Ch. 6 Pediatric Success - NCLEX Practice Q's

25. A 16-year-old being treated for hypertension has laboratory values of hemoglobin B 16 g/dL, hematocrit level 43%, sodium 139 mEq/L, potassium 4.4 mEq/L, and total cholesterol of 220 mg/dL. Which drug does the nurse suspect the patient takes based on the total cholesterol? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

Answer: 1. Beta blockers. Rationale: 1. Beta blockers are used with caution in patients with hyperlipidemia, hyper- glycemia, and impotence. 2. Calcium channel blockers do not affect these blood levels. 3. ACE inhibitors do not affect these blood levels. 4. Diuretics do not affect these blood levels. TEST-TAKING HINT: The test taker needs to know side effects of drugs.

39. Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)? 1. Chickenpox or influenza. 2. E. coli or staphylococcus. 3. Mumps or streptococcus A. 4. Streptococcus A or staphylococcus.

Answer: 1. Chickenpox or influenza. Rationale: 1. Both chickenpox and influenza are viral in nature, so consider stopping the aspirin because of the danger of Reye syndrome. 2. E. coli and staphylococcus are not viral, so Reye syndrome is not a factor. 3. Mumps is caused by a virus, so aspirin should not be used to treat fever. Streptococcus A is a bacterium; Reye syndrome is not a factor. 4. Streptococcus A and staphylococcus are not viral, so Reye syndrome is not a factor. TEST-TAKING HINT: Consider Reye syndrome when the patient is taking aspirin and has a viral infection.

36. A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy.

Answer: 1. Congenital heart defect (CHD). Rationale: 1. CHD is found often in children with Down syndrome. 2. This is not associated with Down syndrome. 3. This is not associated with Down syndrome. 4. This is not associated with Down syndrome. TEST-TAKING HINT: A child with a syndrome, such as Down, is likely to have other abnormalities.

42. A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using firm nipples with small openings to slow feedings.

Answer: 1. Feeding formula that is supplemented with additional calories. Rationale: 1. Formula can be supplemented with extra calories, either from a commer- cial supplement, such as Polycose, or from corn syrup. Calories in formula could increase from 20 kcal/oz to 30 kcal/oz or more. 2. The infant would get too tired while feeding, which increases cardiac demand. Limit breastfeeding to a half hour, or 15 minutes per side. 3. Smaller feedings more often, such as every 2 to 3 hours, would decrease cardiac demand. 4. Soft nipples that are easy for the infant to suck would make for less work getting nutrition. TEST-TAKING HINT: Allow the child to get the most nutrition most effectively.

30. A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.

Answer: 1. Hypokalemia. Rationale: 1. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk for digoxin toxicity. 2. Hypomagnesemia does not affect digoxin and is not related to the child rubbing her eyes. 3. Hypocalcemia does not affect digoxin and is not related to the child rubbing her eyes. 4. Hypophosphatemia does not affect digoxin and is not related to the child rubbing her eyes. TEST-TAKING HINT: The test taker knows that furosemide causes the loss of potassium and can cause digoxin toxicity.

16. The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen.

Answer: 1. Immunoglobulin G and aspirin. Rationale: 1. High-dose immunoglobulin G and salicylate therapy for inflammation are the current treatment for KD. 2. Immunoglobulin G is correct, but ACE inhibitors are incorrect for treatment. 3. Heparin may be used for the child with an aneurysm, but not immuno-globulin E. 4. Immunoglobulin E and ibuprofen are not correct. TEST-TAKING HINT: Consider anti-inflammatory medications for treatment of KD.

53. Which patient could require feeding by gavage? 1. Infant with congestive heart failure (CHF). 2. Toddler with repair of transposition of the great vessels. 3. Toddler with Kawasaki disease (KD) in the acute phase. 4. School-age child with rheumatic fever (RF) and chorea.

Answer: 1. Infant with congestive heart failure (CHF). Rationale: 1. The child may experience increased cardiac demand while feeding. Feed- ings by gavage eliminate that work and still provide high-calorie intake for growth. 2. Transposition of the great vessels should be repaired before the toddler years, so that child would not need to be gavage-fed. 3. A toddler with KD in the acute phase does not need to be gavage-fed. 4. An RF patient with St. Vitus' dance (chorea) does not need to be gavage-fed. Most of these children do not have CHF. TEST-TAKING HINT: The test taker should consider how gavage feedings would affect the work of the heart.

54. Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.

Answer: 1. Polycythemia and clubbing. Rationale: 1. The hypoxemia stimulates erythro- poiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia. 2. Anemia and barrel chest do not occur as a result of hypoxemia. Hypoxemia stimulates the production of erythropoietin to increase the number of red blood cells to carry more oxygen. The barrel chest is the result of air trapping. 3. Increased white blood cells occur as the result of an infection, not hypoxemia. Hypoxemia does not cause a decreased number of platelets. 4. An elevated erythrocyte sedimentation rate is the result of inflammation in the body. Peripheral edema can be caused by CHF. TEST-TAKING HINT: The test taker could eliminate answers 2, 3, and 4 by knowing that they do not cause hypoxemia in CHF.

46. The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse's best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for physicians to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

Answer: 2. "Your baby's defect is small and will likely close on its own by 1 year of age." Rationale: 1. This is not a collegial response, and the nurse should explain to the parents why an operation is not necessary now. 2. Usually a VSD will close on its own within the first year of life. 3. It is not common for physicians to wait until respiratory distress develops because that puts the infant at greater risk for complications. The defect is small and will likely close on its own. 4. Small defects usually close on their own within the first year. TEST-TAKING HINT: Know the various treatments depending on size of the defect. VSD is the most common CHD.

44. Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr. 2. 1 cc/kg/hr. 3. 30 cc/hr. 4. 1 oz/hr.

Answer: 2. 1 cc/kg/hr. Rationale: 1. This is incorrect because 0.5 cc/kg/hr is below the normal pediatric urine output. 2. Normal pediatric urine output is 1 cc/kg/hr. 3. This is incorrect because 30 cc/hr is above the normal pediatric urine output. 4. This is incorrect because 1 oz/hr is above the normal pediatric urine output. TEST-TAKING HINT: The test taker needs to know that normal urine output for a child is 1 cc/kg/hr.

22. BP screenings to detect end-organ damage should be done routinely beginning at what age? 1. Birth. 2. 3 years. 3. 8 years. 4. 13 years.

Answer: 2. 3 years. Rationale: 1. Birth is too early, and readings are often not reliable due to patient movement. 2. Age 3 years is the recommended age to establish a baseline BP in a normal healthy child. 3. Age 8 years is too late to detect early damage. 4. Age 13 years is too late to detect early damage. TEST-TAKING HINT: The test taker needs to know that 3 years of age is the recommended age to begin BP measurements in healthy children.

49. A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has: 1. Ventricular septal defect (VSD). 2. Aortic stenosis (AS). 3. Mitral valve prolapse. 4. Tricuspid atresia.

Answer: 2. Aortic stenosis (AS). Rationale: 1. Murmur and CHF are often found in infancy. 2. AS can progress, and the child can develop exercise intolerance that can be better when resting. 3. Mitral valve prolapse causes a murmur and palpitations, usually in adulthood. 4. Tricuspid atresia causes hypoxemia in infancy. TEST-TAKING HINT: What does each of the last words of the defects mean, and what do those cause?

38. A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of which drug? 1. Calcium channel blocker. 2. Beta blocker. 3. ACE inhibiter. 4. ARB.

Answer: 2. Beta blocker. Rationale: 1. Calcium channel blockers decrease the force of cardiac contraction and slow the electrical conduction of the heart, resulting in slowing of the HR. The HR is normal in this child. 2. The beta blocker not only affects the heart and lungs but also blocks the beta sites in the liver, reducing the amount of glycogen available for use, causing hypoglycemia. The lower HR and BP also suggest ingestion of a cardiac medication. 3. ACE inhibiters block the conversion of a protein from its inactive to its active form. The protein causes constriction of small blood vessels, which raises BP. By blocking this protein, BP is lowered. 4. Angiotensin receptor blockers relax blood vessels, which lowers BP and makes it easier for the heart to pump blood. TEST-TAKING HINT: Know the drug's side effects. In this case, the glucose is blocked.

50. The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS).

Answer: 2. Coarctation of the aorta (COA). Rationale: 1. Transposition of the great vessels does not cause these symptoms. 2. In the older child, COA causes dizzi- ness, headache, fainting, elevated blood pressure, and bounding radial pulses. 3. AS does not cause these symptoms. 4. PS does not cause these symptoms. TEST-TAKING HINT: The test taker should recognize that the child's BP is elevated and her pulses are bounding, which are symptoms of COA.

23. What associated manifestation might the nurse occasionally find in a child diagnosed with Wilms tumor? 1. Atrial fibrillation. 2. Hypertension. 3. Endocarditis. 4. Hyperlipidemia.

Answer: 2. Hypertension. Rationale: 1. Wilms tumor does not affect or cause this condition. 2. Because Wilms tumor sits on the kid- ney, it can be associated with secondary hypertension. It does not affect or cause the other conditions. 3. Wilms tumor does not affect or cause this condition. 4. Wilms tumor does not affect or cause this condition. TEST-TAKING HINT: Where is the Wilms tumor located?

37. The Norwood procedure is used to correct: 1. Transposition of the great vessels. 2. Hypoplastic left heart syndrome. 3. Tetralogy of Fallot (TOF). 4. Patent ductus arteriosus (PDA).

Answer: 2. Hypoplastic left heart syndrome. Rationale: 1. Transposition of the great vessels requires different surgical procedures. 2. The Norwood procedure is specific to hypoplastic left heart syndrome. 3. TOF requires different surgical procedures. 4. PDA requires different surgical procedures. TEST-TAKING HINT: Review surgical treatment of CHD.

43. An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff? 1. Soy. 2. Latex. 3. Penicillin. 4. Dairy

Answer: 2. Latex. Rationale: 1. Children with spina bifida (myelo -meningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy. 2.Children with spina bifida (myelo -meningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy. 3. Children with spina bifida (myelo -meningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy. 4. Children with spina bifida (myelo -meningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy. TEST-TAKING HINT: Material that composes the balloon catheter is made of latex, which is a common allergy in a child with a myelomeningocele

57. The mother of a toddler reports that the child's father has just had a myocardial infarction (MI). Because of this information, the nurse recommends the child have a(n): 1. Electrocardiogram. 2. Lipid profile. 3. Echocardiogram. 4. Cardiac catheterization.

Answer: 2. Lipid profile. Rationale: 1. Current recommendations are for a lipid profile in children over 2 years with a first- or second-degree relative with stroke, myocardial infarction, angina, or sudden cardiac death. Also screen if parent, sibling, or grandparent has cholesterol of 240 mg/dL or greater. 2. Current recommendations are for a lipid profile in children over 2 years with a first- or second-degree relative with stroke, myocardial infarction, angina, or sudden cardiac death. Also screen if parent, sibling, or grandpar- ent has cholesterol of 240 mg/dL or greater. 3. Current recommendations are for a lipid profile in children over 2 years with a first- or second-degree relative with stroke, myocardial infarction, angina, or sudden cardiac death. Also screen if parent, sibling, or grandparent has cholesterol of 240 mg/dL or greater. 4. Current recommendations are for a lipid profile in children over 2 years with a first- or second-degree relative with stroke, myocardial infarction, angina, or sudden cardiac death. Also screen if parent, sibling, or grandparent has cholesterol of 240 mg/dL or greater. TEST-TAKING HINT: Think about the cause of the father's MI.

13. While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2. The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. Patent ductus arteriosus (PDA). 3. Ventricular septal defect (VSD). 4. Bronchopulmonary dysplasia.

Answer: 2. Patent ductus arteriosus (PDA). Rationale: 1. Pulmonary hypertension is a pulmonary condition, which does not create a heart murmur. 2. The main identifier in the stem is the machine-like murmur, which is the hallmark of a PDA. 3. A VSD does not produce a machine-like murmur. 4. Bronchopulmonary dysplasia is a pulmonary condition, which does not create a heart murmur. TEST-TAKING HINT: The test taker need to know common murmur sounds.

27. While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left.

Answer: 2. Polycythemia. Rationale: 1. The nurse should expect a normal platelet count in an infant with a CHD of decreased pulmonary blood flow. 2. Polycythemia is the result of the body attempting to increase the oxygen sup- ply in the presence of hypoxia by in- creasing the total number of red blood cells to carry the oxygen. 3. Ferritin measures the amount of iron stored in the body and not affected by decreased pulmonary blood flow. 4. "Shift to the left" refers to an increase in the number of immature white blood cells. TEST-TAKING HINT: The test taker needs to know what laboratory values hypoxia can affect.

33. A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

Answer: 2. Pulses. Rationale: 1. Pain needs to be assessed post procedure but is not the priority. 2. Checking for pulses, especially in the canulated extremity, would assure perfusion to that extremity and is the priority post procedure. 3. Hemoglobin and hematocrit levels would be checked post procedure if the child had bled very much during or after the procedure. 4. The catheterization report would be of interest to know what was determined from the procedure. This would also be good to check on the patient post procedure. TEST-TAKING HINT: The test taker would know that the priority is assessing the cannulated extremity, checking for adequate perfusion.

55. Aspirin has been ordered for the child with rheumatic fever (RF) in order to: 1. Keep the patent ductus arteriosus (PDA) open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis.

Answer: 2. Reduce joint inflammation. Rationale: 1. Aspirin is not used to treat this condition. A PDA does not occur with RF. 2. Joint inflammation is experienced in RF; aspirin therapy helps with inflammation and pain. 3. Strawberry tongue is manifested in KD; aspirin is not used to treat this disease. 4. Aspirin is not used to treat this condition. TEST-TAKING HINT: Know the manifesta- tions of RF.

7. Which finding might delay a cardiac catheterization procedure on a 1-year-old? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

Answer: 2. Severe diaper rash. Rationale: 1. This may be a reason the child needs the catheterization. 2. A child with severe diaper rash has potential for infection if the interven- tionist makes the standard groin approach. 3. Shellfish, not soy, is an allergy concern. 4. This may be a reason the child needs the catheterization. TEST-TAKING HINT: Consider the risk for infection as a delaying factor

40. The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness? 1. Kawasaki disease (KD). 2. Strep throat. 3. Malignant hypertension. 4. Atrial fibrillation.

Answer: 2. Strep throat. Rationale: 1. KD does not result in this condition, called chorea or St. Vitus' dance. 2. Chorea can be a manifestation of RF, with a higher incidence in females. 3. Malignant hypertension does not result in this condition, called chorea or St. Vitus' dance. 4. Atrial fibrillation is not an illness. TEST-TAKING HINT: The test taker can eliminate answer 1 because KD can cause damage to coronary arteries.

60. Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."

Answer: 3. "I know she will be irritable for 2 months after her symptoms started." Rationale: 1. Arthritis in KD is always temporary. 2. Peeling palms and feet are painless. 3. Children can be irritable for 2 months after the symptoms of the disease start. 4. Tylenol is never given in high doses due to liver failure, and it is not an anti- inflammatory. Aspirin is given in high doses for KD. TEST-TAKING HINT: The test taker must know about KD to choose the best response.

12. On examination, a nurse hears a murmur at the left sternal border (LSB) in a child with diarrhea and fever. The parent asks why the pediatrician never said anything about the murmur. The nurse explains: 1. "The pediatrician is not a cardiologist." 2. "Murmurs are difficult to detect, especially in children." 3. "The fever increased the intensity of the murmur." 4. "We need to refer the child to an interventional cardiologist."

Answer: 3. "The fever increased the intensity of the murmur." Rationale: 1. This is not a collegial response. 2. The increased CO of the fever increases the intensity of the murmur, making it easier to hear. 3. The increased CO of the fever increases the intensity of the murmur, making it easier to hear. 4. This child does not need to see an interventional cardiologist. The murmur needs to be diagnosed first, and then a treatment plan would be developed. TEST-TAKING HINT: Consider the pathophysiology of fever.

61. Which assessment indicates that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr.

Answer: 3. 50th percentile height and weight for age. Rationale: 1. HR of 56 beats per minute is likely due to digoxin toxicity. 2. Elevated count of red blood cells indicates polycythemia secondary to hypoxemia. 3. The 50th percentile height and weight for age shows good growth and development, indicating good nutrition and perfusion. 4. Urine output of 0.5 cc/kg/hr indicates that furosemide is not being given as ordered; the output is too low. TEST-TAKING HINT: The test taker should know the expected responses of medications used to treat CHF.

24. Which drug should not be used to control secondary hypertension in a sexually active adolescent female who uses intermittent birth control? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

Answer: 3. ACE inhibitors. Rationale: 1. ACE inhibitors and angiotensin II receptor blockers can cause birth defects. The others are not teratogenic. 2. ACE inhibitors and angiotensin II receptor blockers can cause birth defects. The others are not teratogenic. 3.ACE inhibitors and angiotensin II receptor blockers can cause birth de- fects. The others are not teratogenic. 4. ACE inhibitors and angiotensin II receptors can cause birth defects. The others are not teratogenic. TEST-TAKING HINT: The test taker needs to know which of these drugs are teratogenic.

32. In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).

Answer: 3. Coarctation of the aorta (COA). Rationale: 1. BPs would not need to be taken in both the upper and lower extremities in trans- position of the great vessels. The aorta and pulmonary arteries are in opposite positions, which does not change the BP readings. 2. AS is a narrowing of the aortic valve, which does not affect the BP in the extremities. 3. With COA there is narrowing of the aorta, which increases pressure proxi- mal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lower- than-expected BP and weak pulses in the lower extremities. 4. TOF is a congenital cardiac problem with four defects that do not affect the BP in the extremities. TEST-TAKING HINT: The test taker must know the anatomy of the defects and what assessments are to be made in each one.

31. Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

Answer: 3. Feeding in semi-Fowler position. Rationale: 1. The nurse would not need to restrict fluids, as the child likely would not be getting overloaded with oral fluids. 2. The infant likely will have sodium depletion because of the chronic diuretic use; the infant needs a normal source of sodium, so low-sodium formula would not be used. 3. The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so fluid in the lungs can go to the base of the lungs, allowing better expansion. 4. Breast milk has slightly less sodium than formula, and the child needs a normal source of sodium because of the diuretic. TEST-TAKING HINT: Infants are not able to concentrate urine well and may have sodium depletion, so they need a normal source of sodium.

59. A heart transplant may be indicated for a child with severe heart failure and: 1. Patent ductus arteriosus (PDA). 2. Ventricular septal defect (VSD). 3. Hypoplastic left heart syndrome. 4. Pulmonic stenosis (PS).

Answer: 3. Hypoplastic left heart syndrome. Rationale: 1. Severe heart failure can be an indication for heart transplant if quality of life is decreased. 2. Severe heart failure can be an indication for heart transplant if quality of life is decreased. 3. Hypoplastic left heart syndrome is treated by the Norwood procedure, or heart transplant. 4. Severe heart failure can be an indication for heart transplant if quality of life is decreased. TEST-TAKING HINT: Consider severe heart failure and which complex of CHD.

51. Which medication should the nurse give to a child diagnosed with transposition of the great vessels? 1. Ibuprofen. 2. Betamethasone. 3. Prostaglandin E. 4. Indocin.

Answer: 3. Prostaglandin E. Rationale: 1. Ibuprofen blocks prostaglandins, which would speed up the closing of the PDA. 2. Betamethasone blocks prostaglandins, which would speed up the closing of the PDA. 3. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery. 4. Indocin is used to treat osteoarthritis and gout. TEST-TAKING HINT: The test taker would know that children who have transposition of the great vessels also have another cardiac defect, and the common one is PDA.

58. During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.

Answer: 3. Squatting. Rationale: 1. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. This occurs with squatting. 2. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. This occurs with squatting. 3. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. 4. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. TEST-TAKING HINT: The child self-assumes this position during the spell.

41. The most common cardiac dysrhythmia in pediatrics is: 1. Ventricular tachycardia. 2. Sinus bradycardia. 3. Supraventricular tachycardia. 4. First-degree heart block.

Answer: 3. Supraventricular tachycardia. Rationale: 1. Ventricular tachycardia is uncommon in children. 2. Sinus bradycardia is uncommon in children. 3. Supraventricular tachycardia is most common in children. 4. First-degree heart block is uncommon in children. TEST-TAKING HINT: Consider a tachycardiac rhythm in a pediatric patient.

6. Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin indicates the need for further education? 1. "I will give the medication at regular 12-hour intervals." 2. "If he vomits, I will not give a make-up dose." 3. "If I miss a dose, I will not give an extra dose" 4. "I will mix the digoxin in some formula to make it taste better."

Answer: 4. "I will mix the digoxin in some formula to make it taste better." Rationale: 1. This is appropriate for digoxin administration. 2. This is appropriate for digoxin administration. 3. This is appropriate for digoxin administration. 4. If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate. TEST-TAKING HINT: What if the child does not drink all the formula?

35. A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

Answer: 4. "She will need to take the antibiotics for the rest of her life." Rationale: 1. This could be true for a patient with a less severe form of RF. 2. This could be true for a patient with a less severe form of RF. 3. This could be true for a patient with a less severe form of RF. 4. Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life. TEST-TAKING HINT: The test taker would know that the severity of the damage to the heart valves determines how long pro-phylaxic antibiotics will be administered

8. The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

Answer: 4. Apply direct pressure 1 inch above the puncture site. Rationale: 1. This is not an appropriate action. 2. This is not an appropriate action. 3. This can be done after applying direct pressure 1 inch above the puncture site. 4. Applying direct pressure 1 inch above the puncture site will localize pressure over the vessel site. TEST-TAKING HINT: Consider the risk for volume depletion.

18. During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.

Answer: 4. Hold the child in knee-chest position to decrease venous blood return. Rationale: 1. Laying the child flat would increase pre-load, increasing blood to the heart, there-fore making respiratory distress worse. 2. Laying the child flat with legs elevated would increase preload, increasing blood to the heart, therefore making respiratory distress worse. 3. Sitting the child on the parent's lap with legs dangling might possibly help, but it would not be as effective as the knee-chest position in occluding the venous return. 4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery. TEST-TAKING HINT: The test taker should choose the response that decreases the preload in this patient.

21. A toddler who has been hospitalized for vomiting due to gastroenteritis is sleeping and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child? 1. Rapid pulmonary flutter. 2. Sinus bradycardia. 3. Rapid atrial fibrillation. 4. Supraventricular tachycardia.

Answer: 4. Supraventricular tachycardia. Rationale: 1. This is not a real dysrhythmia. 2. Sinus bradycardia is a slow rate for the child's age. 3. Rapid atrial fibrillation is an irregular rhythm. 4. SVT is often above 200 and a result of dehydration, which a vomiting child could have. The rapid rate causes a low CO, resulting in low BP and prolonged capillary refill. TEST-TAKING HINT: The HR is regular and very rapid for a child of any age. The child has been vomiting, which can result in dehydration.

28. The nurse is caring for a 9-month-old who was born with a congenital heart defect (CHD). Assessment reveals a HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.

Answer: Congestive heart failure or CHF. Rationale: TEST-TAKING HINT: All of these are signs of pump failure. The infant is likely to have diaphoresis only on the scalp. The signs are not unlike those of an adult with this condition.

15. A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has _____________________.

Answer: Kawasaki disease or KD. Rationale: TEST-TAKING HINT: Classic signs of KD include red eyes with no discharge; dry, cracked lips; strawberry tongue; and red, swollen, and peeling palms and soles of the feet. Incidence of KD is higher in males. The strongest indicator for this disease is the hallmark strawberry tongue.

48. Patent ductus arteriosus causes what type of shunt? _____________________.

Answer: Left to right Rationale: Blood flows from the higher pressure aorta to the lower pressure pulmonary artery, resulting in a left to right shunt. TEST-TAKING HINT: What is the CHD classification of PDA?

47. The flow of blood through the heart with an atrial septal defect (ASD) is _____________________.

Answer: Left to right. Rationale: The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. TEST-TAKING HINT: What is the CHD classification of ASD?

10. Indomethacin may be given to close which congenital heart defect (CHD) in newborns? _____________________

Answer: Patent ductus arteriosus or PDA Rationale: TEST-TAKING HINT: Prostaglandins allow the duct to remain open; thus, a prostaglandin inhibitor, such as Indocin or ibuprofen, can help close the duct.

11. For the child with hypoplastic left heart syndrome, which drug may be given to allow the patent ductus arteriosus (PDA) to remain open until surgery? _____________________

Answer: Prostaglandin E. Rationale: TEST-TAKING HINT: Prostaglandin E main- tains ductal patency to promote blood flow until the Norwood procedure is begun. Consider the opposite of wanting to close the PDA.

20. A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called _____________________.

Answer: Tetralogy of Fallot or TOF. Rationale: "Tet" spells are characteristic of TOF. TEST-TAKING HINT: Know the congenital heart defect classifications.

5. What should the nurse assess prior to administering digoxin? Select all that apply. 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

Answer: 2. Apical pulse rate. Rationale: 1. The sclera has nothing to do with CHF. 2. The apical pulse rate is assessed because digoxin decreases the HR, and if the HR is <60, digoxin should not be administered. 3. Cough would not be assessed before adminis- tration. It is more commonly seen in patients who have been prescribed ACE inhibitors. 4. Liver function tests are not assessed before digoxin is administered. Digoxin can lower HR and cause dysrhythmias. TEST-TAKING HINT: The test taker should know that the sclera and liver function tests have nothing to do with digoxin. Cough could be associated with ACE inhibitors.

34. Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him the aspirin that is ordered for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain."

Answer: 3. "I will give him the aspirin that is ordered for pain and inflammation." Rationale: 1. During the acute phase, limit any manipulation of the joint, and avoid heat or cold. 2. During the acute phase, limit any manipulation of the joint, and avoid heat or cold. 3. Aspirin is the drug of choice for treatment of RF. 4. During the acute phase, limit any manipulation of the joint, and avoid heat or cold. TEST-TAKING HINT: The test taker should know that aspirin is the drug of choice and that manipulation of the joint should be limited during the acute phase.

26. The _____________________ serves as the septal opening between the atria of the fetal heart.

Answer: Foramen ovale. Rationale: TEST-TAKING HINT: The foramen ovale is the septal opening between the atria of the fetal heart. The test taker needs to know basic fetal circulation.

45. A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow of blood through the heart is _____________________.

Answer: Left to right. Rationale: The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. TEST-TAKING HINT: The test taker should know that the classification for this defect is left to right.

14. Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

Answer: 1, 2, 3 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. Rationale: 1. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 2. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 3. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 4. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 5. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 6. Hypoplastic left heart syndrome is a CHD and has no relation to KD. TEST-TAKING HINT: KD is an inflammation of small- and medium-sized blood vessels.

19. Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident. 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

Answer: 1, 2, 3, 4, 6 1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident. 4. Developmental delays. 6. Brain damage. Rationale: 1. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 2. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 3. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 4. Developmental delays can be caused by multiple hospitalizations and surgeries. The child usually catches up to the appropriate level. 5. Hypoxia can increase the risk for bacterial endocarditis, not viral pericarditis. 6. Brain damage can be caused by hypoxia, blood clots, and stroke. 7. Hypoxic episodes cause acidosis, not alkalosis. TEST-TAKING HINT: Hypoxic episodes in a child with CHD ("tet spells") can cause polycythemia and strokes.

3. Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

Answer: 1, 2, 4, 6 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 4. Pulmonic stenosis (PS). 6. Overriding aorta. Rationale: 1. TOF is a congenital defect with a ven- tricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. TOF is a congenital defect with ventric- ular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 3. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 4. TOF is a congenital defect with ventric- ular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 5. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 6. TOF is a congenital defect with ventric- ular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 7. PDA is not one of the defects in tetralogy of Fallot. TEST-TAKING HINT: Tetralogy of Fallot has four defects. Pulmonary stenosis causes decreased pulmonary flow.

1.What can an electrocardiogram (ECG) detect? Select all that apply. 1. Ischemia. 2. Injury. 3. Cardiac output (CO). 4. Dysrhythmias. 5. Systemic vascular resistance (SVR). 6. Occlusion pressure. 7. Conduction delay.

Answer: 1, 2, 4, 7 1. Ischemia. 2. Injury. 4. Dysrhythmias. 7. Conduction delay. Rationale: 1. An electrocardiogram can indicate ischemia of the heart muscle. 2. An electrocardiogram can indicate injury to the heart muscle. 3. An electrocardiogram does not indicate CO. 4. An electrocardiogram can show dysrhythmias. 5. An electrocardiogram does not show SVR. 6. An electrocardiogram does not show occlusion pressures. 7. An electrocardiogram does show conduction delays. TEST-TAKING HINT: The electrocardiogram checks the electrical system of the heart, not the mechanical system. CO is mechanical; occlusion pressure does not have to do with the electrocardiogram; and SVR measures pressures in the peripheral system.

52. Which statement by the mother of a child with rheumatic fever (RF) shows she has an understanding of prevention for her other children? (Select all that apply) 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A streptococcus, I will give them their antibiotic." 4. "If their culture is positive for staphylococcus A, I will give them their antibiotic."

Answer: 1, 3 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 3. "If their culture is positive for group A streptococcus, I will give them their antibiotic." Rationale: 1. Do not use an antibiotic if the disease is not bacterial in origin. Most sore throats are viral. 2. RF is a bacterial infection caused by group A beta-hemolytic streptococcus, and the drug of choice is penicillin. 3. RF is caused by a streptococcus infection, not by staphylococcus. 4. RF is cause by a streptococcus infection, not by staphylococcus TEST-TAKING HINT: The test taker needs to know the cause of RF and how it is treated.

29. The following are examples of acquired heart disease. Select all that apply. 1. Infective endocarditis. 2. Hypoplastic left heart syndrome. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). 6. Transposition of the great vessels.

Answer: 1, 3, 4, 5 1. Infective endocarditis. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). Rationale: 1. Infective endocarditis is an example of an acquired heart problem. 2. Hypoplastic left heart syndrome is a CHD. 3. RF is an acquired heart problem. 4. Cardiomyopathy is an acquired heart problem. 5. KD is an acquired heart problem. 6. Transposition of the great vessels is a CHD. TEST-TAKING HINT: "Acquired" means occurring after birth and seen in an otherwise normal and healthy heart.

9. Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

Answer: 1, 4, 5, 6, 7 1. Allow parents to hold and rock their child. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities. Rationale: 1. Rocking by the parents will comfort the infant and decrease demands. 2. The infant would not be fed when crying because crying increases cardiac demands. The infant might choke if the nipple is placed in the mouth and the child inhales when trying to swallow. 3. Keep the child normothermic to reduce metabolic demands. 4. Frequent position changes will de- crease the risk for infection by avoid- ing immobility with its potential for skin breakdown. 5. An infant sucking the fists could indicate hunger. 6. Change bed linens only when neces- sary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the child. TEST-TAKING HINT: Do all that can be done to decrease demands on the child.

17. Congenital heart defects (CHDs) are classified by which of the following? Select all that apply. 1. Cyanotic defect. 2. Acyanotic defect. 3. Defects with increased pulmonary blood flow. 4. Defects with decreased pulmonary blood flow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.

Answer: 3, 4, 5, 6 3. Defects with increased pulmonary blood flow. 4. Defects with decreased pulmonary blood flow. 5. Mixed defects. 6. Obstructive defects. Rationale: 1. Heart defects are no longer classified as cyanotic or acyanotic. 2. Heart defects are no longer classified as cyanotic or acyanotic. 3. Heart defects are now classified as defects with increased or decreased pulmonary blood flow 4. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 5. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 6. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 7. A murmur may be heard with a CHD, but a murmur does not classify the defect. TEST-TAKING HINT: Know the new classifications, not the older ones.

56. Which vaccines must be delayed for 11 months after the administration of gamma globulin? Select all that apply. 1. Diphtheria, tetanus, and pertussis. 2. Hepatitis B. 3. Inactivated polio virus. 4. Measles, mumps, and rubella. 5. Varicella.

Answer: 4, 5 4. Measles, mumps, and rubella. 5. Varicella. Rationale: 1. Diphtheria, tetanus, and pertussis can be given following administration of gamma globulin. These are killed vaccines, and the only vaccines not administered would be live vaccines such as measles, mumps, rubella. 2. Hepatitis B can be administered following gamma globulin. Live vaccines are held for at least 11 months. 3. Inactivated polio virus can be given following gamma globulin administration. Live vaccines are held for 11 months. 4. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months. 5. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months. TEST-TAKING HINT: The test taker needs to know which vaccines are killed and which are live.

2. A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

Answer: Patent ductus arteriosus or PDA. Rationale: TEST-TAKING HINT: This is a defect with increased pulmonary flow. It should close in the first few weeks of life.

4. A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is _____________________.

Answer: Rheumatic fever or RF. Rationale: To make the diagnosis of RF, major and minor criteria are used. Major criteria include cardi- tis, subcutaneous nodules, erythema margina- tum, chorea, and arthritis. Minor criteria include fever and previous history of RF. TEST-TAKING HINT: It is an inflammatory disease caused by group A beta-hemolytic streptococcus.