Chapter 37 (Cardiovascular/Hematologic Disorders)

The parents of a child with heart failure ask the nurse, "How will the digoxin he is getting help?" Which response by the nurse would be most appropriate?

"Digoxin helps to improve the heart's ability to contract ."

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning?

"I mix ferrous sulfate with milk in a bottle."

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate?

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide?

"Sickle cell disease is passed to a fetus when both parents have the gene."

The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation?

"The baby seems more comfortable over my shoulder."

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?

"We can stop the penicillin when her symptoms disappear."

The nurse is caring for a child with a hematologic disorder. When educating the family about oral corticosteroid administration at home, which education by the nurse is most important?

"You will need to give this medication every day until discontinued."

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was:

80 beats per minute.

The nurse in the emergency department is caring for a 10-year-old female child with sickle cell crisis. Child rates pain 10 on a scale of 0 to 10. Vital signs: 99.8°F (37.6°C); heart rate, 122 beats/min; blood pressure, 92/50 mm Hg; respiratory rate, 26 breaths/min; oxygen saturation, 92% on room air.

A. Administer oxygen to maintain oxygen saturation greater than 95%. B. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. C. Administer 100 mcg/kg morphine IV for pain prn q4 hours.

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply.

A. Administering oxygen B. Administering analgesics C. Maintaining fluid intake

The nurse is evaluating the effectiveness of teaching provided to the parents of a school-age child prescribed liquid ferrous sulfate for iron-deficiency anemia. Which observations indicate that teaching has been effective? Select all that apply.

A. Parent places medication in orange juice. B. Child consumes fresh raw fruit and drinks water. C. Parent provides liquid-prepared medication to the child with a straw. D. Child goes to the bathroom to brush teeth immediately after taking the medication.

Which nursing diagnosis would best apply to a child experiencing rheumatic fever?

Activity intolerance related to increased cardiac workload

A child is hospitalized with a diagnosis of sickle cell crisis. The nurse has completed an assessment with the above findings. Which intervention is the nurse's priority in providing care?

Administer intravenous fluids as prescribed.

What information would be included in the care plan of an infant in heart failure?

Begin formulas with increased calories.

What will the nurse include in the feeding plan for a breastfed infant with congenital heart disease?

Breastfeed with small, frequent feeds.

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client?

Handle the child gently when transferring to a stretcher.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

Iliac crest

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child?

Implement strategies to address the child's pain.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura?

Ineffective tissue perfusion related to poor platelet formation

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

Infection

The nurse will select which meal as the best choice for a child with iron-deficiency anemia?

cheeseburger, broccoli, and fresh strawberries

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?

Initiate intravenous access.

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3 μl (18,000 x 109/L). Which medication would the nurse most likely expect to be ordered?

Intravenous immune globulin

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding?

Jerky movements of the face and upper extremities

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?

Monitor the site dressing and vital signs.

The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included?

Not to pick or irritate the nose

An infant with congenital heart disease is not growing and developing adequately. The nurse will institute what feeding strategy?

Raise the caloric density of the feeding beyond 20 calories per ounce.

Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura?

Risk for bleeding related to insufficient platelet formation

To prevent infective endocarditis in the child with an artificial heart valve, the nurse teaches parents to:

administer prophylactic antibiotics before dental work.

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks the child seems to have lack of coordination, facial grimaces and repetitive involuntary movements. Based on these symptoms the nurse would suspect what condition?

chorea

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which will the nurse include as an adjunctive measure to control bleeding?

compression

After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with:

factor VIII.

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care?

giving ferrous sulfate with orange juice between meals

The nurse is caring for a child with suspected heart arrhythmia. The child will wear an ambulatory electrocardiograph monitor for 24 hours. What is the most important instruction for the nurse to give the child and parent during monitoring?

how and when to use the event button

The nurse is providing care at a local clinic that treats children with hemophilia. The nurse understands that if bleeding is not treated effectively, the children are at high risk for development of chronic disabling disease involving the:

joints.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

notify a health care provider if the child develops an upper respiratory infection.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as:

petechiae.

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?

slightly yellow sclera

A nurse is caring for a child who is experiencing heart failure. Which assessment data was most likely seen when initially examined?

tachycardia