Peds Unit 2 Practice Questions.EXAM2

40. The Heimlich maneuver is recommended for airway obstruction in children older than _____ year(s). a.1 b.4 c.8 d.12

a.1 ANS: A The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. Younger than 1 year, back blows and chest thrusts are administered. The Heimlich maneuver can be used in children older than 1 year.

16. 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

a.Bronchitis ANS: 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.

2. The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for? a.Cardiac arrhythmia b.Hypostatic pneumonia c.Heart failure d.Rapidly increasing blood pressure

a.Cardiac arrhythmia ANS: A Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

36. 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.

a.Diet should be high in carbohydrates and protein. ANS: 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.

2. A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing? a.Dyspnea b.Tachypnea c.Hypopnea d.Orthopnea

a.Dyspnea ANS: A Dyspnea is labored breathing. Tachypnea is rapid breathing. Hypopnea is breathing that is too shallow. Orthopnea is difficulty breathing except in upright position.

1. Which condition in a child should alert a nurse for increased fluid requirements? a.Fever b.Mechanical ventilation c.Congestive heart failure d.Increased intracranial pressure (ICP)

a.Fever ANS: A Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

15. An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. a.60 b.70 c.90 d.100

b.70 ANS: B If a 1-minute apical pulse is less than 70 beats/min for an older child, the digoxin is withheld; 60 beats/min is the cut-off for holding the digoxin dose in an adult. A pulse below 90 to 110 beats/min is the determination for not giving a digoxin dose to infants and young children.

9. 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.

d.a feeling of fullness in the ear. ANS: 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.

11. An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a."I should administer all the prescribed medication." b."I should continue medication until the symptoms subside." c."I will immediately stop giving medication if I notice a change in hearing." d."I will stop giving medication if fever is still present in 24 hours."

a."I should administer all the prescribed medication." ANS: A Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of AOM. Antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside. It should be continued.

34. The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? a.Administering penicillin b.Avoiding salicylates (aspirin) c.Imposing strict bed rest for 4 to 6 weeks d.Administering corticosteroids if chorea develops

a.Administering penicillin ANS: A The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice. Salicylates can be used to control the inflammatory process, especially in the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile stage, but it does not need to be strict. The chorea is transient and will resolve without treatment.

12. An infant's parents ask the nurse about preventing OM. Which should be recommended? a.Avoid tobacco smoke. b.Use nasal decongestant. c.Avoid children with OM. d.Bottle-feed or breastfeed in supine position.

a.Avoid tobacco smoke. ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory tract infection (URI) symptoms. Children should be fed in an upright position to prevent OM.

4. Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action? a.Avoid using for more than 3 days. b.Keep drops to use again for nasal congestion. c.Administer drops until nasal congestion subsides. d.Administer drops after feedings and at bedtime.

a.Avoid using for more than 3 days. ANS: A Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

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

a.Before chest physiotherapy (CPT) ANS: A Bronchodilators should be given before CPT to open bronchi and make expectoration easier. Aerosolized bronchodilator medications are not helpful when used after CPT. Oxygen administration is necessary only in acute episodes with caution because of chronic carbon dioxide retention.

1. An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.) a.Cluster care to conserve energy b.Round-the-clock administration of antitussive agents c.Strict intake and output to avoid congestive heart failure d.Administration of antibiotics

a.Cluster care to conserve energy d.Administration of antibiotics ANS: A, D Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

43. A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status? a.Continuous b.Every 30 minutes c.Every hour d.Every 2 hours

a.Continuous ANS: A The child on supplemental oxygen requires intermittent or continuous oxygenation monitoring, depending on severity of respiratory compromise and initial oxygenation status. The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring.

11. A 3-year-old child has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102° F even though she had acetaminophen 2 hours ago. The nurse's action should be based on which statement? a.Fevers such as this are common with viral illnesses. b.Seizures are common in children when antipyretics are ineffective. c.Fever over 102° F indicates greater severity of illness. d.Fever over 102° F indicates a probable bacterial infection.

a.Fevers such as this are common with viral illnesses. ANS: A Most fevers are of brief duration, with limited consequences, and are viral. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection.

29. Parents of a child with cystic fibrosis ask the nurse about genetic implications of the disorder. Which statement, made by the nurse, expresses accurately the genetic implications? a.If it is present in a child, both parents are carriers of this defective gene. b.It is inherited as an autosomal dominant trait. c.It is a genetic defect found primarily in non-Caucasian population groups. d.There is a 50% chance that siblings of an affected child also will be affected.

a.If it is present in a child, both parents are carriers of this defective gene. ANS: A CF is an autosomal recessive gene inherited from both parents and is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

1. Which is described as the time interval between infection or exposure to disease and appearance of initial symptoms? a.Incubation period b.Prodromal period c.Desquamation period d.Period of communicability

a.Incubation period ANS: A The incubation period is the interval between infection or exposure and appearance of symptoms. The prodromal period is the interval between the time when early manifestations of disease appear and the overt clinical syndrome is evident. Desquamation refers to the shedding of skin. The period of communicability is the time or times during which an infectious agent may be transferred directly or indirectly from an infected person to another person.

30. A nurse is teaching nursing students about clinical manifestations of cystic fibrosis (CF). Which is/are the earliest recognizable clinical manifestation(s) of CF? a.Meconium ileus b.History of poor intestinal absorption c.Foul-smelling, frothy, greasy stools d.Recurrent pneumonia and lung infections

a.Meconium ileus ANS: A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools are a later manifestation of CF. Recurrent respiratory tract infections are a later sign of CF.

4. The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron deficiency anemia is common during toddlerhood? a.Milk is a poor source of iron. b.Iron cannot be stored during fetal development. c.Fetal iron stores are depleted by age 1 month. d.Dietary iron cannot be started until age 12 months.

a.Milk is a poor source of iron. ANS: A Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

24. 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.Nonproductive cough, wheezing ANS: 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.

9. Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process?" a.Normal adult hemoglobin is replaced by abnormal hemoglobin. b.There is a lack of cellular hemoglobin being produced. c.There is a deficiency in the production of globulin chains. d.The size and depth of the hemoglobin are affected.

a.Normal adult hemoglobin is replaced by abnormal hemoglobin. ANS: A Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron deficiency anemia affects the size and depth of the color.

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

a.Osler nodes ANS: A Osler 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 nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.

33. The nurse is conducting a staff in-service on childhood-acquired heart diseases. Which is a major clinical manifestation of rheumatic fever? a.Polyarthritis b.Osler nodes c.Janeway spots d.Splinter hemorrhages of distal third of nails

a.Polyarthritis ANS: A Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation of rheumatic fever. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. Osler nodes, Janeway spots, and splinter hemorrhages are characteristic of infective endocarditis.

6. The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching? a."I should avoid tub baths but may shower." b."I have to stay on strict bed rest for 3 days." c."I should remove the pressure dressing the day after the procedure." d."I may attend school but should avoid exercise for several days."

b."I have to stay on strict bed rest for 3 days." ANS: B The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.

13. 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.Complete obstruction ANS: 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.

26. β-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.

b.Dilate the bronchioles. ANS: B β-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.

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

b.Epiglottitis ANS: 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.

21. The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which is essential in this child's care? a.Monitor pulse oximetry. b.Monitor arterial blood gases. c.Administer oxygen if respiratory distress develops. d.Administer oxygen if child's lips become bright, cherry red.

b.Monitor arterial blood gases. ANS: B Arterial blood gases are the best way to monitor carbon monoxide poisoning. Pulse oximetry is contraindicated in the case of carbon monoxide poisoning because the PaO2 may be normal. The child should receive 100% oxygen as quickly as possible, not only if respiratory distress or other symptoms develop.

14. Which best describes acute glomerulonephritis? a.Occurs after a urinary tract infection b.Occurs after a streptococcal infection c.Associated with renal vascular disorders d.Associated with structural anomalies of genitourinary tract

b.Occurs after a streptococcal infection ANS: B Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A â-hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies.

1. The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older? a.The amount of lymphoid tissue decreases. b.Repeated exposure to organisms causes increased immunity. c.Viral organisms are less prevalent in the population. d.Secondary infections rarely occur after viral illnesses.

b.Repeated exposure to organisms causes increased immunity. ANS: B Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and group A β-hemolytic streptococcal infections.

10. A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? a.Atrial septal defect b.Tetralogy of Fallot c.Ventricular septal defect d.Patent ductus arteriosus

b.Tetralogy of Fallot ANS: B Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

15. 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.The mother's presence will reduce anxiety and ease child's respiratory efforts. ANS: 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.

34. 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.Voice alters ANS: 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. β2 agonists can cause tachycardia and jitteriness.

17. The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? a.Seizures b.Vomiting c.Bradypnea d.Tachycardia

b.Vomiting ANS: B Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower heart rate, not respiratory rate. The heart rate will be slower, not faster.

22. A nurse is admitting an infant with asthma. The nurse understands that asthma in infants is usually triggered by: a.medications. b.a viral infection. c.exposure to cold air. d.allergy to dust or dust mites.

b.a viral infection. ANS: B Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease.

14. A school-age child is admitted in vasoocclusive sickle cell crisis. The child's care should include: a.correction of acidosis. b.adequate hydration and pain management. c.pain management and administration of heparin. d.adequate oxygenation and replacement of factor VIII.

b.adequate hydration and pain management ANS: B The mgmt of crises includes adequate hydration, minimization of energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. Hydration and pain control are two of the major goals of therapy. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII is not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.

8. 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

c.Amantadine hydrochloride (Symmetrel) to reduce symptoms ANS: 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.

6. The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation? a.Fussiness b.Coughing c.A fever over 99° F d.Signs of an earache

d.Signs of an earache ANS: D If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and the infant should be referred to a practitioner for evaluation. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. Fever is common in viral illnesses.

29. Which is the most common causative agent of bacterial endocarditis? a.Staphylococcus albus b.Streptococcus hemolyticus c.Staphylococcus albicans d.Streptococcus viridans

d.Streptococcus viridans ANS: D S. viridans is the most common causative agent in bacterial (infective) endocarditis. Staphylococcus albus, Streptococcus hemolyticus, and Staphylococcus albicans are not common causative agents.

32. 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.Sweat chloride test ANS: 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.

41. A nurse is caring for a child in acute respiratory failure. Which blood gas analysis indicates the child is still in respiratory acidosis? a.pH 7.50, CO2 48 b.pH 7.30, CO2 30 c.pH 7.32, CO2 50 d.pH 7.48, CO2 33

ANS: C pH 7.32, CO2 50 Respiratory failure is a process that involves pulmonary dysfunction generally resulting in impaired alveolar gas exchange, which can lead to hypoxemia or hypercapnia. Acidosis indicates the pH is <7.35 and the CO2 is >45. Metabolic acidosis if the pH is <7.35 but the CO2 is low Alkalosis is when the pH is >7.45. If the pH is high and the CO2 is high, it is metabolic alkalosis. When the pH is high and the CO2 is low, it is respiratory alkalosis.

17. The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a.poor appetite. b.increased potassium intake. c.reduction of edema. d.restriction to bed rest.

c.reduction of edema. ANS: C This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 pounds in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

9. The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot? a.Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b.Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c.Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy d.Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

a.Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy ANS: A Tetralogy of Fallot has these four characteristics: pulmonic stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not atrial stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy, is present in tetralogy of Fallot. Tetralogy of Fallot has right ventricular hypertrophy, not left ventricular hypertrophy, and an atrial septal defect, not aortic hypertrophy.

31. A child is being admitted to the hospital to be tested for cystic fibrosis (CF). Which tests should the nurse expect? a.Sweat chloride test, stool for fat, chest radiograph films b.Stool test for fat, gastric contents for hydrochloride, chest radiograph films c.Sweat chloride test, bronchoscopy, duodenal fluid analysis d.Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

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

23. A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? a.There is heightened airway reactivity. b.There is decreased resistance in the airway. c.The single cause of asthma is an allergic hypersensitivity. d.It is inherited.

a.There is heightened airway reactivity. ANS: A In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. In bronchial asthma, there is increased resistance in the airway. There are multiple causes of asthma, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors. Atopy or development of an immunoglobulin E (IgE)-mediated response is inherited but is not the only cause of asthma.

3. Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections? a.They are safer. b.They are less expensive. c.Respiratory secretions are dried. d.A more comfortable environment is produced.

a.They are safer. ANS: A Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but cool-mist vaporizers present decreased risk for burns and growth of organisms.

3. The nurse should monitor for which effect on the cardiovascular system when a child is immobilized? a.Venous stasis b.Increased vasopressor mechanism c.Normal distribution of blood volume d.Increased efficiency of orthostatic neurovascular reflexes

a.Venous stasis ANS: A The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.

37. The nurse is teaching a mother how to perform chest physical therapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to: a.cover the skin with a shirt or gown before percussing. b.strike the chest wall with a flat-hand position. c.percuss over the entire trunk anteriorly and posteriorly. d.percuss before positioning for postural drainage.

a.cover the skin with a shirt or gown before percussing. ANS: A For postural drainage and percussion, the child should be dressed in a light shirt to protect the skin and placed in the appropriate postural drainage positions. The chest wall is struck with a cupped-hand, not a flat-hand position. The procedure should be done over the rib cage only. Positioning precedes the percussion.

13. Meperidine (Demerol) is not recommended for children in sickle cell crisis because it: a.may induce seizures. b.is easily addictive. c.is not adequate for pain relief. d.is given by intramuscular injection.

a.may induce seizures. ANS: A A metabolite of meperidine, normeperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with sickle cell disease are particularly at risk for normeperidine-induced seizures. Meperidine is no more addictive than other narcotic agents. Meperidine is adequate for pain relief. It is available for IV infusion.

31. The primary nursing intervention to prevent bacterial endocarditis is to: a.institute measures to prevent dental procedures. b.counsel parents of high-risk children about prophylactic antibiotics. c.observe children for complications, such as embolism and heart failure. d.encourage restricted mobility in susceptible children.

b.counsel parents of high-risk children about prophylactic antibiotics. ANS: B The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. Children should be observed for complications such as embolism and heart failure and restricted mobility should be encouraged in susceptible children, but maintaining good oral health and prophylactic antibiotics is important.

15. A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show: a.bacteriuria, hematuria. b.hematuria, proteinuria. c.bacteriuria, increased specific gravity. d.proteinuria, decreased specific gravity.

b.hematuria, proteinuria. ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

20. The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include: a.forcing fluids. b.monitoring pulse oximetry. c.instituting seizure precautions. d.encouraging a high-protein diet.

b.monitoring pulse oximetry. ANS: B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

18. The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a."You will need to decrease the number of calories in your child's diet." b."Your child's diet will need an increased amount of protein." c."You will need to avoid adding salt to your child's food." d."Your child's diet will consist of low-fat, low-carbohydrate foods."

c."You will need to avoid adding salt to your child's food." ANS: C For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

1. Which child should the nurse document as being anemic? a.7-year-old child with a hemoglobin of 11.5 g/dl b.3-year-old child with a hemoglobin of 12 g/dl c.14-year-old child with a hemoglobin of 10 g/dl d.1-year-old child with a hemoglobin of 13 g/dl

c.14-year-old child with a hemoglobin of 10 g/dl ANS: C Anemia is a condition in which the number of red blood cells, or hemoglobin concentration, is reduced below the normal values for age. Anemia is defined as a hemoglobin level below 10 or 11 g/dl. The child with a hemoglobin of 10 g/dl would be considered anemic. The normal hemoglobin for a child after 2 years of age is 11.5 to 15.5 g/dl.

16. A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. a.60 b.70 c.90 to 110 d.110 to 120

c.90 to 110 ANS: C If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a 6-month-old. 60 beats/min is the cut-off for holding the digoxin dose in an adult. 70 beats/min is the determining heart rate to hold a dose of digoxin for an older child. 110 to 120 beats/min is an acceptable heart rate to administer digoxin to a 6-month-old.

5. The nurse is teaching parents of an infant about the causes of iron deficiency anemia. Which statement best describes iron deficiency anemia in infants? a.It is caused by depression of the hematopoietic system. b.It is easily diagnosed because of an infant's emaciated appearance. c.Clinical manifestations are similar regardless of the cause of the anemia. d.Clinical manifestations result from a decreased intake of milk and the premature addition of solid foods.

c.Clinical manifestations are similar regardless of the cause of the anemia. ANS: C In iron deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed in iron deficiency anemia. The bone marrow produces red cells that are smaller and contain less hemoglobin than normal red cells. Children who are iron deficient from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories, but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

3. The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) a.Warm flushed extremities b.Weight loss c.Decreased urinary output d.Sweating (inappropriate) e.Fatigue

c.Decreased urinary output d.Sweating (inappropriate) e.Fatigue ANS: C, D, E The signs and symptoms of heart failure include decreased urinary output, sweating, and fatigue. Other signs include pale, cool extremities, not warm and flushed, and weight gain, not weight loss.

11. The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a.Sickle-shaped cells carry excess oxygen. b.Sickle-shaped cells decrease blood viscosity. c.Increased red blood cell destruction occurs. d.Decreased adhesion of sickle-shaped cells occurs.

c.Increased red blood cell destruction occurs. ANS: C The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. Increased adhesion and entanglement of cells occurs.

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

c.Peripheral edema ANS: C 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.

35. 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.

c.Refer children with sore throats for throat cultures. ANS: C Nurses have a role in prevention—primarily in screening school-age children for sore throats caused by group A β-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 β-hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

25. It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop? a.Cough b.Osteoporosis c.Slowed growth d.Cushing syndrome

c.Slowed growth ANS: C The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing syndrome is caused by long-term systemic steroids.

27. Parents of two school-age children with asthma ask the nurse, "What sports can our children participate in?" The nurse should recommend which sport? a.Soccer b.Running c.Swimming d.Basketball

c.Swimming ANS: C Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Exercise-induced bronchospasm is more common in sports that involve endurance, such as soccer. Prophylaxis with medications may be necessary.

7. 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.

c.after taking antibiotics for 24 hours. ANS: 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.

7. When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is: a.hypospadias. b.pyloric stenosis. c.congenital heart disease. d.congenital hip dysplasia.

c.congenital heart disease. ANS: C Congenital heart malformations, primarily septal defects, are the most common congenital anomaly in Down syndrome. Hypospadias, pyloric stenosis, and congenital hip dysplasia are not frequent congenital anomalies associated with Down syndrome.

7. Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include to: a.administer with meals. b.administer between meals. c.inject deeply into a large muscle. d.massage injection site for 5 minutes after administration of drug.

c.inject deeply into a large muscle. ANS: C Iron dextran is a parenteral form of iron. When administered intramuscularly, it must be injected into a large muscle. Iron dextran is for intramuscular or intravenous (IV) administration. The site should not be massaged to prevent leakage, potential irritation, and staining of the skin.

2. Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. The nurse should explain: a.venipuncture discomfort is very brief. b.only one venipuncture will be needed. c.topical application of local anesthetic can eliminate venipuncture pain. d.most blood tests on children require only a finger puncture because a small amount of blood is needed.

c.topical application of local anesthetic can eliminate venipuncture pain. ANS: C Preschool children are concerned with both pain and the loss of blood. When preparing the child for venipuncture, the nurse will use a topical anesthetic to eliminate any pain. This is a traumatic experience for preschool children. They are concerned about their bodily integrity. A local anesthetic should be used, and a bandage should be applied to maintain bodily integrity. The nurse should not promise one attempt in case multiple attempts are required. Both finger punctures and venipunctures are traumatic for children. Both require preparation.

17. A mother calls the outpatient clinic requesting information on appropriate dosing for over-the-counter medications for her 13-month-old who has symptoms of an upper respiratory tract infection and fever. The box of acetaminophen says to give 120 mg q4h when needed. At his 12-month visit, the nurse practitioner prescribed 150 mg. The nurse's best response is: a."The doses are close enough; it doesn't really matter which one is given." b."It is not appropriate to use dosages based on age because children have a wide range of weights at different ages." c."From your description, medications are not necessary. They should be avoided in children at this age." d."The nurse practitioner ordered the drug based on weight, which is a more accurate way of determining a therapeutic dose."

d."The nurse practitioner ordered the drug based on weight, which is a more accurate way of determining a therapeutic dose." ANS: D The method most often used to determine children's dosage is based on a specific dose per kilogram of body weight. The mother should be given correct information. For a therapeutic effect, the dosage should be based on weight, not age. Acetaminophen can be used to relieve discomfort in children at this age group.

10. 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."

d."We will be sure to keep immunizations up to date." ANS: 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.

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

d.Cardiac valve damage ANS: 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.

2. 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.Encourage to drink 8 ounces of formula every 4 hours. e.Cluster care to encourage adequate rest. f.Place on noninvasive oxygen monitoring. ANS: 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.

5. Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a.Give tepid water baths to reduce fever. b.Encourage food intake to maintain caloric needs. c.Have child wear heavy clothing to prevent chilling. d.Give small amounts of favorite fluids frequently to prevent dehydration.

d.Give small amounts of favorite fluids frequently to prevent dehydration. ANS: D Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

10. Which is a common side effect of short-term corticosteroid therapy? a.Fever b.Hypertension c.Weight loss d.Increased appetite

d.Increased appetite ANS: D Side effects of short-term corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

8. The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested? a.Iron (ferrous sulfate) drops after age 1 month b.Iron-fortified commercial formula by age 4 to 6 months c.Iron-fortified infant cereal by age 2 months d.Iron-fortified infant cereal by age 4 to 6 months

d.Iron-fortified infant cereal by age 4 to 6 months ANS: D Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. The mother can supplement the breastfeeding with iron-fortified infant cereal. Iron supplementation or the introduction of solid foods in a breast-fed baby is not indicated. Providing iron-fortified commercial formula by age 4 to 6 months should be done only if the mother is choosing to discontinue breastfeeding.

28. Which immunization should not be given to a child receiving chemotherapy for cancer? a.Tetanus vaccine b.Inactivated poliovirus vaccine c.Diphtheria, pertussis, tetanus (DPT) d.Measles, rubella, mumps

d.Measles, rubella, mumps ANS: D The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and diphtheria, pertussis, tetanus (DPT) are not live virus vaccines.

12. Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a.Circulatory collapse b.Cardiomegaly, systolic murmurs c.Hepatomegaly, intrahepatic cholestasis d.Painful swelling of hands and feet; painful joints

d.Painful swelling of hands and feet; painful joints ANS: D A vasoocclusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vasoocclusive phenomena.

28. Which drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a.Ephedrine b.Theophylline c.Aminophylline d.Short-acting β2 agonists

d.Short-acting β2 agonists ANS: D Short-acting β2 agonists are the first treatment in an acute asthma exacerbation. Ephedrine is not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations. Aminophylline is not helpful for acute asthma exacerbation.

12. Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include which intervention? a.Delay feeding solid foods until the tongue thrust has stopped. b.Modify diet as necessary to minimize the diarrhea that often occurs. c.Provide calories appropriate to child's age. d.Use a cool-mist vaporizer to keep mucous membranes moist.

d.Use a cool-mist vaporizer to keep mucous membranes moist. ANS: D The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections. A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions. The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. The child is predisposed to constipation. Calories should be appropriate to the child's weight and growth needs, not age.

4. Which explanation regarding cardiac catheterization is appropriate for a preschool child? a.Postural drainage will be performed every 4 to 6 hours after the test. b.It is necessary to be completely "asleep" during the test. c.The test is short, usually taking less than 1 hour. d.When the procedure is done, you will have to keep your leg straight for at least 4 hours.

d.When the procedure is done, you will have to keep your leg straight for at least 4 hours. ANS: D The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.

35. 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.pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. ANS: 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.

16. A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a.blood pressure will stabilize. b.the child will have more energy. c.urine will be free of protein. d.urinary output will increase.

d.urinary output will increase. ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.