Pediatrics Exam #2

The nurse is conducting a physical examination of a child with a suspected cardiovascular disorder. Which of the following findings would the nurse most likely expect to assess if the child had transposition of the great vessels? A) Significant cyanosis without presence of a murmur B) Abrupt cessation of chest output with an increase in heart rate/filling pressure C) Soft systolic ejection D) Holosystolic murmur

A) Significant cyanosis without presence of a murmur

Nursing care of the child with Kawasaki disease is challenging because of: a. the child's irritability. b. predictable disease course. c. complex antibiotic therapy. d. the child's ongoing requests for food.

ANS: A Patient irritability is a hallmark of Kawasaki disease and the most challenging problem. A quiet environment is necessary to promote rest. The diagnosis is often difficult to make, and the course of the disease can be unpredictable. Intravenous gamma globulin and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to eat. Soft foods and fluids should be offered to prevent dehydration.

The nurse is caring for a child with Kawasaki disease in the acute phase. Which of the following clinical manifestations would the nurse expect to observe? a. Osler nodes b. Cervical lymphadenopathy c. Strawberry tongue d. Chorea e. Erythematous palms f. Polyarthritis

ANS: B, C, E Clinical manifestations of Kawasaki disease in the acute phase include cervical lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic fever.

When caring for the child with Kawasaki disease, the nurse should know which of the following? a. Aspirin is contraindicated. b. Principal area of involvement is the joints. c. Child's fever is usually responsive to antibiotics within 48 hours. d. Therapeutic management includes administration of gamma globulin and salicylates.

ANS: D High-dose intravenous gamma globulin and salicylate therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. The fever of Kawasaki disease is unresponsive to antibiotics. It is responsive to antiinflammatory doses of aspirin and antipyretics

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is which of the following? a. Notify the physician. b. Place child in Trendelenburg position. c. Apply a new bandage with more pressure. d. Apply direct pressure above catheterization site.

ANS: D When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified and a new bandage with more pressure can be applied after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. Trendelenburg position would not be a helpful intervention. It would increase the drainage from the lower extremities.

A nurse is preparing for the admission of a child with a diagnosis of acute-stage Kawasaki disease. On assessment of the child, the nurse expects to note which clinical manifestation of the acute stage of the disease? a) cracked lips b) a normal appearance c) conjunctival hyperemia d) desquamation of the skin

Answer: C In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal, but signs of inflammation may be present.

The nurse is caring for a 10-year-old boy following a cardiac catheterization. Four hours after the procedure, the nurse notes some minor bleeding at the site. Which action would be most appropriate?Change the dressing. Contact the physician. Apply pressure 1 inch above the site. Ensure that the child's leg is kept straight.

Apply pressure 1 inch above the site.

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

Assessing for the presence of femoral pulses

Acute rheumatic fever.. which of the following assessments is the nurse's priority?

Auscultating the rate & characteristics of the child's heart sounds.

John is a 6-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be which of the following? a. Directed at his parents because he is too young to understand b. Adapted to his level of development so that he can understand c. Done several days before the procedure so he will be prepared d. Provide details about the actual procedures so he will know what to expect

B. Adapted to his level of development so that he can understand.

The nurse is caring for three children with cardiac conditions who are taking digoxin (Lanoxin). Prior to giving the medication, the nurse would check which lab results because of the risk for digoxin toxicity? A. Hemoglobin and hematocrit B. Potassium and magnesium C. Glucose and phosphorus D. BUN and platelets

B. Potassium and magnesium Hypokalemia and hypomagnesemia can increase the risk for digoxin toxicity. In children with altered renal function, the dose needs to be decreased. Glucose and phosphorus levels are not related to digoxin toxicity. An elevated BUN could indicate altered renal function and affect the digoxin level but not the platelet level. Hemoglobin and hematocrit are not related to digoxin toxicity.

After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow? A) Tetralogy of Fallot B) Atrial septal defect C) Hypoplastic left heart syndrome D) Transposition of the great vessels

D) Transposition of the great vessels

A nurse caring for a child post cardiac catheterization assesses that the distal pulse of the catheter site is weaker and capillary refill less than 3 seconds. What is the most appropriate nursing action? A. Elevate the affected extremity. B. Notify the physician of the observation. C. Apply warm compresses to insertion site. D. Record the assessment finding.

D. Record the assessment finding.The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization and should gradually increase in strength. The capillary refill is normal. Elevation is not necessary; the extremity is kept straight. Because a weaker pulse is an expected finding and the capillary refill is within normal range, the nurse should document this and continue to monitor. The insertion site is kept dry.

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting? Feeding problems Bradypnea Bradycardia Yellowish color

Feeding problems

When caring for a child with Kawasaki Disease, the nurse would know that: a.management includes administration of aspirin and IVIG. b.steroid creams are used for the hand peeling. c. joint pain is a permanent problem. d. antibiotics should be administered exactly every 8 hours by IV.

Management includes administration of aspirin and IVIG.

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

Peeling hands and feet and fever

What would be the most important measure to implement for an infant who develops heart failure? A. Planning ways to reduce salt intake B. Placing her in a semi-Fowler's position C. Restricting milk intake daily D. Keeping her supine and playing quiet games

Placing her in a semi-Fowler's position

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents the following expected finding: Appropriate mastery of developmental milestones Steady weight gain since birth Softening of the nail beds Intact rooting reflex

Softening of the nail beds

What assessment will the nurse include in a child's care plan with rheumatic fever?

Sore throat in the past 2-6 weeks

A child is being watched for possible heart failure. Which sign would alert the nurse that congestive heart failure could be developing? A. Tachypnea B. Bradycardia C. Inability to sweat D. Increased urine output

Tachypnea Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic. Urine output usually will be decreased.

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

• The 16-year-old child has a heart rate of 54 beats per minute • The 5-year-old child has developed vomiting, diarrhea and is difficult to arouse • The 2-year-old child has a digoxin level of 2.4 ng/mL from a blood draw this morning