Pediatrics Test 2 Study Questions

A child is hospitalized with heart failure and is receiving furosemide (Lasix). Which nursing action is the priority? A. Administer oxygen. B. Encourage rest. C. Provide meticulous skin care. D. Monitor brain natriuretic peptide.

A A child with heart failure receiving furosemide will have pulmonary congestion from fluid backup into the lungs. The nurse should provide oxygen as the priority action. The other actions are important for this child but do not take priority. Rest will help the body heal and reduce metabolic needs. Skin care is important for edematous tissues. Brain natriuretic peptide does help quantify fluid retention, but monitoring does not actively provide care for the child.

A nurse is planning a seminar to address asthma in the community. To have the greatest impact, which demographic group should the nurse target? A. African American children B. Children with allergies C. Inner-city youth, all ethnicities D. School-age children

A African American children have a 60% higher prevalence of asthma, a 260% higher rate of emergency department visits, a 250% higher hospitalization rate, and a 500% higher mortality rate than white children. To have the greatest impact on this chronic disease, the nurse should target African American children and their parents/guardians and caretakers. Up to 40% of children with asthma have no allergies. Low socioeconomic status is a risk factor, not living in an inner city specifically. Children of all ages are affected.

A 4-year-old girl is brought to the emergency department. She has a "frog-like" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. Which nursing action is the priority for this patient? A. Maintain the airway. B. Obtain a throat culture. C. Start an intravenous line. D. Transport for a chest x-ray.

A Airway, breathing, and circulation are the primary concerns for all patients. When a patient has acute respiratory distress, the most important nursing intervention is maintaining an airway. Starting an IV is important, but it is not the primary concern. Obtaining a throat culture would be contraindicated at this time, as it could cause vomiting or occlusion of the airway. The child should not be transported for x-ray; it should be done with portable equipment.

A nurse is caring for an infant diagnosed with esophageal atresia (EA) and a tracheoesophageal fistula (TEF) prior to surgical correction. Which assessment finding indicates that a priority goal is being met? A. Airway patent with frequent suction B. Gavage feedings tolerated well C. Identification of support system by parents D. Temperature within normal range

A All assessments indicate that goals for important nursing diagnoses have been met; however, airway takes priority. Maintaining a patent airway is the most important goal.

The pediatric nurse examines a neonate and documents that the baby is pink in color when crying but turns bluish when quiet. Which question would be most appropriate to ask the parent? A. "Does the baby have trouble when eating?" B. "Have your other children had this problem?" C. "How many respiratory infections has she had?" D. "You don't ever prop her bottle, do you?"

A Choanal atresia is a congenital malformation of the nose in which there is blockage of the posterior side of the nose. It often is associated with bony abnormalities and may affect one side or both sides of the nose. A child with bilateral choanal atresia usually displays respiratory problems during development. A newborn who is pink in color when crying, yet turns bluish when quiet should be suspected of having bilateral choanal atresia or another defect impeding the nasal airway. Another sign of this disorder is feeding difficulties and resultant lack of weight gain. Because this is not genetic, asking about other children with the condition is irrelevant. The number of respiratory infections will not give information as to the possible diagnosis. Because of the potential for aspiration, the baby should be fed in a semi-upright to upright position; however, the wording of the question might make the parent feel defensive.

A nurse is teaching a community class on heart disease in children. Which information about prevention is most important for the nurse to share? A. Many conditions are genetic, and preventative gene therapy may become possible. B. Maintaining good control of diabetes and hypertension prevents most cases. C. Prevention is impossible because there are few known causes of heart disease. D. Taking 400 mg/day of folic acid will prevent most known cardiac diseases.

A Most cases of congenital cardiac disease have no known cause. The most accurate statement is that genetic causes of heart disease may be prevented with gene therapy in the future. Controlling chronic health conditions is important but not the most accurate answer. Prevention is not totally impossible. Folic acid is important but has the most impact on preventing neural tube defects.

The parent of a 7-month-old baby who has been diagnosed with influenza asks the nurse if the baby can have Tamiflu (oseltamivir). Which response by the nurse is the most appropriate? A. "Children younger than 1 year old cannot take this medication," B. "I'm not sure; let's see how much your baby weighs today." C. "No, children can't take it because it contains aspirin products." D. "Yes, and you can take it, too, if you develop flu symptoms."

A Tamiflu is contraindicated in children younger than 1 year old. The nurse should advise the parent of this fact.

The perinatal nurse is explaining blood transport though fetal circulation to the new nurse. How does the perinatal nurse describe the foramen ovale? A. Opening in the heart's septum between the right and left atria B. Vascular channel between the pulmonary artery and the descending aorta C. Vascular channel connecting the umbilical vein to the inferior vena cava D. Vascular route connecting the heart to the extremities

A The foramen ovale is an opening in the heart's septum between the right and left atria. The vascular channel between the pulmonary artery and descending aorta is the ductus arteriosus. The channel connecting the umbilical vein to the inferior vena cava is the ductus venosus. The closest thing to a route connecting the heart to the extremities would be the aorta, which then leads to peripheral and cerebral circulation.

The mother of a toddler reports to the nurse that the child becomes cyanotic when he cries. Which question by the nurse is most important to ask the mother? A. "Does he squat while he cries?" B. "How long does the cyanosis last?" C. "Is he growing normally?" D. "What was his birth weight?"

A The mother is describing a "tet" spell, which is a hallmark sign of tetralogy of Fallot. A child with this condition becomes cyanotic when playing or crying and draws his or her legs up or squats. By doing this, the child lowers his or her pulmonary vascular resistance and relieves the cyanosis. The other questions are important, but will not give information specific to this condition.

The mother of a 5-year-old girl describes her daughter's symptoms to the nurse in the emergency room. She states that her daughter has had "a dry, hacking cough for the past 3 days that gets worse during the night." She further states that "now she is coughing up phlegm." Which discharge instruction does the nurse plan to provide? A. "Do not be surprised if she vomits her secretions." B. "Give your child cough drops as often as needed." C. "Return if she is not better after 3 days of antibiotics." D. "You can use a warm-mist humidifier in her room."

A This child has manifestations of bronchitis, which is frequently viral in nature. A dry, hacking cough gives way to a productive cough. Older children can be encouraged to cough up their secretions, but younger children often swallow them, leading to vomiting. Cough drops are not generally used, so as to encourage secretion mobilization. Because this disease is usually viral in nature, antibiotics are not routinely used. Cool-mist humidifiers are preferred over warm.

A woman in her 26th week of pregnancy is in preterm labor. What can the nurse conclude about this baby's ability to survive? A. Cannot survive, as all organ systems are too immature B. Might survive, as lungs can breathe air with rhythmic breathing C. Probably will not survive, as all organ systems have not formed D. Will survive, because all body systems are completely mature

B A baby born at this gestation can survive because the lungs are capable of breathing air, they produce surfactant, and the central nervous system can regulate body temperature and direct rhythmic breathing. Many obstacles remain for a baby born this early, and survival is not guaranteed. The other statements are inaccurate.

A nurse notes that a child's chart describes a heave. Which assessment should the nurse perform to correlate with this finding? A. Assess for nausea. B. Auscultate for heart sounds. C. Listen to lung sounds. D. Review the last ECG.

B A heave is an abnormal tremor that accompanies a vascular or cardiac murmur, so the nurse would listen to heart sounds. Lung sounds and ECGs are not directly related to a heave. Nausea is not related at all.

A school-age child is brought to the clinic by a parent who reports that the child becomes short of breath with activity. Which assessment finding would the nurse correlate with this condition? A. Bulging fontanels B. Elevated brain natriuretic peptide C. Peripheral edema D. Weight loss

B Brain natriuretic peptide (BNP) is a measure of fluid overload, often seen in heart failure. An elevation in the laboratory value indicates that the child is retaining fluids. Bulging fontanels would not be seen in this age group. Children do not have peripheral edema, as is common in adults. Weight gain, not loss, would occur with fluid retention.

The pediatric nurse assessing a patient for breath sounds documents a loud, high-pitched sound heard only over the trachea. The nurse should document this finding as which of the following? A. Adventitious breath sound B. Bronchial breath sound C. Bronchovesicular breath sound D. Vesicular breath sound

B Bronchial breath sounds are loud, high-pitched, and heard only over the trachea. Bronchovesicular breath sounds are of intermediate intensity and pitch, with equal inspiratory and expiratory phases. These sounds are best heard between the scapulae and over the mainstem bronchi. Vesicular breath sounds are heard throughout the lung fields. These soft and low-pitched sounds have a longer inspiratory than expiratory phase. Adventitious sounds of these three classifications are described as crackles, wheezes, and rhonchi, respectively.

A child has been diagnosed with an atrioventricular canal defect (AVC). While awaiting surgical correction, which teaching takes priority? A. Care of tubes and drains postoperatively B. Feeding the child frequent, small amounts C. Monitoring weight gain and urine output D. Returning for all scheduled appointments

B Children with uncorrected AVC have shortness of breath, leading to feeding problems. The parents should be taught to feed the child small amounts frequently to limit dyspnea that may accompany feeding. The child will not go home with drains and tubes postoperatively. Monitoring weight gain and urine output is important for all children with cardiac defects. Returning for appointments is important for all children.

A nurse is teaching the parents of a 10-year-old child diagnosed with cystic fibrosis. Which instruction by the nurse is most appropriate? A. "For Pseudomonas infections, we can use penicillin antibiotics." B. "Preventing respiratory infections is crucial for quality of life." C. "Unfortunately, your child is sterile and unable to have children." D. "With pancreatic enzymes, vitamin replacement is not needed."

B Cystic fibrosis (CF) is characterized by frequent, severe respiratory infections, often caused by Pseudomonas, which is treated with tobramycin (TOBI) or azithromycin (Zithromax). Preventing respiratory infections is a crucial part of caring for the child with CF. Reproduction is often affected in people with CF, but without testing, it is impossible to say that the child is sterile. Vitamin replacement is needed along with pancreatic enzyme replacement.

A child has truncus arteriosus with hypotension and poor perfusion. Which medication does the nurse prepare to administer? A. Amiodarone (Cordarone) B. Clopidogrel (Plavix) C. Dopamine (Intropin) D. Isoproterenol (Isuprel)

B Drugs used in this condition include preload- and afterload-reducing agents and positive isotropes. Dopamine is a positive isotrope. The other drugs would not be appropriate.

A pregnant woman is confused about the terms "embryo" and "fetus." How does the nurse explain the difference? A. "The baby can't be called a fetus until the limbs and organs have formed." B. "The baby is an embryo until 8 weeks' gestation; then it is called a fetus." C. "There really isn't any difference between the terms; they are interchangeable." D. "Your baby is a fetus until the kidneys are matured and he makes urine."

B During the first 8 weeks of gestation, the baby is called an embryo. By the end of the eighth week, the embryo has developed enough to be called a fetus. The other statements are inaccurate.

A student nurse asks the faculty why a child with patent ductus arteriosus (PDA) is taking a nonsteroidal anti-inflammatory drug (NSAID). Which response by the faculty is the most appropriate? A. Decreases venous stasis, lowering risks of clotting B. Inhibits prostaglandin, which helps close the PDA C. Provides long-lasting pain and inflammation control D. Reduces swelling around the PDA, making surgery easier

B Prostaglandin helps keep the PDA open, so an NSAID that inhibits prostaglandin synthesis will help close the opening. This is especially beneficial for premature infants. It is not used for venous stasis, pain relief, or swelling.

A student asks the faculty member to explain why the fetus has such a low PO2. What explanation by the faculty member is most accurate? A. Blood from the mother is deoxygenated. B. It keeps the ductus arteriosus open. C. It maintains maternal circulation. D. It supports the foramen ovale.

B The low fetal PO2 helps to maintain fetal (not maternal) circulation and keeps the ductus arteriosus open. It also helps keep the pulmonary vascular bed constricted. Blood from the mother is oxygenated. It does not support the foramen ovale.

A nurse is assessing patients for the presence of patent ductus arteriosus (PDA). Which patient should the nurse assess first? A. 1-year old, history of frequent colds B. 4-year old, blood pressure of 102/36 mm Hg C. Infant with history of poor feeding D. Toddler with murmur at right sternal border

B This child has a wide pulse pressure, which is a sign of PDA. The nurse would assess this child first. Frequent colds and poor feeding can be seen in PDA, but they are vague symptoms and could be related to a number of other conditions. The murmur of a PDA is heard best at the left subclavicular margin.

A new nurse in the emergency department is examining a 4-year-old child who is sitting upright, is drooling, and is restless. Which action by the new nurse causes an experienced nurse to intervene? A. Attaches a cardiac monitor and oximeter B. Attempts to assess throat with a tongue blade C. Permits child to remain in an upright position D. Prepares to administer racemic epinephrine (MicroNefrin)

B This child has manifestations of acute epiglottitis. The nurse should not look into the child's throat, as this may precipitate laryngeal spasm and total airway obstruction. The experienced nurse should intervene if the new nurse attempts to do so. The other interventions are appropriate.

A child in the family practice clinic reports that "my ear itches." On otoscopic exam, the ear canal is swollen, red, and full of debris. Which instruction does the nurse anticipate giving the parent? A. Clean the ear canals occasionally with a cotton swab. B. Dry the ear canals with a hair dryer set on low. C. Give the full course of antibiotics even if the child is better. D. Your child should not be allowed to swim in the future.

B This child has manifestations of otitis externa. Often called swimmer's ear, it is not always associated with swimming. However, the parents need to investigate strategies for keeping the ears dry, including using a hair dryer set on low, wearing ear plugs or a swimming cap, or using solutions designed to promote drying. The parents should not insert anything into the ear canal. Antibiotics are not used with this condition. Swimming is not prohibited.

The nurse is caring for a child with bronchopulmonary dysplasia receiving furosemide (Lasix). Which finding would lead the nurse to conclude the child has a side effect of this drug? A. Acidosis B. Hypercarbia C. Hypokalemia D. Thrombocytopenia

C A side effect of Lasix is hypokalemia. The other laboratory abnormalities are not associated with this drug.

A child hospitalized with heart failure has extremely high blood pressure. Which medication does the nurse prepare to administer? A. Digoxin (Lanoxin) B. Dobutamine (Dobutrex) C. Enalapril (Vasotec) D. Hydrochlorothiazide (Aquazide)

C Enalapril is an ACE inhibitor that reduces systemic vascular resistance, or afterload. Digoxin and dobutamine are positive inotropic agents. Hydrochlorothiazide is a diuretic.

A pediatric clinic nurse teaches parents how to care for their toddler who has nasal congestion. What anatomical difference between children and adults is a concern with congestion in children? A. Children this age should not have congestion. B. Larger tonsils trap mucus, leading to gagging. C. The narrow trachea can become obstructed easily. D. Phlegm can migrate into the eustachian tubes.

C Excess mucus production can lead to airway obstruction in children due to the narrowed lumen size of their tracheas.

A student has read that hematopoiesis occurring in the wall of the yolk sac declines after the eighth week of gestation and asks the instructor for clarification. What statement by the faculty member is most accurate? A. "All of the blood needed is transported across the placenta." B. "Bone marrow production of blood begins in week 8." C. "The fetal liver takes over that function then." D. "You must have misread that information."

C Formation and development of red blood cells (hematopoiesis) occurs in the wall of the yolk sac beginning in the third week. The function gradually declines after the eighth gestational week when the fetal liver begins to take over this process.

A child hospitalized with heart failure has manifestations related to increased preload. Which drug does the nurse prepare to administer? A. Digoxin (Lanoxin) B. Dopamine (Intropin) C. Furosemide (Lasix) D. Metoprolol (Toprol)

C Furosemide is a diuretic, used to rid the body of excess fluid, and it is excess fluid that leads to increased preload. Digoxin is often used in heart failure for its positive inotropic actions. Dopamine increases contractility. Metoprolol is a beta blocker, and its major effect is blocking sympathetic nervous system activity.

A nurse is educating the parents of a 5-year-old with bacterial otitis media. Which discharge instruction is most important? A. "Bring her back if she is not better in 1 week." B. "Do not allow your child to swim in the future." C. "Give the full course of antibiotics even if she is better." D. "Ice packs are a good way to manage her ear pain."

C Giving the full course of antibiotics is crucial to prevent the development of resistant bacteria. If the child is not showing improvement in 48 to 72 hours, she should be reassessed. Swimming is not prohibited after the infection heals. Heat is a better option for ear pain.

A 3-year-old child is 4 hours post-cardiac catheterization via the right femoral artery. Which assessment finding should the nurse report to the provider? A. Crying, complaining of pain at site B. Restless, tries to get up repeatedly C. Right pedal pulse weaker than left D. Wants to be held by a parent

C Pedal pulses should be equal (or unchanged) after a cardiac catheterization. If a pedal pulse on the insertion side is weaker, arterial flow to the extremity may have been disrupted, and this should be reported. Pain is expected and is treated with acetaminophen. A 3-year-old would be expected to want to get up and not lie still and might want to be held. Sedation might be required to maintain bedrest with the affected leg kept straight.

What has the greatest influence on preload? A. Blood pressure B. Contractility C. Fluid volume D. Heart rate

C Preload is equivalent to venous blood return to the atria and end diastolic volumes of the heart. This is directly influenced by fluid volume. Heart rate and contractility have some influence, but they are not the major determinants of preload. Blood pressure is not a direct influence on preload.

A student reviewing the anatomy and physiology of the fetal circulatory system learns that the highest concentration of oxygen in fetal blood is measured at what level? A. 10-20 mm Hg B. 20-25 mm Hg C. 30-35 mm Hg D. 40-50 mm Hg

C The highest concentration of oxygen (PO2) in fetal circulation is found in the blood returning from the placenta via the umbilical vein and is measured at 30-35 mm Hg.

Which artery carries deoxygenated blood? A. Aorta B. Inferior vena cava C. Pulmonary artery D. Subclavian artery

C The pulmonary artery is the only artery in the body to carry deoxygenated blood. It is an artery because it carries blood away from the heart.

Which is the average oxygen saturation of blood in the right atrium? A. 25% B. 50% C. 70% D. 98%

C The right atrium is the collecting chamber that receives blood from the entire body except for the lungs. The oxygen saturation of this blood is approximately 70%.

A nurse is assessing a school-age child admitted with new heart murmur, arthritis-type symptoms, erythema marginatum, and fever. When taking the child's history, which question is most likely to provide important information? A. "Did your child have any vaccinations recently?" B. "Has your child been exposed to contagious illnesses?" C. "Has your child had a sore throat in the last 2 to 3 weeks?" D. "Is there a family history of autoimmune disorders?"

C This child is displaying manifestations of rheumatic fever, which typically arises after an episode of acute pharyngitis. The nurse should ask about recent sore throats. The other questions are not as likely to provide vital information.

A school-age child with asthma came to the emergency department with a respiratory rate of 44 breaths/minute and wheezes heard throughout. After two breathing treatments, the nurse assesses a respiratory rate of 8 breaths/minute and hears no wheezing. The child is lying quietly on the bed. What action by the nurse is best? A. Allow the child to rest undisturbed. B. Call for another respiratory treatment. C. Obtain oxygen saturation; notify provider. D. Reassess the child in 30 minutes.

C This respiratory rate is too low for a child of any age and is indicative of exhaustion and the inability to breathe effectively. The absence of wheezes may indicate lack of ventilation. The nurse should obtain an oxygen saturation and notify the provider immediately. Without action, the child could progress to respiratory arrest. There is no indication that the child needs another breathing treatment.

The pediatric nurse working in a hospital setting uses both standard precautions and transmission-based precautions for patients. Which patient requires only standard precautions? A. Infectious diarrhea B. Staphylococcal infection C. Tonsillitis D. Tuberculosis

C Transmission-based precautions are intended to prevent the transmission of pathogens from those with infectious diseases. Transmission-based precautions include airborne, droplet (TB), and contact precautions (infectious diarrhea and staph infection). Standard precautions are used on all patients, including those with tonsillitis.

The pediatric nurse explains to the parents of a 1-year-old patient with pneumonia that the differences between the adult's and child's respiratory system affect function and subsequent respiratory conditions. Which difference does the nurse include in the discussion with the patient's parents? A. Infants are obligate nose breathers until 6 months of age. B. The epiglottis in the child under 8 is shorter and more rigid. C. The larynx and the glottis are higher in the younger child's neck. D. In the child, there are more functional muscles in the neck and less soft tissue.

C Until about age 4 weeks, infants are obligate nose breathers and do not open their mouths to breathe. The epiglottis in the younger (usually age 8 years and younger) child is longer and flaccid (floppy), which makes it more susceptible to swelling. The larynx and the glottis are higher in the younger child's neck, which makes the child more prone to aspiration. There are fewer functional muscles in the neck, and the increased amount of soft tissue makes the younger child more susceptible to infection and edema.

A 5-year-old child is brought into the clinic by a parent, who reports the child has a "sore throat." Which assessment finding would require immediate notification to the health-care provider? A. Difficulty swallowing B. Inflamed, red pharynx C. Refusing to eat the last 2 days D. Strawberry-colored tongue

D A strawberry-red tongue, petechiae on the palate, and a fine red rash on the trunk or abdomen are consistent with pharyngitis caused by Streptococcus A infection, which needs immediate treatment. The other manifestations are seen with viral pharyngitis infections.

A child has been admitted with Kawasaki disease and is started on aspirin and warfarin (Coumadin). For which nursing diagnosis does the nurse plan interventions as the priority? A. Acute pain related to mouth redness and cracked lips B. Altered body image related to peeling skin rash C. Altered nutrition: less than body requirements D. Risk for bleeding related to medication effects

D Actual nursing diagnoses take priority over "risk for" diagnoses when the actual diagnoses exist. There is no information in the stem to show that the child has impaired mucous membranes leading to pain, an altered body image related to rash, or altered nutrition, although all of these are possible for this child. Risk for injury is the priority because the child is taking two medications that alter coagulation, and for patient safety, this is a critical diagnosis.

A child had a tonsillectomy this morning. What action by the nurse is most important for the child's safety? A. Avoid giving her red popsicles. B. Limit activity the first night. C. Offer ice cream when awake. D. Position the child on her side.

D After tonsillectomy, children are placed on their side to facilitate drainage and prevent aspiration. Maintaining a patent airway is the priority. Red-colored foods or fluids are not given, as the nurse may not be able to differentiate between the food and bloody drainage; however, this is not a priority for safety. Activity should be limited, but this does not take priority over maintaining the airway. Ice cream and other dairy products are not given because they coat the throat and usually cause coughing or throat clearing, which can lead to bleeding.

A child is in the pediatric intensive care unit 2 hours after a surgical repair of an atrial septal defect (ASD). Postoperative nursing actions include which of the following? A. Administer pain medication. B. Maintain venous access. C. Monitor chest tube drainage. D. The nurse will take all of these actions.

D All actions are important for the child postoperatively following an ASD repair. This child will be on a mechanical ventilator, so airway is the priority. The nurse will suction secretions as needed to maintain a patent airway.

A 5-year-old child is being discharged after valve replacement surgery. Which discharge information specific to this child does the nurse provide? A. "Be sure to keep all follow-up appointments." B. "Encourage your child to eat a healthy diet." C. "Monitor the chest incision for redness or heat." D. "This valve will need replacement in about 5 years."

D All options are appropriate for any child with a heart condition or after surgery. The option most specific to this child's condition is informing the parents that as the child grows, the valve will need to be replaced about once every 5 years.

A child diagnosed with a heart murmur is scheduled for an echocardiogram. Which information about this diagnostic test does the nurse provide to the family? A. Allows visualization of the heart's electrical activity B. Gives direct pressure measurements across valves C. Provides more specific information than other tests D. Shows the location and size of a heart defect

D An echocardiogram is a noninvasive test that can show the size and location of a heart defect. An electrocardiogram (ECG) provides visualization of the heart's electrical activity. Direct pressure measurements are obtained with cardiac catheterization. More specific information can be obtained about heart defects via a magnetic resonance angiogram or computed tomographic angiogram.

A school-age child has asthma and lives in a home where both parents smoke. The nurse has provided extensive education to the parents on the dangers of second-hand smoke. Which assessment by the nurse indicates that goals for a family nursing diagnosis have been met? A. Child's clothing no longer smells of cigarette smoke B. Father states he has quit smoking; mother has cut down C. Parents state they smoke only in the basement now D. Significant decrease in asthma "attacks" over a year

D An important goal for this family is understanding how to avoid exposing their child to second-hand smoke. The only objective assessment data to show that the child is not exposed to smoke is the decrease in asthma "attacks" the child has had in the last year. New clothing will not smell like smoke; if the mother continues to smoke even in lesser amounts, the child will still be exposed; and smoking anywhere in the house pollutes all the air in the house.

The mother of a 5-year-old child calls the clinic to ask if her child has a mild respiratory infection or needs to be seen. Which question by the nurse would elicit the most helpful information? A. "Can your child swallow without pain?" B. "Does the child have a sore throat?" C. "Is your child coughing occasionally?" D. "Was the onset gradual or sudden?"

D Common "colds" or nasopharyngitis usually have a gradual onset. A rapid onset would indicate a more serious condition. The other manifestations are commonly seen in this disorder.

A child has had a closure device inserted in interventional radiology for an atrial septal defect (ASD). Two hours later the child is pale, tachycardic, and hypotensive. Which action by the nurse takes priority? A. Administer a beta blocker to slow the heart rate down. B. Document findings then notify the health-care provider. C. Increase the rate of the IV fluid administration. D. Prepare the child to return to interventional radiology.

D Complications from insertion of closure devices include bleeding, cardiac tamponade, or migration of the device. The provider needs to be notified stat, and the child prepared to return to the interventional radiology suite. A beta blocker is inappropriate in this setting. The nurse should notify the provider and obtain orders prior to changing IV fluid rates. Documentation needs to be thorough, but should wait until after the provider is notified.

On physical assessment of the skin of a patient, the nurse documents cyanosis. What other related assessment should the nurse perform? A. Ask the parent about yellow and orange vegetable intake. B. Draw blood for hemoglobin, hematocrit, and liver function studies. C. Palpate all the child's lymph nodes, assessing for enlargement. D. Take the child's vital signs, including blood pressure and pulse.

D Cyanosis may indicate a compromised cardiorespiratory state, and the nurse should assess measures of cardiac output and respiratory function. Taking vital signs will give the nurse information about these two systems. Vegetable intake, laboratory studies (including liver function tests), and palpating lymph nodes are not related to cyanosis.

A nurse is counseling a couple whose child has been diagnosed with cystic fibrosis. They understand that this is an inherited disease, but don't know how the child got it, as neither of them is affected. What response by the nurse is best? A. "Are you certain that you (points to man) are the biological father?" B. "Maybe each of you has a mild case that hasn't been diagnosed yet." C. "Something in your environment must have altered one of the genes." D. "This is a recessive disorder, meaning that each of you is just a carrier."

D Cystic fibrosis is an example of an autosomal recessive inheritance problem. Both parents carry an altered gene for this condition (carriers), but both parents must pass this altered version on to their child in order for it to be expressed. Asking if the man is the father is accusatory and unhelpful. Each parent has the gene, but not the disease, so they don't have a mild form. An environmental factor can cause genetic mutations, but this is not the case in this type of inheritance.

The nurse is teaching the parents of a child who had a surgical correction of a congenital heart defect about subacute bacterial endocarditis (SBE). Which recommendation regarding antibiotic administration prior to dental cleanings is the most appropriate? A. All children with congenital heart defects need SBE prophylaxis. B. Chronic SBE prophylaxis is recommended for most similar children. C. Risks for SBE are very high but easily prevented with antibiotics. D. The provider must weigh the risk-to-benefit ratio for SBE prophylaxis.

D In 2007 the American Heart Association made major changes to the guidelines for prophylaxis needed for patients who have known cardiac disease. The provider needs to weigh the risk-to-benefit ratio, as prophylaxis will only prevent a few cases of SBE and the risk of antibiotic resistance is high. When used, SBE prophylaxis is usually a one-time dose. The actual risk of SBE from dental procedures is less than that from toothbrushing.

A father brings his 1-year-old son to the clinic and states that when he kisses the child's cheek, it tastes salty. Which diagnostic test does the nurse educate the father on based on the father's statement? A. Large bowel barium series B. Pancreatic enzyme analysis C. Pulmonary function studies D. Quantitative sweat chloride test

D Salty-tasting sweat and tears are a characteristic finding in cystic fibrosis. The diagnostic test for this disorder is the quantitative sweat chloride test. Pancreatic enzyme studies are invasive and not usually performed on children. Pulmonary function studies are done in older children who can cooperate. Large bowel barium studies are not needed.

A couple has been told that there is a problem with their pregnancy. They only remember the term "ductus venosus." The nurse explains that there is a problem in the circulation between which two structures? A. Pulmonary artery and descending aorta B. Pulmonary vein and pulmonary artery C. Right and left atria in the heart D. Umbilical cord and inferior vena cava

D The ductus venosus is a vascular channel connecting the umbilical vein to the inferior vena cava. The ductus arteriosus connects the pulmonary artery and descending aorta. The foramen ovale is an opening in the septum between the right and left atria of the heart.

The nursing student studying respiratory anatomy and physiology learns that which tissue or organ grows faster than any other tissue or organ in a child? A. Diaphragm B. Epiglottis C. Lungs D. Tonsils

D The lymphoid tissue of the tonsils is absent at birth, but grows more rapidly in a child than any other tissue.

A child has been admitted for suspected bacterial endocarditis. What action takes priority? A. Administering antibiotics B. Education on valve replacement C. Giving an antipyretic D. Obtaining blood cultures

D The priority action is to obtain blood cultures, either drawn by the nurse or laboratory. Antibiotics are not started until these are collected. If the child is febrile, an antipyretic is appropriate, but it is not the priority. Education on valve replacement is not warranted until later in the course of the disease if it is needed.

The nurse assessing a newborn's umbilical cord stump would document which finding as normal anatomy? A. One artery, one vein B. One artery, two veins C. Two veins, two arteries D. One vein, two arteries

D The vessels in the umbilical cord are comprised of two arteries and one vein.

The nurse is assigned to four patients on the pediatric progressive care unit. After receiving shift report, which patient should the nurse see first? A. Blood pressure of 88/56 mm Hg in 4-year-old child with heart failure B. Child crying inconsolably after his parents went home C. Pain 5/10 in a child 2 days after cardiac surgery D. Temperature 104.6°F (40.3°C) 3 days after dental visit

D This child likely has infective endocarditis or bacterial endocarditis. Any high fever after an invasive procedure or dental cleaning needs to be investigated for this possibility. The blood pressure of 88/56 mm Hg is at about the 50% percentile for a 4-year-old and would be considered adequate. Pain is an expected finding after surgery and needs to be treated, but not as the priority. The crying child could be comforted by a nursing assistant, child-life specialist, social worker, or even a volunteer until the nurse can see the child.

A 5-year-old child is having an acute asthma attack. How does the nurse position the child while waiting for a respiratory treatment? A. Prone across the parent's lap B. Semi-Fowler's position in bed C. Upright in a hard-backed chair D. Upright in the tripod position

D Tripod positioning is often seen in children with respiratory distress. In this position the child sits upright leaning forward on outstretched arms with the jaw thrust forward. This position maximizes airway opening and use of accessory muscles. The nurse can assist the child into this position. The other positions will not be as helpful. However, it is important to note that because children having respiratory distress are often anxious, it is important to allow the child to assume the position in which he or she is most comfortable.