Unit 2

What is Patent urachus?

refers to a fistula between the bladder and umbilicus.

The parents of a 4-year-old boy tell the nurse, "We're really worried that our child doesn't have 20/20 vision. It seems that he doesn't always see clearly at a distance." What is the best response by the nurse?

"20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns."

A 13-year-old reports she recently saw a television program showing surgery to correct vision problems. She states she hates wearing glasses and wants to have this procedure done. What is the best response by the nurse?

"Although there are surgeries for vision, they are not normally recommended for someone your age."

A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement?

"Benzocaine drops should be placed in your ear to numb it and reduce pain."

The caregiver of a 2-year-old calls the clinic concerned that her child may have pushed paper into her ears, and she asks the nurse what to do. The mother found the child pushing on her ears with torn paper on the floor in front of her. What would be the appropriate response by the nurse?

"The child should be seen by a care provider. Don't put anything in her ear and bring her in right away."

The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision?

"Children's vision is not completely developed by this age. Your child might outgrow this nearsightedness."

A 5-year-old develops an otitis media with effusion. Myringotomy tube insertion is scheduled. The mother asks, "Why does this have to be done at the hospital?" What would be your best response?

"He will need to lie still afterward, so he will need to remain at the hospital for a short time."

The health care provider orders amoxicillin 35 mg/kg/day in three divided doses for a child with otitis media. The child weighs 44 lb and the medication is available in a suspension of 50 mg/mL. What is the total daily dosage in mL for this child?

14 mL

Correct response: Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, TABLE 41.2 Common Surgical Procedures and Nursing Measures for Congenital Heart Defects, p. 1474.

A 6-year-old girl is diagnosed with aortic stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother? Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization No treatment is necessary, as the defect will resolve spontaneously Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing Surgical closure by ductal ligation

Correct response: Pulses weaker in lower extremities compared to upper extremities Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Coarctation of the Aorta, p. 1482. With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased systemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot.

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta? Pulses weaker in upper extremities compared to lower extremities Pulses weaker in lower extremities compared to upper extremities Cyanosis with crying Cyanosis with feeding

In addition to presenting symptoms, which laboratory finding indicates nephrosis? A. Hypoalbuminemia B. Low specific gravity C. Decreased hemoglobin level D. Decreased hematocrit

A. Hypoalbuminemia

What is the best way for the nurse to detect fluid retention in a child with nephrotic syndrome who has not yet been toilet-trained? A. Weigh the child daily. B. Check the urine for blood. C. Measure the abdominal girth weekly. D. Count the number of wet diapers.

A. Weigh the child daily.

Which urine test result is abnormal? A. pH: 4.0 B. Specific gravity: 1.020 C. Protein level: absent D. Glucose level: absent

A. pH: 4.0

A 2-year-old has a history of fever and fussiness. Which additional symptoms would make the nurse suspect a urinary tract infection?

Abdominal pain

The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement?

Administering antibiotics as soon as they're available

The 12-year-old child has developed a stye. Which may be included in the child's care?

Apply hot, moist compresses to the affected area.

The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan?

Assess the child's ability to convey information.

The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is

Astigmatism

An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What is the most appropriate approach by the nurse? A. Help parents understand that no one knows how this occurs. B. Explain the disorder so that parents can explain it to others. C. Encourage parents not to worry while the tests are being done. D. Suggest that parents avoid family and friends until the gender is assigned.

B. Explain the disorder so that parents can explain it to others.

The nurse obtains a history from the mother of a child with glomerulonephritis about how he became ill. What would the nurse expect her to tell you she noticed?

Dirty green urine

The school nurse is assessing a student complaining of left eye pain. Upon visual inspection, the nurse notes left conjunctivae redness and thick, colored discharge. The nurse understands that these signs and symptoms are consistent with which diagnosis?

Bacterial conjunctivitis

The parent of a child hospitalized with acute glomerulonephritis asks the nurse, "Why are blood pressure readings being taken so often?" What is the best explanation by the nurse? A. "Blood pressure fluctuations are a common side effect of antibiotic therapy." B. "Blood pressure fluctuations are a sign that the condition has become chronic." C. "Acute hypertension must be anticipated and identified." D. "Hypotension can lead to sudden shock can develop at any time."

C. "Acute hypertension must be anticipated and identified."

When a child with nephrotic syndrome is confined to bed, what is an appropriate nursing intervention? A. Restrain the child as necessary. B. Discourage parents from holding the child. C. Adjust activities to child's tolerance level. D. Perform passive range-of-motion exercises daily.

C. Adjust activities to child's tolerance level.

A 4-year-old male is continuing to have periodic daytime and nocturnal enuresis, His mother is very worried and calls the pediatrician's office nurse for advice. What information would be appropriate for the nurse to give? (Select all that apply.) A. He needs evaluation by a psychiatrist before having a medical workup to determine if there are anxiety issues present. B. Diet modifications can be made including avoidance of extraneous sugar and caffeine intake after late afternoon. C. Reassure the mother that the cause will be found through testing. D. It's important to limit the child's interactions with others until the situation is corrected. E. The child needs to realize that he can control the enuresis if he wants to. F. Urinary tract infections can cause enuresis.

C. Reassure the mother that the cause will be found through testing. F. Urinary tract infections can cause enuresis.

A young child is diagnosed with vesicoureteral reflux. What would the nurse expect to read in the medical history that the child had been experiencing? A. Incontinence B. Hypotension C. Recurrent kidney infections D. Increased renal arterial perfusion

C. Recurrent kidney infections

If the child is following a normal development process, visual acuity gradually increases from birth. What is most accurate regarding the age children develop 20/20 vision?

Children usually develop 20/20 vision by 5 years of age.

The nurse is caring for a 10-year-old child with bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. What should the nurse teach the patient about the care of the eye?

Clean the discharge away from the inner to outer canthus.

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure?

During this procedure, small tubes are inserted into the typmpanic membrane.

The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement?

Encouraging the child to keep his hands away from his eyes.

The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority?

Ensuring the protective eye patch is securely in place

The nurse is planning care for a school-age child with a black eye. Which outcome would be the most appropriate for this patient?

Evidence of bleeding will be reabsorbed within 1 to 3 weeks.

A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the most common cause?

Staphylococcus aureus

The school nurse is instructing the classroom teacher regarding a student newly diagnosed with amblyopia. To prepare for classroom instruction, which concept is most important to understand?

Student placement in the room is important but all other teaching methods may remain the same.

A 16-year-old tells you she has terrible dysmenorrhea. Which action would be the best health teaching measure regarding this?

Take over-the-counter ibuprofen for its prostaglandin action. An anti-inflammatory medication is most helpful in reducing the discomfort of dysmenorrhea.

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

Tea-colored urine The presenting symptom in acute glomerulonephritis is grossly bloody urine.

A voiding cystourethrogram (VCUG) is ordered on a child. What education should be provided to the parents?

The VCUG will rule out VUR.

The outpatient care clinic receives the 2020 National Health Goals that focus on prevention, early detection, treatment, and rehabilitation of vision problems. What should the nurse remind each patient to do to ensure eye health?

Use personal protective eyewear during recreation and hazardous situations.

The nurse is caring for a child who has been admitted to the acute care facility with manifestations consistent with hydronephrosis. Which of the following diagnostic tests can the nurse anticipate will be performed to confirm diagnosis? Select all that apply a. intravenous pyelogram (IVP) b. Urinalysis c. Voiding cystourethrogram (VCUG) d. complete blood count e. renal ultrasound

a. intravenous pyelogram (IVP) c. Voiding cystourethrogram (VCUG) e. renal ultrasound

The nurse is discussing genitourinary conditions with a group of 16-year-old girls. One of the girls says she has heard about girls who have stopped taking birth control pills and now don't have periods. The condition the girl is referring to is:

amenorrhea.

The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media infection. Which statement by the mother indicates she has the correct understanding of the information provided?

"I should continue to breastfeed my son because it lowers the incidence of acute otitis media."

The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education?

"I will use Visine drops in his infected eye to help reduce redness."

The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition?

"Our son's condition may resolve on its own."

The nurse is educating a 13-year-old paintball enthusiast about sports-related injuries. Which comment is most likely to be accepted by the child?

"Play tough, but wear protective gear."

The mother of a child having myringotomy tubes placed asks, "Will my son lose his hearing while the tubes are in place?" What is the nurse's best answer?

"The tubes are inserted into a section of eardrum in which the hearing is not affected."

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is your best response?

"The tubes remain in place for 6 to 12 months until they come out by themselves."

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate?

"What you are describing may be what is called myopia."

The nurse has recently admitted a blind child to the pediatric unit. Which interventions should the nurse implement? Select all that apply.

- Identify herself to let child know she is there before touching the child. - Allow the child additional time to think about a response to a question. - Explain what individuals are doing.

Correct response: Avoid drawing a blood specimen from the right femoral vein before the procedure Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, CARDIAC CATHETERIZATION, p. 1463. Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine.

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection? Record pedal pulses Keep the child NPO for 2 to 4 hours before the procedure Apply EMLA cream to the catheter insertion site Avoid drawing a blood specimen from the right femoral vein before the procedure

Correct response: nonsterioidal anti-inflammatory drugs (NSAIDs) Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Acute Rheumatic Fever, p. 1495. Medications used in the treatment of rheumatic fever include penicillin, salicylates (aspirin), and corticosteroids. Insulin would be given for diabetes and dilantin for seizure disorders. Antivirals are not relevant to the treatment of a bacterial infection.

A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers? insulin antiviral phenytoin nonsterioidal anti-inflammatory drugs (NSAIDs)

Correct response: "My child cannot have any thing to eat or drink after midnight the day of the test." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 41.1, p. 1466. Ambulatory electrocardiographic monitoring (Holter) testing is an exam that spans approximately 24 hours. The test is done to review the activity of the heart. The child is encouraged to follow one's normal activities during the test. There is no need for the child to be NPO prior to or during the test.

A child will be undergoing a Holter monitor test. Which statement by the parent indicates the need for further instruction? "This test will monitor my child for about 24 hours." "Wearing a snug shirt the day of the test will be helpful." "My child cannot have any thing to eat or drink after midnight the day of the test." "We do not need to alter our activities during the testing period."

Correct response: bounding pulse Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Process Overview for the Child with an Alteration in Perfusion/ Cardiovascular Disorder, p. 1465.

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note? preference to resting on the right side appropriate mastery of developmental milestones bounding pulse pitting periorbital edema

Correct response: tetralogy of Fallot Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Tetralogy of Fallot, p. 1475. Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.

A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis? aortic stenosis coarctation of aorta pulmonary stenosis tetralogy of Fallot

Correct response: lower extremities Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Process Overview for the Child with an Alteration in Perfusion/ Cardiovascular Disorder, p. 1464. Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities.

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child? lower extremities presacral region hands face

Correct response: 80 beats/min Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, DRUG GUIDE 41.1, p. 1469. Prior to administering each dose of digoxin, the nurse would count the apical pulse for 1 full minute, noting rate, rhythm, and quality. The nurse would withhold the dose and notify the health care if the apical pulse is less than 60 in an adolescent, less than 90 in an infant.

A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate? 118 beats/min 102 beats/min 94 beats/min 80 beats/min

An infant born with congenital glaucoma is scheduled for surgery. Which preoperative order should the nurse question for this patient?

A preoperative injection of atropine

9. A child requires supplemental oxygen therapy at 8 liters per minute. Which delivery device would the nurse most likely expect to be used? A. Simple mask B. Venturi mask C. Nasal cannula D. Oxygen hood

Answer: A Rationale: A simple mask would be used to deliver a flow rate of 8 liters per minute. A Venturi mask would be used to deliver a specific percentage of oxygen, from 24% to 50%. A nasal cannula would be used to deliver no more than 4 liters per minute. An oxygen hood requires a liter flow of 10 to 15 liters per minute. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1420

16. The nurse is preparing to perform a physical examination of a child with asthma. Which technique would the nurse be least likely to perform? A. Inspection B. Palpation C. Percussion D. Auscultation

Answer: B Rationale: When examining the child with asthma, the nurse would inspect, auscultate, and percuss. Palpation would not be used. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1440

4. Bacterial pneumonia is suspected in a 4-year-old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? A. Fever B. Oxygen saturation level of 96% C. Tachypnea with retractions D. Pale skin color

Answer: C Rationale: Pneumonia is usually a self-limiting disease. Children with bacterial pneumonia can be successfully managed at home if the work of breathing is not severe and oxygen saturation is within normal limits. Hospitalization would most likely be required for the child with tachypnea, significant retractions, poor oral intake, or lethargy for the administration of supplemental oxygen, intravenous hydration, and antibiotics. Fever, although common in children with pneumonia, would not necessitate hospitalization. An oxygen saturation level of 96% would be within normal limits. Pallor (pale skin color) occurs as a result of peripheral vasoconstriction in an effort to conserve oxygen for vital functions; this finding also would not necessitate hospitalization. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1431

A 5-year-old female has been sent to the school nurse for urinary incontinence three times in the past 2 days. What nursing action should be taken first? A. Talking with the parents about a possible school phobia. B. Determining if there are emotional causes. C. Talking with the parents about a possible urinary tract infection. D. Asking the parents if there is a possible structural defect of the urinary tract.

C. Talking with the parents about a possible urinary tract infection.

Correct response: Assessing for the presence of femoral pulses Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Coarctation of the Aorta, p. 1482. Coarctation of the aorta is a defect where there is narrowing of the aorta, which is the largest vessel carrying oxygenated blood to the body. As a result of this narrowing, blood flow is impeded causing pressure to increase in the area proximal to the defect and decrease distal to the defect. As a result, the blood pressure will be higher in the upper part of the body and decreased in the lower part of the body. The pulses will be full or bounding in the upper part of the body and weak or absent in the lower part of the body. When assessing an infant with coarctation there may be weak or absent femoral pulses. There will also be differences in the blood pressure readings. These infants may or may not have a murmur and will be no more fussy than other babies.

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition? Observing for excessive crying Auscultating for a cardiac murmur Recording an upper extremity blood pressure Assessing for the presence of femoral pulses

A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage bladder spasms?

Encourage high fluid intake.

The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child?

Eyes Edema is usually the presenting symptom in nephrotic syndrome, appearing first around the eyes and ankles.

An infant is diagnosed with a urinary tract infection. What would the nurse expect on assessment?

Failure to thrive Infants and neonates have poor feeding when they have a urinary tract infection.

Hearing aids can improve hearing for children who have inner ear or nerve deafness.

False

Peritoneal dialysis is so effective that 3 hours of peritoneal dialysis accomplishes as much as 12 hours of hemodialysis.

False Hemodialysis can be done as a continuous process, but it is so effective 3 hours of hemodialysis accomplishes as much as 12 hours of peritoneal dialysis.

The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply.

Oxybutynin Imipramine Desmopressin

The nurse is caring for a child on a pediatric unit who has hemodialysis 3 times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child?

Grilled chicken, half of a banana, and flavored water Since hemodialysis is usually performed only every other day, larger amounts of waste products build up in the child's blood; therefore, the child must follow a stricter diet between hemodialysis treatments, though dietary restrictions are usually lifted while the child is actually undergoing the treatment. Since the kidneys are not functioning, foods high in sodium, protein, and potassium must be avoided.

The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. The nurse documents this finding as:

Hypospadias

An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client?

Instill a few drops of a topical anesthetic into the affected eye

A child returns to the clinic after an episode of otitis externa, which has resolved. What would the nurse emphasize as the priority for preventing future episodes?

Keeping ear canals dry,

When examining the musculoskeletal system of the child, which would be indicative of a potential kidney problem?

Muscle weakness

When developing the preoperative plan of care for an infant with bladder exstrophy, which intervention would the nurse least likely include?

Placing the infant in a side-lying position

The nurse is taking a health history for a 9-year-old with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis?

Recently helped clean the basement

The nurse is caring for a preschool-aged child diagnosed with acute otitis media. Which intervention should be a priority for the nurse?

Relieving pain

The nurse is caring for a 3-year-old with hypospadias. After a surgical repair, he has a urethral urinary catheter inserted. What would the nurse want to teach the parents?

The catheter insertion site will leave only a minimal scar.

Correct response: wheezing Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Infective Endocarditis, p. 1494. The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset, nausea, and abdominal distress are common with oral antibiotics and do not need to be reported immediately.

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction? wheezing stomach upset abdominal distress nausea with diarrhea

Correct response: mild-to-late ejection click at the apex Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Process Overview for the Child with an Alteration in Perfusion/ Cardiovascular Disorder, p. 1465.

The nurse is auscultating heart sounds of a child with a mitral valve prolapse. The nurse should expect which assessment finding? mild-to-late ejection click at the apex clicks on the upper left sternal border intensifying of S2 sounds abnormal splitting of S2 sounds

Correct response: Administer indomethacin. Give prostaglandin E1 (PGE1). Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, DRUG GUIDE 41.1, p. 1470.

The nurse is caring for a child with aortic stenosis. Which health care provider prescription(s) will the nurse question? Select all that apply. Apply a cardiac monitor. Administer indomethacin. Prepare for balloon dilation. Give prostaglandin E1 (PGE1). Obtain echocardiogram.

Correct response: "While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, DISORDERS WITH INCREASED PULMONARY FLOW, p. 1478.

The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents asks the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the nurse? "This is something we should talk with the physician about. Maybe it would help your baby." "Oxygen isn't always the best treatment for your child's condition. Surgery is necessary." "While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help." "I can only place oxygen on your child if the doctor orders oxygen."

Correct response: "I should plan to have vegetables with each evening meal served." "Adding fresh fruits to my child's lunch is a good idea." "My child loves chicken and I can still serve it but I need to remove the skin." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Dyslipidemia, p. 1499. Hyperlipidemia refers to high levels of lipids (fats/cholesterol) in the blood. High lipid levels are a risk factor for the development of atherosclerosis, which can result in coronary artery disease, a serious cardiovascular disorder occurring in adults. Dietary management is the first step in the prevention and management of hyperlipidemia in children older than 2 years of age. The diet should consist primarily of fruits, vegetables, low-fat dairy products, whole grains, beans, lean meat, poultry, and fish. As in adults, fat should account for no more than 30% of daily caloric intake. Fat intake may vary over a period of days, as many young children are picky eaters. Limit saturated fats by choosing lean meats, removing skin from poultry before cooking, and avoiding palm, palm kernel, and coconut oils as well as hydrogenated fats.

The nurse is reviewing nutritional recommendations with the parents of a teen diagnosed with hyperlipidemia. Which statements indicate an understanding of the recommended diet for this condition? Select all that apply. "Adding fresh fruits to my child's lunch is a good idea." "I should plan to have vegetables with each evening meal served." "Cooking with palm oil will be helpful." "My child loves chicken and I can still serve it but I need to remove the skin." "I need to limit fat intake in meals to 40%."

The nurse is caring for an 8-year-old hospitalized child who is visually impaired. Which nursing intervention would be the highest priority in helping this child reduce anxiety related to hospitalization?

The nurse talks to the child when entering and leaving the room.

Correct response: 16-year-old child with a heart rate of 54 beats per minute 2-year-old child whose digoxin level was 2.4 ng/ml from a blood draw this morning 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, DRUG GUIDE 41.1, p. 1469. The nurse should not administer digoxin to children with the following issues: The adolescent with an apical pulse under 60 beats per minute, the child with a digoxin level above 2 ng/mL, and the child who exhibiting signs of digoxin toxicity.

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? Select all that apply. 2-year-old child whose digoxin level was 2.4 ng/ml from a blood draw this morning 16-year-old child with a heart rate of 54 beats per minute 12-year-old child whose digoxin level was 0.9 ng/ml on a blood draw this morning 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse 4-month-old child with an apical heart rate of 102 beats per minute

The nurse is educating the parents of a 5-year-old girl with infectious conjunctivitis about the disorder. Which information is most important to provide to prevent the spread of the disorder?

Washing hands frequently

The nurse is working with a child with altered genitourinary status. Which intervention would be included in the plan of care with excess fluid volume?

Weigh the child twice a day on the same scale.

Correct response: Begin formulas with increased calories. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1493. Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering.

What information would be included in the care plan of an infant in heart failure? Maintain child in the supine position. Administer digoxin even if the infant is vomiting. Begin formulas with increased calories. Encourage larger, less frequent feedings.

Correct response: obstruction of blood flow to the lungs Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Tricuspid Atresia, p. 1477.

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of what factor as the major mechanism involved? obstruction of blood flow to the lungs mixing of well-oxygenated and poorly oxygenated blood narrowing of the major vessel increased pulmonary blood flow

Correct response: The liver size increases in right-sided heart failure. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1491. The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding? The spleen size increases due to increased destruction of red blood cells. The liver size increases due to cardiac medications. The spleen size increases due to frequent infection. The liver size increases in right-sided heart failure.

The nurse is caring for a child with epididymitis. When planning care which of the following interventions may be included? a. scrotal elevation b. warm compresses c. corticosteroid therapy d. catheterization

a. scrotal elevation

The nurse is administering cyclophasophamide as ordered for a 12 year old boy with nephrotic syndrome. Which of the following instructions is most accurate regarding administration of this cytotoxic drug? a. administer in the evening on an empty stomach b. provide adequate hydration and encourage fluids and voiding during and after administration c. administer in the morning, encourage fluids and voiding during and after administration d. encourage fluids, adequate food intake, and voiding before and after administration

c. administer in the morning, encourage fluids and voiding during and after administration

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which of the following characteristics of this condition would the nurse expect to assess, including information from the chart review a. hemolytic anemia, acute renal failure and hypotension b. dirty green colored urine, elevated erythrocytes sedimentation, and depressed serum complement level c. hemolytic anemia, thrombocytopenia, and acute renal failure d. thhrombocytopenia, hemolytic anemia, and nocturia several times each night

c. hemolytic anemia, thrombocytopenia, and acute renal failure

The nurse is caring for a 10 year old girl presenting with fever, dysuria, flank pain, urgency, and hematuria. The nurse would expect to help obtain which of the following tests first to reveal preliminary information about the urinary system? a. total protein, globulin, and albumin b. creatinine clearance c. urinalysis d. urine culture and sensitivity

c. urinalysis

The nurse is planning the discharge instructions for the parents of a 1 month old child who has had a circumcision completed. Which of the following should be included in the education provided? a. use Vaseline on the head of the penis for the first 2 weeks after the procedure b. report any bleeding to the physician c. reduce the child's fluid intake to reduce voiding during the first 24 hours d. report redness or swellling on the penile shaft

d. report redness or swellling on the penile shaft

The most effective approach to prepare a school-aged boy for a myringotomy procedure is to

explain the procedure to the child using puppets.

The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the

importance of patching as prescribed.

What is Bladder exstrophy ?

involves the bladder lying open and exposed on the abdomen.

What is Hypospadias?

is a condition in which the urethral opening in on the ventral surface of the penis.

What is Epispadias?

is present when the urethral opening is on the dorsal surface of the penis.

Correct response: Place the infant in the knee-chest position. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Tetralogy of Fallot, p. 1477. Place child in the knee-to-chest position. This position is the first priority of the child with tetralogy of Fallot. Cyanosis is caused by the heart defect and placing the child in this position will decrease the cyanosis.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority? Place the infant in the knee-chest position. Prepare the infant for surgery. Raise the head of the bed. Start an IV for fluids.

12. A parent asks the nurse about immunizing her 7-month-old daughter against the flu. Which response by the nurse would be most appropriate? A. "She really doesn't need the vaccine until she reaches 1 year of age." B. "She will probably receive it the next time she is to get her routine shots." C. "Since your daughter is older than 6 months, she should get the vaccine every year." D. "The vaccine has many side effects, so she wouldn't get it until she's ready to go to school."

Answer: C Rationale: The current recommendations are for all children older than 6 months of age to be immunized yearly against influenza. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 1424

A mother asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the mother?

The frequency of otitis media is reduced in breast-fed infants.

The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment?

The infant does not imitate facial expressions.

Correct response: heart failure Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1491. Infective endocarditis would present with intermittent, unexplained low-grade fever, fatigue, anorexia, weight loss, or flu-like symptoms. Characteristics of cardiomyopathy include respiratory distress, fatigue, poor growth (dilated), chest pain, dizziness, and syncope. Abdominal pain, joint pain, fever, irritability are signs of Kawasaki disease.

The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder? Kawasaki Disease heart failure infective endocarditis cardiomyopathy

Correct response: Digoxin Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, DRUG GUIDE 41.1, p. 1469. The use of large doses of digoxin at the beginning of therapy to build up the blood levels of the drug to a therapeutic level is known as digitalization. During the 24 hours digitalization is occurring, the child should be on a cardiac monitor and the nurse should monitor the PR interval and a decreased ventricular rate. The other listed medications are not administered in this manner. Albuterol is inhaled for asthma treatment and used primarily for exacerbations. Ferrous sulfate is give for iron-deficiency anemia, and spironolactone is a diuretic.

The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level? Digoxin Albuterol sulfate Spironolactone Ferrous sulfate

Correct response: Tachycardia Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1492.

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure? Splenomegaly Bradycardia Tachycardia Inability to sweat

Correct response: Activity intolerance related to inability of heart to sustain extra workload Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Acute Rheumatic Fever, p. 1495. Acute rheumatic fever affects the joints, central nervous system, skin, and soft tissue. It causes chronic, progressive damage to the heart and valves. Children with rheumatic fever need to reduce activity to relieve stress on the heart and joints during the course of the illness. Rheumatic fever does not produce cardiomegaly nor does it interfere with respirations or the ability to oxygenate the body. Children with rheumatic fever may develop chorea. These movements are involuntary and are not related to hyperexcitability.

Which nursing diagnosis would best apply to a child with rheumatic fever? Disturbed sleep pattern related to hyperexcitability Ineffective breathing pattern related to cardiomegaly Risk for self-directed violence related to development of cerebral anoxia Activity intolerance related to inability of heart to sustain extra workload

Correct response: tiring easily when eating shortness of breath when playing crackles on lung auscultation Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1491. Explanation: Manifestations of heart failure include difficulty feeding or eating or becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension.

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply. shortness of breath when playing tiring easily when eating bradycardia crackles on lung auscultation hypertension

Correct response: This test will check how blood is flowing through the heart. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 41.1, p. 1466. An echocardiogram (echo) is a noninvasive ultrasound used to assess the heart wall thickness, the size of the heart chambers, the motion of the valves and septa, and the relationship of the great vessels to other cardiac structures. The test evaluates how blood is flowing through the heart and how effective the heart is in pumping. An echo does not check the electrical impulses. This would be done with an electrocardiogram.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? This test will check how blood is flowing through the heart. This invasive test will measure the blockage in the heart. This test will only determine the size of the heart. This noninvasive test will check the electrical impulses in the heart.

Correct response: This is caused by an opening that usually closes by 1 week of age. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Patent Ductus Arteriosus, p. 1481. A PDA is caused by an opening called the ductus arteriosus. A PDA usually closes by 1 week of age. If it does not close, the defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education? Your child may need multiple surgeries to correct this defect. This type of defect is caused by having a genetic predisposition for it. An IV for fluids will be started immediately. This is caused by an opening that usually closes by 1 week of age.

18. A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which would the nurse instruct the parents to administer orally? A. Recombinant human DNase B. Bronchodilators C. Anti-inflammatory agents D. Pancreatic enzymes

Answer: D Rationale: Pancreatic enzymes are administered orally to promote adequate digestion and absorption of nutrients. Recombinant human DNase, bronchodilators, and anti-inflammatory agents are typically administered by inhalation. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Reference: p. 1447-1448

Correct response: Assess blood pressure in all extremities. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Coarctation of the Aorta, p. 1482. An infant with decreased pulse strength in the lower extremities may have coarctation of the aorta. Assessing blood pressures in all extremities is most helpful in assisting the nurse with gathering assessment data prior to contacting the health care provider. The nurse does not have enough information to apply oxygen at this time or prepare the newborn for balloon angioplasty.

The nurse is assessing an infant and notes brachial pulses of 2+ and femoral pulses of 1+. Which action will the nurse perform first? Contact the health care provider. Apply appropriate oxygen device. Prepare for balloon angioplasty. Assess blood pressure in all extremities.

Correct response: Place the child in a knee-to-chest position. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, BOX 41.1 Relieving Hypercyanotic Spells, p. 1487. The priority nursing action is to place the infant or child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen would be provided as ordered. Once a child is placed in the knee-to-chest position, medications would be given as ordered.

The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority? Use a calm, comforting approach. Place the child in a knee-to-chest position. Administer morphine as prescribed. Provide supplemental oxygen.

Correct response: placing the infant in a semi-Fowler position Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1493. Placing an infant with heart failure in a semi-Fowler position reduces the pressure of the abdominal contents against the chest and allows for better lung expansion. Keeping the infant supine would cause more pressure on the heart and lungs and increase the work of the heart and lungs. Infants with heart disease need calories to grow. They are given formula or breast milk which is fortified with extra nutrients. Thus the infant can have an intake of the same amount of fluid but receive extra nutrients.

What would be the most important measure to implement for an infant who develops heart failure? placing the infant in a semi-Fowler position keeping the infant supine and playing quiet games planning ways to reduce salt intake restricting milk intake daily

Correct response: Peeling hands and feet; fever Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Kawasaki Disease, p. 1498. Kawasaki disease is an acute systemic vasculitis. Symptoms begin with very high fevers. One of the signs of Kawasaki disease is the peeling hands and feet and in perineal region. The child is usually tachycardic and laboratory values would indicate increased platelets and decreased hemoglobin. Another classic sign of Kawasaki is the strawberry tongue. The other symptoms are not necessarily characteristic of Kawasaki disease. The child should be evaluated if there are impalpable pulses because this could indicate a heart defect or some other serious illness.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? Low blood pressure and decreased heart rate Decreased heart rate and impalpable pulse Peeling hands and feet; fever Irritability and dry mucous membranes

Correct response: "Make sure you are fully immunized." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Process Overview for the Child with an Alteration in Perfusion/ Cardiovascular Disorder, pp. 1463-1464. The cause of congenital heart disease often cannot be documented, although it is associated with familial patterns of inheritance and possibly triggers such as rubella (German measles) and varicella (chickenpox) infection during pregnancy. Women need to enter pregnancy fully immunized to help prevent infection during pregnancy. Encouraging the child to eat a low-sodium diet and exercise as he or she grows up will help prevent acquired heart disease, not congenital heart disease.

A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can do to reduce the risk of this type of condition occurring in her baby. What information should the nurse mention to this client? "Make sure you encourage a low-sodium diet in your child as he grows up." "Make sure you are fully immunized." "There is really nothing you can do." "Make sure that you encourage your child to exercise as he grows up."

A 6-year-old girl born with a myelomeningocele has a neurogenic bladder disorder. Her parents have been performing clean intermittent catheterization. Based on the knowledge of child development and chronic disability, what action should the nurse implement? A. Teach the child to do self-catheterization. B. Teach the child appropriate bladder control. C. Continue having the parents do the catheterization. D. Encourage the family to consider urinary diversion.

A. Teach the child to do self-catheterization.

Correct response: femoral pulse weaker than brachial pulse. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Coarctation of the Aorta, p. 1482. A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure. With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased systemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot.

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: narrow pulse. bounding pulse. hepatomegaly. femoral pulse weaker than brachial pulse.

Correct response: "The feeling of the heart skipping a beat is common." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, TEACHING GUIDELINES 41.1 Providing Care After a Cardiac Catheterization, p. 1472. Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. The tub bath statement is appropriate because tub baths should be avoided for about 3 days. The strenuous activity statement is appropriate because strenuous activity is limited for about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported.

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching? "Strenuous activity should be limited for the next 3 days." "We need to avoid a tub bath for the next 3 days." "We need to watch for changes in skin color or difficulty breathing." "The feeling of the heart skipping a beat is common."

Correct response: Polycythemia Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Tetralogy of Fallot, p. 1477. Tetralogy of Fallot is a congenital heart defect causing decreased pulmonary blood flow. This causes mild to severe oxygen desaturation. To compensate for the low blood oxygenation the kidneys produce erythropoietin to stimulate the bone marrow to make more red blood cells (RBCs). The increased amount of RBCs is known as polycythemia. This increased blood volume causes more workload on the heart. It also does not increase the amount of blood reaching the lungs so the child remains desaturated. Leukopenia, increased platelets, and anemia are not associated with tetralogy of Fallot.

When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover? Anemia Leukopenia Increased platelet level Polycythemia

Correct response: These wires are connected to the heart and will detect if your infant's heart gets out of rhythm. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, COMMON MEDICAL TREATMENTS 41.1, p. 1469. Following cardiac repair there is always a possibility of arrhythmias. The wires are placed and connected to an external pacemaker. This is done as a preventive measure and can be used if an arrhythmia occurs. Once it is felt the child is in no danger of an arrhythmia, the wires are removed. There is no set time period in which this occurs. The wires do not deliver ongoing electrical shocks to maintain rhythm. This would be done by a permanent pacemaker implanted under the skin. There is no measurement of fluid in the heart by wires. Any measurements would need to be performed by echocardiogram or cardiac catheterization.

A nurse is caring for an infant who just had open-heart surgery and the parents are asking why there are wires coming out of the infant's chest. What is the best response by the nurse? The wires are measuring the fluid level in the heart. The wires are left in the heart for 1 month after surgery in case of potential arrhythmias. The wires will administer ongoing electrical shocks to the heart to maintain rhythm. These wires are connected to the heart and will detect if your infant's heart gets out of rhythm.

Correct response: "We can stop the penicillin when her symptoms disappear." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Acute Rheumatic Fever, p. 1495. For a child with rheumatic fever, drug therapy must be given for the full 10 to 14 days to ensure complete eradication of the infection. The drug must not be stopped when the signs and symptoms disappear. To prevent recurrent attacks, prophylactic antibiotic therapy is prescribed for at least 5 years or until the child is 18 years old. Additional prophylactic therapy should be instituted when dental or tonsillar surgery is planned.

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed? "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years." "If she needs dental surgery, we might need additional medication." "She needs to take the drug for the full 14 days." "We can stop the penicillin when her symptoms disappear."

Correct response: Notify the doctor immediately. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, BOX 41.2 Possible Complications After Cardiac Surgery, p. 1490. The nurse would notify the doctor immediately. Cardiac tamponade is a medical emergency and should be addressed. The child can die if intervention is postponed. It would not be appropriate to perform any interventions until confirming that this is the actual diagnosis.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention? Elevate the head of the bed. Notify the doctor immediately. Observe vitals every two hours. Administer epinephrine.

22. A child has been prescribed a nasal cannula for oxygen delivery. What should the nurse do before applying the cannula? A. Assess patency of the nares B. Test the oxygen saturation C. Add humidification to the delivery device D. Assess the lung sounds

Answer: A Rationale: A nasal cannula is a good delivery device for children, because it allows them to eat and talk unobstructed. Because the device is designed for flow through the nares, the patency of the nares should be assessed prior to using the cannula. If the nares are blocked from secretions, suctioning may be required. If there is a defect in the upper airway causing blockage, the nasal cannula may not be an appropriate oxygen delivery device. The oxygen saturation should have been measured and used as a guide for the prescription of oxygen therapy. Adding humidification is a way to keep the upper airways from becoming too dry, but oxygen can be started before humidity is added. Anytime a child is sick enough to require oxygen all respiratory assessments, including lung sounds, should be done. It does not matter, however, what the lung sounds are if the child is in enough distress to require oxygen. The lung sounds can be assessed after oxygen is started. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1420

20. The nurse is preparing to provide tracheostomy care to an infant. After gathering the necessary equipment, what would the nurse do next? A. Position the infant supine with a towel roll under the neck. B. Cut the new tracheostomy ties to the appropriate length. C. Cut the tracheostomy ties from around the tracheostomy tube. D. Cleanse around the site of the tracheostomy with the prescribed solution.

Answer: A Rationale: After gathering the necessary equipment, the nurse would position the infant supine with a blanket or towel roll to extend the neck. Then the nurse would open all the packaging and cut the new tracheostomy ties to the appropriate length. This would be followed by cleaning the site with the appropriate solution and then rinsing it. After placing the precut sterile gauze under the tracheostomy tube, the nurse would cut the ties and remove them from the tube while an assistant holds the tube in place. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1455

6. The nurse is educating the parents of a 7-year-old boy with asthma about the medications that have been prescribed. Which drug would the nurse identify as an adjunct to a β2-adrenergic agonist for treatment of bronchospasm? A. Ipratropium B. Montelukast C. Cromolyn D. Theophylline

Answer: A Rationale: Ipratropium is an anticholinergic administered via inhalation to produce bronchodilation without systemic effects. It is generally used as an adjunct to a β2-adrenergic agonist. Montelukast decreases the inflammatory response by antagonizing the effects of leukotrienes. Cromolyn prevents release of histamine from sensitized mast cells. Theophylline provides for continuous airway relaxation. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Reference: p. 1439

7. The nurse is caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which action? A. Suctioning a tracheostomy tube B. Administering drugs with a nebulizer C. Providing tracheostomy care D. Suctioning with a bulb syringe

Answer: A Rationale: Supplemental oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe do not require supplemental oxygen. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1454

29. A child is hospitalized with pneumonia. The nurse assesses an increase in the work of breathing and in the respiratory rate. What intervention should the nurse do first to help this child? A. Elevate the head of the bed B. Administer oxygen C. Notify the health care provider D. Obtain oxygen saturation levels

Answer: A Rationale: The child who is experiencing increased work of breathing should be placed in a position to better open the airway and provide more room for lung expansion. Generally this is acomplished by elevating the head of the bed. If this does not improve the work of breathing, then administering oxygen should be done. The oxygen saturation should be measured because it will provide information as to the severity of the respiratory problem, but this measurement will not directly help the child. The health care provider should be notified if the child continues to deteriorate. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1414

23. The nurse is obtaining a health history of a child suspected of tuberculosis. What question would the nurse ask first about the child's cough? A. "How long has your child had a cough?" B. "Does your child cough only at night?" C. "Does your child cough up anything when coughing?" D. "Has your child been around anyone who is coughing?"

Answer: A Rationale: Tuberculosis is a highly contagious disease. Most children contract it from an infected immediate household member. When taking the health history, the nurse should ask about symptoms such as malaise, weight loss, anorexia, chest tightness and a cough. The child's cough from tuberculosis is described as progressing slowly over several weeks and months rather than having an acute onset. Asking about the production from the cough is a way to determine if hemoptysis has occurred. Asking about being around anyone coughing is a way to determine if the child has been exposed to anyone with tuberculosis. Coughing only at night could be related to other respiratory disorders such as asthma. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 1433

27. A child is in the emergency department with an asthma exaccerbation. Upon asucultation the nurse is unable to hear air movement in the lungs. What action should the nurse take first? A. Administer a beta-2 adrenergic agonist B. Administer oxygen C. Start a peripheral IV D. Administer corticosteroids

Answer: A Rationale: When lungs sounds are unable to be heard in a child with asthma, the child is very ill. This means there is severe airway obstruction. The air movement is so severe wheezes cannot be heard. The priority treatment is to administer an inhaled short term bronchodilator (beta-2 adrenergic agonist). The child may require numerous inhalations until bronchodilation occurs and air can pass through the bronchi. Oxygen can be started but until the brochi are dilated no oxygen can get through to the lung fields. In IV would need to be started and IV steroids administered to reduce the inflammation, but the priority is bronchodilation. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 1417

28. A hospitalized child suddenly begins reporting "my chest hurts," is tachypneic, and has tachycardia. The nurse auscultates the lung sounds and finds absent breath sounds on one side. After notifying the health care provide what action would the nurse take first? A. Prepare for chest tube insertion B. Administer oxygen C. Obtain oxygen saturation measurement D. Prepare for mechanical ventilation

Answer: A Rationale: A pneumothorax is a collection of air in the pleural space. Trapped air consumes space in the pleural cavity causing a partial or complete collapse. The priority symptom a nurse would assess is the decreased or absent lung sounds on the affected side. A pneumothorax can occur spontaneously in a healthy child or it can occur in a child with chronic lung disease, has been on a ventilator or has had thoracic surgery. Additional symptoms the child would experience would be chest pain, tachypnea, retractions, grunting, cyanosis and tachycardia. Many of these symptoms could be present with any child with an acute or chronic lung disease or respiratory distress, but the defining symptom is the absent breath sounds.The treatment for a pneumothoriax is with a chest tube so the priority action would be to gather supplies and prepare for the health care provider to insert a chest tube. Obtaining an oxygen saturation level measurement will only provide data, it will not help the child in distress. Oxygen may need to be administered, but with a pneumothorax it will be very ineffective. Mechanical ventilation would be a last resort and could actually make the situation worse if the lung was not reinflated. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1435

13. A child with a pneumothorax has a chest tube attached to a water seal system. When assessing the child, the nurse notices that the chest tube has become disconnected from the drainage system. What would the nurse do first? A. Notify the physician. B. Apply an occlusive dressing. C. Clamp the chest tube. D. Perform a respiratory assessment.

Answer: C Rationale: If a chest tube becomes disconnected from the water seal drainage system, the nurse would first clamp the chest tube to prevent air from entering the child's chest cavity. Then the nurse would perform a respiratory assessment and notify the physician. An occlusive dressing would be applied first if the chest tube became dislodged from the child's chest. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1435

25. The nurse is preparing a room for a child being transferred out of the intensive care unit. The child has a tracheostomy. What item(s) are essential for the nurse to have available at the bedside in case of emergency? Select all that apply. A. A new tracheostomy tube of the same size B. A new tracheostomy tube of a smaller size C. A bag valve mask D. A sterile tracheostomy kit E. Cleaning supplies for the tracheostomy

Answer: A, B, C Rationale: A child with a tracheostomy can have an emergent situation for any number of reasons. It is important to always have emergency equipment at the bedside to provide immediate care when these situations arrive. Two spare tracheostomy tubes should always be at the bedside, one the same size as in place and once a size smaller. These would be needed if the tube became dislodged. A bag valve mask needs to remain at the bedside at all times. Ideally it should be connected to oxygen, but that is an individual protocol for the health care organization. The bag can be used to hyperoxygenate the child prior to or following suctioning or it can be used in an emergent situation such as a respiratory arrest. Sterile tracheostomy kits and cleaning supplies can be available at the bedside, but they are used for routine cleaning and not for emergencies. Question format: Multiple Select Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1454

30. An infant with a high respiratory rate is NPO and is receiving IV fluids. What assessment(s) will the nurse make to assure this infant is hydrated? Select all that apply. A. Measure skin turgor B. Palpate anterior fontanel C. Determine urine output D. Review electrolyte laboratory results E. Assess the lung sounds

Answer: A, B, C Rationale: IV fluids are necessary many times for infants and children who are experiencing high respiratory rates. The high respiratory rates make the child very tired from the increased work of breathing. In an infant there are very little reserves so the infant tires very quickly, especially when the work of sucking is added to the compromised respiratory state. To determine if the infant is hydrated the nurse should assess the skin turgor, palpate for a flat anterior fontanel, observe for moist mucus membranes and measure the urine output. The urine output should be 1 to 2ml/kg/hr. The electrolyte laboratory results will tell the nurse if the infant has an electrolyte imbalance, not a fluid imbalance. Assessing the lung sounds will not tell if the child is hydrated, only if the lungs are "wet" and fluid overloaded. The infant would also exhibit additional signs of respiratory distress if the lungs are fluid overloaded. Question format: Multiple Select Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1415

24. The nurse is teaching the parent of a child with cystic fibrosis about nutrition requirements for the child. What should be included in this teaching? A. "Give your child high-calorie foods and snacks." B. "Feed your child foods that are high in protein." C. "Administer water soluble vitamins." D. "Give panreatic enzymes with meals." E. "Give your child foods high in fat."

Answer: A, B, D Rationale: Children with cystic fibrosis (CF) have trouble digesting and absorbing nutrients. They tend to be underweight. For optimal health, their diets should be high in calories and high in protein, with the supplementation of fat soluble vitamins and pancreatic enzymes. This diet helps with growth and the optimal nutrients. The fat soluble vitamins (vitamins A, D, E and K) are needed, because children with CF have trouble absorbing fat and need the vitamin supplementation to aid in fat absorption. Water soluble vitamins (the B vitamins and vitamin C) do not aid in fat absorption. The child should not have a high-fat diet, because the extra fat is difficult to digest and be absorbed. Pancreatic enzymes are necessary because they are missing due to the disease process. They are necessary to aid in digestion. They should be ingested with meals. Question format: Multiple Select Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 1447-1448

26. A parent with a child who has cystic fibrosis asks the nurse how to determine if the child is receiving an adequate amount of pancreatic enzymes. How should the nurse respond? Select all that apply. A. "The dose is adequate when your child is only having 1 to 2 stools per day." B. "The dose is adequate when your child's weight is improving." C. "The dose prescribed is based on your child's pancreatic laboratory values so it should be correct." D. "When your child starts to eat more quantity of food you will need to adjust the amount of enzyme pills." E. "You will need to give your child less enzyme pills when high-fat foods are eaten."

Answer: A, B, D Rationale: Pancreatic enzymes are required for the child with cystic fibrosis (CF) to help absorb nutrients from the diet and to aid in digestion. They are given with each meal and snack the child eats. The number of capsules required at each dose depends upon the diagnosis of how the pancreas is functioning and the amount of food needing to be digested. The pancreatic laboratory values may detemine a baseline for the number of pills to start with, but the dosage is adjusted regularly. The dosage of pancreatic enzymes is adjusted until an adequate growth pattern is established and the child is having no more than 1 to 2 stools per day. The child should be given an increased number of enzyme pills when a meal with high-fat content is consumed, not fewer. Question format: Multiple Select Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Reference: p. 1449

15. A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? A. Salmeterol B. Albuterol C. Ipratropium D. Cromolyn

Answer: B Rationale: Albuterol is a short-acting β2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting β2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to β2-adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cell stabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Teaching/Learning Reference: p. 1439

10. A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which finding? A. Children's demand for oxygen is lower than that of adults. B. Children develop hypoxemia more rapidly than adults do. C. An increase in oxygen saturation leads to a much larger decrease in pO2. D. Children's bronchi are wider in diameter than those of an adult.

Answer: B Rationale: Children develop hypoxemia more rapidly than adults do because they have a significantly higher metabolic rate and faster resting respiratory rates than adults do, which leads to a higher demand for oxygen. A smaller decrease in oxygen saturation reflects a disproportionately much larger decrease in pO2. The bronchi in children are narrower than in adults, placing them at higher risk for lower airway obstruction. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Reference: p. 1408

17. A nursing instructor is preparing a class on chronic lung disease. What information would the instructor include when describing this disorder? A. It is a result of cystic fibrosis. B. It is seen most commonly in premature infants. C. It typically affects females more often than males. D. It is characterized by bradypnea.

Answer: B Rationale: Chronic lung disease, formerly known as bronchopulmonary dysplasia, is often diagnosed in infants who have experienced respiratory distress syndrome, most commonly seen in premature infants. Male gender is a risk factor for development. Tachypnea and increased work of breathing are characteristic of chronic lung disease. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Reference: p. 1446

1. The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which test as most helpful in determining the extent of the child's hypoxia? A. Pulmonary function test B. Pulse oximetry C. Peak expiratory flow D. Chest radiograph

Answer: B Rationale: Pulse oximetry is a useful tool for determining the extent of hypoxia. It can be used by the nurse for continuous or intermittent monitoring. Pulmonary function testing measures respiratory flow and lung volumes and is indicated for asthma, cystic fibrosis, and chronic lung disease. Peak expiratory flow testing is used to monitor the adequacy of asthma control. Chest radiographs can show hyperinflation, atelectasis, pneumonia, foreign bodies, pleural effusion, and abnormal heart or lung size. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1413

5. The nurse is assessing a 5-year-old girl who is anxious, has a high fever, speaks in a whisper, and sits up with her neck thrust forward. Based on these findings, what would be least appropriate for the nurse to perform? A. Providing 100% oxygen B. Visualizing the throat C. Having the child sit forward D. Auscultating for lung sounds

Answer: B Rationale: The child is exhibiting signs and symptoms of epiglottitis, which can be life-threatening. Under no circumstances should the nurse attempt to visualize the throat. Reflex laryngospasm may occur, precipitating immediate airway occlusion. Providing 100% oxygen in the least invasive manner that is most acceptable to the child is a sound intervention, as is allowing the child to assume a position of sitting forward with the neck extended. Auscultation would reveal breath sounds consistent with an obstructed airway. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 1428

14. A nurse is preparing a teaching plan for the family of a child with allergic rhinitis. When describing the immune reaction that occurs, the nurse would identify the role of which immunoglobulin? A. IgA B. IgE C. IgG D. IgM

Answer: B Rationale: The immunoglobulin involved in the immune response associated with allergic rhinitis is IgE. IgA, IgG, and IgM are not involved in this response. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Reference: p. 1436

3. A nurse is administering 100% oxygen to a child with a pneumothorax based on the understanding that this treatment is used primarily for which reason? A. Improve gas exchange B. Bypass the obstruction C. Hasten air reabsorption D. Prevent hypoxemia

Answer: C Rationale: Administration of 100% oxygen is used to treat pneumothorax primarily because it hastens the reabsorption of air. Generally this is used only for a few hours. Although the oxygen also improves gas exchange and prevents hypoxemia, these are not the reasons for its use in this situation. There is no obstruction with a pneumothorax. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1435

19. When performing the physical examination of a child with cystic fibrosis, what would the nurse expect to assess? A. Dullness over the lung fields B. Increased diaphragmatic excursion C. Decreased tactile fremitus D. Hyperresonance over the liver

Answer: C Rationale: Examination of a child with cystic fibrosis typically reveals decreased tactile fremitus over areas of atelectasis, hyperresonance over the lung fields from air trapping, decreased diaphragmatic excursion, and dullness over the liver when enlarged. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 1449

2. The nurse is discussing discharge instructions with the parents of a 6-year-old who had a tonsillectomy. What is the most important thing to stress? A. Administer analgesics. B. Encourage the child to drink liquids. C. Inspect the throat for bleeding. D. Apply an ice collar.

Answer: C Rationale: Inspecting the throat for bleeding is the most important discharge information to give the parents. Hemorrhage is unusual postoperatively but may occur any time from the immediate postoperative period to as late as 10 days after surgery. The nurse should inspect the throat for bleeding. Mucus tinged with blood may be expected, but fresh blood in the secretions indicates bleeding. Administering analgesics, encouraging fluids and applying an ice color are important but not as important as assessing for bleeding. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Reference: p. 1426

21. A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. What would the nurse have most likely assessed? A. High fever B. Dysphagia C. Toxic appearance D. Inspiratory stridor

Answer: D Rationale: A child with croup typically develops a bark-like cough often at night. This may be accompanied by inspiratory stridor and suprasternal retractions. Temperature may be normal or slightly elevated. A high fever, dysphagia, and toxic appearance are associated with epiglottitis. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 1427

8. The nurse is examining a 5-year-old. Which sign or symptom is a reliable first indication of respiratory illness in children? A. Slow, irregular breathing B. A bluish tinge to the lips C. Increasing lethargy D. Rapid, shallow breathing

Answer: D Rationale: Tachypnea, or increased respiratory rate, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing and increasing listlessness are signs that the child's condition is worsening. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 1410

11. The nurse is providing care to several children who have been brought to the clinic by the parents reporting cold-like symptoms. The nurse would most likely suspect sinusitis in which child? A. A 2-year-old with thin watery nasal discharge B. A 3-year-old with sneezing and coughing C. A 5-year-old with nasal congestion and sore throat D. A 7-year-old with halitosis and thick, yellow nasal discharge

Answer: D Rationale: The frontal sinuses, those most commonly associated with sinus infection, develop by age 6 to 8 years. Therefore, the 7-year-old would most likely experience sinusitis. In addition, this child also exhibits halitosis and a thick, yellow nasal discharge, other findings associated with sinusitis. Thin watery discharge in a 2-year-old is more likely to indicate allergic rhinitis. A 3-year-old with coughing and sneezing or a 5-year-old with nasal congestion and sore throat suggests the common cold. Question format: Multiple Choice Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 1422

A teacher sends a child to see the school nurse for irritability and bruising. Which symptom would be indicative of hemolytic uremic syndrome?

Oliguria and jaundice Signs of hemolytic uremic syndrome include oliguria, irritability, jaundice, bloody diarrhea, purpura, ecchymosis, and pallor 5 to 10 days after a prodromal illness. The child also usually experiences anorexia, slight fevers, and can become lethargic.

Correct response: "We will be sure to not allow our child to ride a bicycle for at least 2 weeks." "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, TABLE 41.2 Common Surgical Procedures and Nursing Measures for Congenital Heart Defects, p. 1474. With the Gore® Helex device, strenuous activity should be avoided for 2 weeks after the procedure, so neither soccer or bicycle riding would be allowed. Children should be monitored for the possible presence of atrial arrhythmias (lifelong) after surgical closure for the defect. Infection is a complication that must be monitored for and reported to the physician, and medications must be given as prescribed.

The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements? Select all that apply. "Our child will be so excited to get back to soccer league in a few days." "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed." "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." "It's wonderful that our child will never have an abnormal heart rhythm again." "We will be sure to not allow our child to ride a bicycle for at least 2 weeks."

Correct response: Initiate intravenous access. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Kawasaki Disease, p. 1498. A child with signs of Kawasaki disease is at risk for dehydration due to a prolonged fever and oral pain. The priority for the nurse is to establish intravenous access to begin IV fluids. Placing the child on a soft diet will be done after ensuring IV access. Pain is not a priority, and children with Kawasaki disease are given aspirin because of the anti-inflammatory properties of aspirin, instead of acetaminophen. Because the child already has the required four signs of Kawasaki disease, assessing cervical lymph nodes is minimally helpful and could be performed later.

The nurse is caring for child who present to the emergency department with reports of a fever for 5 days. The nurse notes a diffuse maculopapular rash, reddened cracked lips, erythema of hands, and bilateral conjunctivitis and suspects Kawasaki disease. Which nursing action is priority? Assess cervical lymph nodes. Initiate intravenous access. Administer acetaminophen. Place the child on a soft diet.

Correct response: 1-week-old newborn whose oxygenation is not improving with oxygen Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Process Overview for the Child with an Alteration in Perfusion/ Cardiovascular Disorder, p. 1464.

The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse? 1-week-old newborn whose oxygenation is not improving with oxygen 1-year-old child with a temporal temperature of 101°F (38.3°C) 2-year-old child with clubbing noted on the fingers 6-month-old infant with edema on the face and presacral area

Correct response: High-frequency sound waves are directed toward the heart Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Tetralogy of Fallot, p. 1477. Echocardiography, or ultrasound cardiography, has become the primary diagnostic test for congenital heart disease. An echocardiogram involves high-frequency sound waves, directed toward the heart, being used to locate and study the movement and dimensions of cardiac structures, such as the size of chambers; thickness of walls; relationship of major vessels to chambers; and the thickness, motion, and pressure gradients of valves. You can remind parents that echocardiography does not use x-rays so it can be repeated at frequent intervals without exposing their child to the possible risk of radiation. The other answers refer to other types of diagnostic tests, including X-ray studies, radioangiocardiography, and phonocardiography.

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. What should the nurse mention in explaining how this diagnostic test works? High-frequency sound waves are directed toward the heart A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video X-rays are directed toward the heart

Correct response: Child A with a total cholesterol of 150 mg/dl and low-density lipoprotein (LDL) of 80 mg/dl. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Dyslipidemia, p. 1499. Total cholesterol levels below 170 mg/dl and LDL levels less than 100 mg/dl are considered within the acceptable range. Total cholesterol levels between 170 and 199 mg/dl and LDL levels between 100 and 129 mg/dl are considered borderline. Total cholesterol levels between 170 and 199 mg/dl and LDL levels between 100 and 129 mg/dl are considered borderline. Total cholesterol levels greater than or equal to 200 mg/dl and LDL levels greater than or equal to 130 mg/dl are considered elevated and place this child at greatest risk.

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia? Child C with a total cholesterol level of 190 mg/dl and LDL of 125 mg/dl. Child D with a total cholesterol level of 220 mg/dl and LDL of 138 mg/dl. Child A with a total cholesterol of 150 mg/dl and low-density lipoprotein (LDL) of 80 mg/dl. Child B with a total cholesterol level of 175 mg/dl and LDL of 105 mg/dl.

Correct response: "Children who have this diagnosis may have had strep throat." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, TABLE 41.1 Examples of Questions for Obtaining a Child's Health History, p. 1464. Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever? "This disorder is caused by genetic factors." "Children who have this diagnosis may have had strep throat." "Being up-to-date on immunizations is the best way to prevent this disorder." "The onset and progression of this disorder is rapid."

Correct response: "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Process Overview for the Child with an Alteration in Perfusion/ Cardiovascular Disorder, p. 1464. Clubbing (which is what the parents are describing) of fingertips or toes can occur from the chronic hypoxia that occurs with disorders with decreased pulmonary blood flow, such as tricuspid atresia. Using the term "low oxygen levels in the blood" rather than "chronic hypoxia" is a better way to explain what is happening to the parents. Clubbing is not the result of increased cardiac workload. Red blood cell pooling is not the cause of clubbing. Although clubbing is a possible result of tricuspid atresia, telling the parents this is a "common complication" does not address the parent's concerns.

The parents of a 2-year-old toddler newly diagnosed with tricuspid atresia ask the nurse, "I do not understand why our toddler's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is best? "The number of red blood cells has significantly increased from the heart defect, resulting in the cells pooling in the fingertips." "Increased cardiac workload from your toddler's heart defect affects various parts of the body, including the fingers." "This is a common complication of tricuspid atresia. Unfortunately, there is nothing we can do to treat it." "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes."

Correct response: altered cardiopulmonary tissue perfusion risk Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Tetralogy of Fallot, p. 1475. Nursing priority following cardiac surgery will focus on assessing for ineffective cardiopulmonary tissue perfusion. Monitoring for excess fluid volume, infection, and anxiety will be monitored after ensuring cardiopulmonary tissue perfusion is adequate.

Which problem-based nursing care plan will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot? fluid overload risk surgical site infection risk acute parental anxiety altered cardiopulmonary tissue perfusion risk

a nurse is caring for a 13 year old boy with end stage renal disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which of the following is the appropriate nursing action? a. administer his routine medications as scheduled b. take his blood pressure measurement in extremity with AV fistula c. withhold his routine medication until after dialysis is completed d. assess the Tenckhoff catheter site

c. withhold his routine medication until after dialysis is completed