Pediatrics

A nurse is assessing an infant who has heart failure. Which of the following findings should the nurse expect? (Select all that apply.) A. Bradycardia B. Cool extremities C. Peripheral edema D. Increased urinary output E. Nasal flaring

A. A client who has heart failure will exhibit tachycardia as the heart attempts to meet the body's demands. B. CORRECT: A client who has heart failure will exhibit cool extremities as the heart is unable to adequately circulate oxygenated blood. C. CORRECT: A client who has heart failure will exhibit peripheral edema as the heart is unable to adequately circulate blood through the body and back to the heart. D. With heart failure, the heart is unable to keep up with the body's demands. A decrease in urinary output is a manifestation of heart failure. E. CORRECT: A client who has heart failure will exhibit nasal flaring due to inadequate oxygenation of blood.

A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? (Select all that apply.) A. Weak femoral pulses B. Cool skin of lower extremities C. Severe cyanosis D. Clubbing of the fingers

A. CORRECT: Narrowing of the lumen of the aorta results in obstruction of blood flow from the ventricle, resulting in weak or absent femoral pulses. B. CORRECT: Narrowing of the lumen of the aorta results in obstruction of blood flow from the ventricle, resulting in cool skin of the lower extremities. C. A client who has coarctation of the aorta exhibits adequate oxygenation of blood. Severe cyanosis is not present. D. Clubbing of the fingers is a manifestation of chronic hypoxemia and will not be observed in an infant who has coarctation of the aorta. E. CORRECT: Heart failure occurs when the heart is unable to meet the body's demands, and is a manifestation of coarctation of the aorta.

A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following findings should the nurse expect? (Select all that apply.) A. Erythema marginatum (rash) B. Continuous joint pain of the digits C. Tender, subcutaneous nodules D. Decreased erythrocyte sedimentation rate E. Elevated C-reactive protein

A. CORRECT: Rheumatic fever is caused by Group A beta-hemolytic streptococcus. An erythema marginatum (rash) is a manifestation. B. A client who has rheumatic fever exhibits migratory joint pain of the large joints. C. A client who has rheumatic fever exhibits nontender subcutaneous nodules of bony prominences. D. Rheumatic fever is caused by Group A beta-hemolytic streptococcus, which results in an elevated erythrocyte sedimentation rate. E. CORRECT: Rheumatic fever is caused by Group A beta-hemolytic streptococcus. An increase in C-reactive protein is a manifestation.

A nurse is providing teaching to the mother of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include? A. "Do not offer your baby fluids after giving the medication." B. "Digoxin increases your baby's heart rate." C."Give the correct dose of medication at regularly scheduled times." D."If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount."

A. Digoxin can be given without regard to food or fluids. B. Digoxin slows the heart rate by increasing contractility of the heart. C. CORRECT: The correct amount of digoxin should be administered at regularly scheduled times to maintain therapeutic blood levels. D. It is not recommended to repeat digoxin following an emesis because it is impossible to determine how much medication was lost.

A nurse is caring for a 2-year-old child who has a heart defect and is scheduled for cardiac catheterization. Which of the following actions should the nurse take? A. Place on NPO status for 12 hr prior to the procedure. B. Check for iodine or shellfish allergies prior to the procedure. C. Elevate the affected extremity following the procedure. D. Limit fluid intake following the procedure

A. The child should remain NPO 4 to 6 hr prior to the procedure. B. CORRECT: Iodine-based dyes can be used in this procedure, so the child is assessed for allergies to iodine or shellfish which could lead to anaphylaxis. C. The affected extremity should be maintained in a straight position following the procedure. D. Fluids should be encouraged after the procedure to maintain adequate urine output and promote excretion of the dye.

The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess? a. Obesity from overeating. b. Clubbing of the nail beds. c. Squatting during play activities. d. Exercise intolerance.

a. Children with CHD causing chronic cyanosis are likely to demonstrate failure to thrive, not obesity. They frequently develop clubbing of the nail beds and exercise intolerance, and those with tetralogy of Fallot or pulmonary stenosis may display hypercyanotic spells (squatting).

The nurse is evaluating a parent's understanding of treatment for torticollis. Which response best indicates that the parent understands the appropriate treatment? a. Encourages the infant to turn the head to the unaffected side b. States that prone positioning for sleep will be needed c. Places the infant on the affected side d. Stretches the infant's neck to the opposite side and holds it for 5 seconds

a. Placing desirable objects on the child's unaffected side and positioning the infant so that he or she will have to turn the head to the unaffected side to view the parent or toys is one intervention that assists with the relief of torticollis.

Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? a. Previous streptococcal throat infection. b. History of open heart surgery at 5 years of age. c. Playing too much soccer and not getting enough rest. d. Exposure to a sibling with pneumonia.

a. Rheumatic fever occurs as a sequela to group A streptococcal infection.

A 5-year-old who had a renal transplant 9 months ago and has no history of chickenpox presents to the pediatric clinic for his vaccinations. Which is the most appropriate set to give? a. DTaP, IPV. b. DTaP, IPV, MMR, varicella. c. DTaP, IPV, varicella. d. IPV only.

a. The routine schedule for healthy 4- to 6-year-olds includes DTaP, IPV, and MMR. If the child had not had chickenpox in the past and was unvaccinated, then varicella would also be warranted. The child in this case is taking chronic immunosuppressive medications for his renal transplant, however, and immunosuppression is a contraindication for live vaccine use (measles and varicella are live vaccines).

A 4-year-old girl presents with recurrent urinary tract infection. A prior workup did not reveal any urinary tract abnormalities. What is the priority nursing action? a. Obtain a sterile urine sample after completion of antibiotics. b. Teach appropriate toileting hygiene. c. Prepare the child for surgery to reimplant the ureters. d. Administer antibiotics intramuscularly.

b. Inappropriate toileting hygiene is the cause of most UTIs in preschool girls. Although obtaining a urine specimen to insure eradication of bacteria after completion of the antibiotic course is important, the priority is with patient teaching. Infected urine may cause reflux and reflux may scar the kidneys, leading to hypertension later in life.

When the nurse is caring for a child with hemolytic-uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention? a. Test urine for specific gravity. b. Weigh child daily. c. Weigh the wet diapers. d. Measure abdominal girth daily.

b. The most accurate measure for determining fluid retention (or loss) is daily weight measured on the same scale, at the same time, in similar clothing or naked.

The nurse is providing education related to use of a brace that the orthopedic surgeon has ordered as treatment for idiopathic scoliosis in an adolescent girl. Which statement by the teen best indicates an understanding of appropriate use of the brace? a. "I can take my brace off only for special occasions." b. "I will take my brace off for only 1 hour per day, for showering." c. "I do not need to wear my brace at night while I am sleeping." d. "It is most important for me to wear my brace during the day, while I am upright."

b. To correct the lateral curvature of the spine, the brace must be worn continuously; it can be removed for no more than 1 hour per day for hygiene purposes.

The nurse is caring for a child with a fractured left femur who has been in skeletal traction for several days. Upon assessment, she notes that the left foot is pale, with a nonpalpable pedal pulse. What is the priority nursing intervention? a. Release the traction, as there may be too much weight on it. b. Nothing; alterations in circulation are expected with skeletal traction. c. Immediately notify the physician or nurse practitioner of this abnormal finding. d. Massage the foot immediately to increase circulation.

c. These findings indicate compartment syndrome, an emergency, so the physician must be notified immediately.

The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? a. Allow early ambulation to encourage activity participation. b. Check pulses above the catheter insertion site for strength and quality. c. Assess extremity distal to the insertion site for temperature and color. d. Change the dressing to evaluate the site for infection.

c. Vessel spasm or hematoma may occur after the catheterization, occluding circulation. The extremity may become pale, feel cool to the touch, and have diminished pulses distal to the insertion site.

The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel? a. Ambulate the children twice daily to promote mobility. b. Encourage commode use to promote bowel function. c. Provide diversionary activities, as the children must stay flat on their backs. d. Assist with log-rolling the children every 2 hours.

d. Frequent position changes promote pulmonary, gastrointestinal, and genitourinary functioning; in the child who has had a spinal fusion, the appropriate method of changing position is by log-rolling to avoid flexing the spine. The nurse also has the opportunity to assess the spinal bandage for drainage or bleeding when the child is log-rolled.

While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? a. Provide supplemental oxygen by face mask. b. Administer a dose of IV morphine sulfate. c. Begin cardiopulmonary resuscitation. d. Place the infant in a knee-to-chest position.

d. Hypercyanotic spells are a dangerous event. Placing the infant in a knee-to-chest position increases systemic vascular resistance, thereby improving pulmonary blood flow. It is the first action the nurse should take.

The nurse is performing education for the parents of an infant with bladder exstrophy. Which statement by the parents would indicate an understanding of the child's future care? a. "Care will be no different than that of any other infant." b. "My infant will only need this one surgery." c. "My child will wear diapers all his life." d. "We will need to care for the urinary diversion."

d. Management of exstrophy of the bladder requires some type of urinary diversion. It may be a continent, catheterizable stoma, or a stoma requiring pouching.

A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? a. Gallop and rales. b. Blood pressure discrepancies in the extremities. c. Right ventricular hypertrophy on ECG. d. Heart murmur.

d. Typically, children with aortic stenosis have a murmur that is best heard along the left sternal border. They do not commonly exhibit a gallop, rales, or right ventricular hypertrophy. Blood pressure and pulse discrepancies between the upper and lower extremities occur with coarctation of the aorta, not aortic stenosis.