Only the pharmacist's—he should alert the floor to possible allergic reactions. D. Only the physician's—she gave the order, the nurse is obligated to follow it.
Option B: The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.
The nurse assesses a male client's respiratory status. Which observation indicates that the client is experiencing difficulty breathing? A. Diaphragmatic breathing. B. Use of accessory muscles. C. Pursed-lip breathing. D. Controlled breathing.
Option B: The use of accessory muscles for respiration indicates the client is having difficulty breathing.
Molly, with suspected rheumatic fever, is admitted to the pediatric unit. When obtaining the child's history, the nurse considers which information to be most important? A. A fever that started 3 days ago. B. A recent episode of pharyngitis. C. Lack of interest in food. D. Vomiting for 2 days.
Option B: A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever.
Which of the following instructions would Nurse Courtney include in a teaching plan that focuses on initial prevention for Sheri who is diagnosed with rheumatic fever? A. Providing an antibiotic before dental work. B. Treating streptococcal throat infections with an antibiotic C. Giving penicillin to patients with rheumatic fever. D. Using corticosteroid to reduce inflammation.
Option B: Rheumatoid fever results from improperly treated group beta-hemolytic streptococcal infections, usually pharyngitis. Therefore, prompt treatment of streptococcal throat infections with an antibiotic is a key preventive measure.
The mother of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make? A. "The child may be allergic to antibiotics." B. "The child is too young to receive antibiotics." C. "Antibiotics are not indicated unless a bacterial infection is present." D. "The child still has the maternal antibodies from birth and does not need antibiotics."
Option C: Croup is a viral respiratory illness, antibiotics would not be effective.
Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions? A. Bronchiolitis. B. Laryngotracheobronchitis (LTB). C. Epiglottitis. D. Pneumonia.
Option C: Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis.
Which of the following respiratory conditions is always considered a medical emergency? A. Asthma. B. Cystic fibrosis (CF). C. Epiglottitis. D. Laryngotracheobronchitis (LTB).
Option C: Epiglottitis, acute and severe inflammation of the epiglottis, is always considered an acute medical emergency because it can lead to acute, life-threatening airway obstruction.
During a 2 month well visit with a patient and her mother, you educate the parent on the most common cause of epiglottitis. You explain to the mother the most common cause of this condition is the: A. Respiratory syncytial virus. B. Influenza virus. C. Haemophilus influenzae type B. D. Rotavirus.
Option C: Most common cases of epiglottitis are caused by a bacteria that attacks the epiglottis called haemophilus influenzae type B.
Veronica's parents were told that their daughter needs ribavirin (Virazole). This drug is used to treat which of the following? A. Cystic fibrosis B. Otitis media C. Respiratory syncytial virus (RSV) D. Bronchitis
Option C: Ribavirin is an antiviral medication used for treating RSV infection and for children with RSV who are compromised (such as children with bronchopulmonary dysplasia or heart disease).
A 9-year-old is admitted with suspected rheumatic fever. Which finding is suggestive of polymigratory arthritis? A. Painless swelling over the extensor surfaces of the joints. B. Irregular movements of the extremities and facial grimacing. C. Swelling, inflammation, and effusion of the joints. D. Faint areas of red demarcation over the back and abdomen.
Option C: The child with polymigratory arthritis will exhibit swollen, painful joints.
Which condition would Nurse Jade suspect when a client complains of a runny nose, itching and burning eyes, and sneezing since visiting a friend who had a cat in the home? A. Anaphylaxis. B. Bronchitis. C. Allergic rhinitis. D. Asthma.
Option C: The client most likely is suffering from allergic rhinitis, an allergic reaction to inhaled airborne allergens; in this case, the friend's cat triggered the client's symptoms.
Which statement is correct regarding the role of epiglottis? A. This structure prevents food from entering the nasopharynx. B. The epiglottis helps with vocal cord vibration. C. After swallowing this structure moves downward to prevent swallowed contents from entering the trachea. D. The epiglottis is found in between the vocal folds.
Option C: The epiglottis is found on the inside of the thyroid cartilage and is at the back of the tongue.
For Aubrey Anne who has allergies, which client statement indicates that the nurse's teaching about her condition has be successful? A. "I don't need to wear any type of mask when I'm cleaning my house." B. "I should stay in the house when there's a low pollen count outside." C. "I should avoid any types of spray, powders, and perfumes." D. "I can wear any type of clothing that I want to as long as I wash it first."
Option C: The goal of teaching a client with allergies focuses on avoidance of the offending agent, and other triggers.
A newly admitted client with streptococcal pharyngitis (tonsillitis) has been placed on droplet precaution. Which of the following statements indicates the best understanding for this type of isolation? A. The client can be placed in a room with another client with measles (rubeola). B. A special mask (N95) should be worn when working with the client. C. Must maintain a spatial distance of 3 feet. D. Gloves should be only worn when giving direct care.
Option C: The most common forms of transmission of an organism in a client with tonsillitis are through coughing, sneezing, and talking. Droplets can travel no more than 3ft so precautions should be maintained when there is a possibility of entering this distance.
The most reliable index to determine the respiratory status of a client is to: A. Observe the chest rising and falling. B. Observe the skin and mucous membrane color. C. Listen and feel the air movement. D. Determine the presence of a femoral pulse.
Option C: To check for breathing, the nurse places her ear and cheek next to the client's mouth and nose to listen and feel for air movement.
Which intervention should Nurse John Joe discuss with Elena who has an allergic disorder and is requesting information for allergy symptom control? (Select all that apply.) A. Instructing the client to refrain from using air conditioning or humidifiers in the house. B. Instructing the client to use curtains instead of pull shades over windows. C. Instructing the client to cover the mattress with a hypoallergenic cover. D. Instructing the client to wear a mask when cleaning. E. Instructing the client to avoid using sprays, powders, and perfumes. F. Instructing the client to change detergents frequently.
Option C: Using hypoallergenic covers and cosmetics will help reduce the chance of an allergic attack. Option D: Wearing mask while cleaning will help decrease the amount of dust entering the lungs. Option E: Avoiding sprays, powders, and perfumes will help decrease the chance of an allergic attack.
Following a tonsillectomy, a female client returns to the medical-surgical unit. The client is lethargic and reports having a sore throat. Which position would be most therapeutic for this client? A. Semi-Fowler's. B. Supine. C. High-Fowler's. D. Side-lying.
Option D: Because of lethargy, the post tonsillectomy client is at risk for aspirating blood from the surgical wound. Therefore, placing the client in the side-lying position until he awake is best.
Group A beta-hemolytic streptococci (GABHS) infection if left unresolved or partially treated can lead to which of the following? A. Influenza. B. Sickle cell anemia. C. Histoplasmosis. D. Rheumatic Fever.
Option D: Rheumatic fever is usually the result of untreated or poorly managed group A β-hemolytic streptococcal infections (GABHS), such as pharyngitis.
A child with croup is placed in a cool, high-humidity tent connected to room air. The primary purpose of the tent is to: A. Prevent insensible water loss. B. Provide a moist environment with oxygen at 30%. C. Prevent dehydration and reduce fever. D. Liquefy secretions and relieve laryngeal spasm.
Option D: The primary reason for placing a child with croup under a mist tent is to liquefy secretions and relieve laryngeal spasms.
A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the MOST APPROPRIATE nursing action? A. Tell the mother that the child must stay in the tent. B. Place a toy in the tent to make the child feel more comfortable. C. Call the health care provider and obtain a prescription for a mild sedative. D. Let the mother hold the child and direct the cool mist over the child's face.
Option D: To decrease the child's anxiety, the mother may hold and accompany the child in the tent.
A child is admitted to the hospital with a suspected rheumatic fever. Which of the following observations is NOT confirming of the diagnosis? A. A history of a sore throat that was self-limited in the past month. B. A reddened rash visible over the trunk and extremities. C. An unexplained fever. D. A negative antistreptolysin O titer.
Option D: Rheumatic fever is caused by an untreated group A B hemolytic Streptococcus infection in the previous 2-6 weeks, confirmed by a positive antistreptolysin O titer.
Croup is caused by what virus?
Parainfluenza virus
