Peds Exam 2 Practice Questions
cleft palate
A nursing student is reviewing information about inheritance and genetic disorders. The student demonstrates understanding of the information by identifying which disorder as involving multifactorial inheritance?
osteosarcoma Osteosarcoma is a malignant tumor of long bone involving rapidly growing bone tissue (mesenchymal-matrix forming cells). It occurs more commonly in boys than in girls and in children who have had radiation for other malignancies as a later life effect
An adolescent who had radiation for a previous malignancy has presented to the pediatric oncology clinic. Which malignancy is the nurse concerned could develop as a complication?
Administer the antiemetic before starting chemotherapy
Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications?
Prepare the infant for surgery. In pyloric stenosis, the thickened muscle of the pylorus causes gastric outlet obstruction. The treatment is a surgical correction called a pyloromyotomy. The condition is not painful, so no analgesics would be needed until after surgical repair.
In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?
Bleeding from the oral mucous membranes Headache Painless cervical lymphadenopathy Low-grade fever
Parents bring their daughter to the health care facility for evaluation. They report that lately the child seems rather pale and really tired. What would the nurse most likely find with further assessment if the child has acute lymphoblastic leukemia (ALL)? Select all that apply.
Iron-chelating drugs Frequent transfusions can lead to complications and additional concerns for the child, including the possibility of iron overload. For these children, iron-chelating drugs such as deferoxamine mesylate may be given.
The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder?
Place the child in a knee-to-chest position The priority nursing action is to place the 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 prescribed.
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?
increasing maternal age
The nurse is educating a female client about genetic disorders. Which statement by the client bestdescribes the major risk factor for trisomy 21?
"We have an appointment next week for the varicella vaccine to be given." "I worry day care will expose my child to measles, so I will have my child vaccinated soon." In the acute phase, high-dose aspirin and intravenous immunoglobulin (IVIG) are given to manage Kawasaki disease. The parent would be taught to avoid vaccines, especially varicella and measles, mumps, rubella vaccine, for several months following IVIG infusion due to the IVIG preventing the body from building antibodies and rendering the vaccines ineffective.
The nurse is educating the family of a child receiving an infusion of intravenous immunoglobulin (IVIG) and high-dose aspirin therapy during the acute phase of Kawasaki disease. What statement(s) by the parent indicates additional teaching is needed? Select all that apply.
"The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." 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.
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?
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 The nurse should not administer digoxin to children with the following issues: apical pulse under 60 beats per minute, digoxin level above 2 ng/ml, and 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.
notify a health care provider if the child develops an upper respiratory infection Infections caused by the Streptococcus pneumoniae can be lethal to a child with sickle cell, because they can cause overwhelming sepsis or meningitis. By 2 months of age the child should be started on Penicillin V as prophylaxis against pneumococcal infections. The child should receive the 7 valent pneumococcal series in infancy. After 2 years of age the child should receive the 23 valent pneumococcal vaccine. He or she should also be immunized against meningitis.
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:
Avoiding further abdominal palpation After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis.
A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care?
Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing Balloon angioplasty by way of cardiac catheterization is the initial procedure for aortic stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed area. As the balloon is inflated, it breaks any adhesions and opens the area.
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?
serum potassium levels serum sodium levels Spironolactone is a potassium-sparing diuretic that competes with aldosterone to result in increased water and sodium excretion (spares potassium). It is used to manage edema due to heart failure and for treatment of hypertension. Serum potassium and sodium levels should be evaluated in someone taking this medication.
A child has been prescribed spironolactone. Which laboratory values should be reviewed when following up on this medication? Select all that apply.
Barium enema A barium enema is successful in reducing a large percentage of intussusception cases. Other cases are reduced surgically.
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition?
antibiotics vitamin supplements total parenteral nutrition For the child with short bowel syndrome, antibiotics, vitamin and mineral supplements, antidiarrheal agents, and total parenteral nutrition are typically prescribed.
A child is diagnosed with short bowel syndrome. What would the nurse expect to be included in the child's plan of care? Select all that apply.
bounding pulse A bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation.
A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note?
pancreatitis The child admitted with the suspicion of pancreatitis typically reports acute onset of persistent abdominal pain. It can be mid-epigastric or periumbilical with radiation to the back or the chest. Nausea and vomiting, fever, tachycardia, hypotension, and jaundice may be present. Abdominal signs such as abdominal distention, decreased bowel sounds, rebound tenderness, and guarding also may be noted.
A parent brings a 10-year-old child to the emergency room with reports of abdominal pain. The nurse performing a physical assessment notes the following symptoms: upper right quadrant pain that radiates to the back; fever; nausea; and abdominal distention. Which disease would the nurse suspect?
Normal to hyperactive bowel sounds early Hypoactive bowel sounds with perforation Irritation and pain in the right lower quadrant Low-grade fever, nausea, anorexia, and vomiting
A school-aged child is brought to the emergency room with severe abdominal pain. The nurse performs a physical assessment. Which assessment parameters indicate appendicitis? Select all that apply.
femoral pulse weaker than brachial pulse A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta
After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:
gastroesophageal reflux disease. Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus. These refluxed contents may be aspirated into the lungs. The child with gastroesophageal reflux disease may present with the physical findings of pneumonia or GER-induced asthma.
An 18-month-old infant is brought to the emergency department with flu-like symptoms. The infant is diagnosed with pneumonia secondary to aspiration of stomach contents. The nurse explains to the parents that pneumonia is a condition that often occurs secondary to:
Bone marrow aspiration Bone marrow aspiration and biopsy are diagnostic.
The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis?
oxygen desaturation while seated in the car seat Prior to discharge from the NICU, the infant will be tested for oxygen desaturation while seated in the car seat.
The nurse is caring for a newborn that is scheduled to be discharged from the NICU. The nurse is aware that the child must be tested for what potential complication prior to discharge?
"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help." For children with congenital defects with increased pulmonary blood flow, oxygen supplementation is not helpful. Oxygen acts as a pulmonary vasodilator. If pulmonary dilation occurs, pulmonary blood flow is even greater, causing tachypnea, increasing lung fluid retention, and eventually causing a much greater problem with oxygenation; therefore, preventing the development of pulmonary disease via early surgical correction is essential.
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?
7 to 14 days
The nurse is providing care to a child who has had an appendectomy for a perforated appendix. The nurse would anticipate intravenous antibiotic therapy for how long?
There is a partial or complete mechanical obstruction in the intestine Congenital aganglionic megacolon, also called Hirschsprung disease, is characterized by persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin
What occurs in the gastrointestinal system of the child with Hirschsprung disease?
mucositis Mucositis, or ulcers of the gum line and mucous membranes of the mouth, is a frequent side effect of methotrexate.
When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect?
Polycythemia 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.
When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover?
painless nodules located on the wrists pericarditis with the presence of a new heart murmur
Which finding(s) is a major criterion used to help the health care provider diagnose acute rheumatic fever in a child? Select all that apply.
It is failure of the chromosomal pair to separate Nondisjunction simply means failure to separate. Nondisjunction can happen at any chromosome and is attributed to 95% of Down syndrome cases.
Which statement about nondisjunction of a chromosome is true?
oral rehydration solutions The nurse is correct to anticipate that oral rehydration fluids such as Pedialyte, Rehydralyte, or Infalyte are initiated. Once the infant is able to tolerate the solution, either a half-strength formula or full-strength formula will be considered.
Which type of nutrition does the nurse anticipate initiating when an infant with gastroenteritis and dehydration begins solid foods?
esophageal atresia Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation
The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder?
"I have to be careful because I am prone to not absorbing nutrients." Crohn disease typically affects the small intestine more than the large intestine and its onset is between the ages of 10 to 20 years. The cobblestone lesions in the small intestine prevent absorption of nutrients that normally occurs.
The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred?
"We should not stop this medication abruptly." Prednisone is a corticosteroid. Stopping the medication abruptly could lead to adrenal insufficiency.
A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful?
"Sickle cell disease is passed to a fetus when both parents have the gene."
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?
Only occurs with feeding Regurgitation typically occurs only with feeding, runs out of the mouth with little force, smells barely sour and is only slightly curdled, appears to cause no pain or distress, occurs only once per feeding, and amounts to only about 1 to 2 tsp. Vomiting may occur at times other than feeding, is forceful and is typically projected 1 ft or more away from infant, is extremely sour smelling and curdled, is typically accompanied by crying, continues until the stomach is empty, and amounts to the full stomach contents.
A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting?
Nausea and vomiting Digoxin is a cardiac glycoside and antiarrhythmic. It can cause toxicity if the dosages increase due to poor absorption, dehydration, etc. Signs of digoxin toxicity are nausea and vomiting, lethargy, and bradycardia.
A nurse is administering digoxin to a 3-year-old child. What would be a reason to hold the dose of digoxin?
Increased RBC Polycythemia can occur in clients with a cyanotic heart defect. The body tries to compensate for having low oxygen levels and produces more red blood cells (RBCs).
A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would mostlikely be seen in a client experiencing polycythemia?
Notify the doctor immediately 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.
A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?
Place the infant in the knee-chest position Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot.
An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the firstpriority?
Prepare the child for admission to the hospital The child's presentation is consistent with cholecystitis, which necessitates surgery in most cases. The child should be kept NPO and antacids are of no benefit.
The emergency department nurse is assessing a child who has presented with a 2-day history of nausea and vomiting with pain that is isolated to the right upper quadrant of the abdomen. Which action is most appropriate?
Digoxin Digoxin is indicated for atrial fibrillation. It increases the contractility of the heart muscle by decreasing conduction and increasing force.
The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?
slightly yellow sclerae Many children with sickle cell anemia develop mild scleral yellowing from excess bilirubin from the breakdown of damaged cells
The nurse is caring for a 4-year-old with sickle cell anemia. A physical finding the nurse might expect to see in him is:
Initiate intravenous access 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.
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?
hard, moveable "olive-like mass" in the upper right quadrant A hard, moveable "olive-like mass" in the right upper quadrant is the hypertrophied pylorus.
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?
medulloblastoma
The nurse is preparing a presentation for a parent group about childhood cancers, focusing on brain tumors in children younger than 14 years. Which type of tumor will the nurse include as one of the most common types in that age group?
"We will need to get a cervical X-ray in a year." "An X-ray will be needed before engaging in strenuous activity." "It is important to avoid overextending or over flexing the neck." In trisomy 21 there is a possibility of atlantoaxial instability. A cervical X-ray is recommended between ages 3 and 5, before any strenuous activity or event, and during procedures it is important to avoid overextending or overflexing the neck.
The nurse is providing education on bone and joint health to the parents of a 2-year-old client with trisomy 21. Which statements made by the parents demonstrate an understanding of this teaching? Select all that apply.
cheeseburger, broccoli, and fresh strawberries Children with iron-deficiency anemia require diets rich in iron and vitamin C (vitamin C enhances iron absorption). Meats are excellent sources of iron. Broccoli is a good source of iron, and strawberries are a good source of vitamin C. To help the body absorb the most iron from the meal, tea and foods rich in calcium (such as milk and cheese) should be avoided.
The nurse will select which meal as the best choice for a child with iron-deficiency anemia?
Begin formulas with increased calories. 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
What information would be included in the care plan of an infant in heart failure?
Intussusception Intussusception, the invagination of one portion of the intestine into another, usually occurs in the second half of the first year of life. Children with this disorder suddenly draw up their legs and cry as if they are in severe pain; they may vomit. After the peristaltic wave that caused the discomfort passes, they are symptom-free and play happily. In approximately 15 minutes, however, the same phenomenon of intense abdominal pain strikes again. After approximately 12 hours, blood appears in the stool and possibly in vomitus, described as a "currant jelly" appearance.
A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case?
Hirschsprung disease The nurse should suspect Hirschsprung disease when the newborn does not pass meconium in the first 24 hours after birth, and has bilious vomiting or abdominal distention and feeding intolerance with bilious aspirates and vomiting.
A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?
feeding problems The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. The heart beats faster in an attempt to increase blood flow.
A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting?
In this disorder the sphincter that leads into the stomach is relaxed Gastroesophageal reflux (GER) occurs when the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus
The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux?
Peeling hands and feet; fever 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.
A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?
"I hope my child does well with the various therapies we have arranged." The child with Down syndrome will likely require individualized physical, occupational and speech therapy.
The nurse is educating a parent of a toddler with Down syndrome. Which statement by the parent indicates teaching was effective?
Do not rub or put pressure on the abdomen The nurse would instruct the child/parent to not rub or put pressure on the abdomen as palpating an inflamed appendix may cause it to rupture.
A child is admitted with a temperature, 101.2°F (38.4°C); pulse rate 100 beats/min; respirations 24 breaths/min. On admission the pain is localized in right lower quadrant. Legs are drawn up against the abdomen. Bowel sounds are sluggish. Rebound tenderness is present. White blood cell count of 17,000/mm3. Ultrasound confirms appendicitis. Which instruction would the nurse give to the child and the parent?
Iron-binding capacity 390 ug/100 ml Serum ferritin 8 ug/100ml Hematocrit 30% As iron-deficiency anemia develops, laboratory studies will reveal a decreased hemoglobin level (less than 11 g/100 ml of blood) and reduced hematocrit level (below 33%). The red blood cells are microcytic, hypochromic, and possibly poikilocytic (irregular in shape). The mean corpuscular volume is low. The mean corpuscular hemoglobin may be reduced. Serum iron levels are normally 70 g/100 ml; with iron-deficiency anemia the level is often as low as 30 g/100 ml, with an increased iron-binding capacity (more than 350 g/100 ml). The level of serum ferritin reflects the extent of iron stores so is less than 10 g/100 ml (normal is 35 g/ml).
A nurse is reviewing laboratory test results of a child with iron-deficiency anemia. Which laboratory results would be communicated with the next shift during shift hand-off? Select all that apply.
100 to 120/70 to 80 mm Hg The normal adolescent's blood pressure averages 100 to 120/70 to 80 mm Hg. The average infant's blood pressure is about 80/55 mm Hg. The toddler or preschool-age child's blood pressure averages 90 to 110/55 to 75 mm Hg. The normal school-age child's blood pressure averages 100 to 120/60 to 75 mm Hg.
The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy?
"We'll need to have a match to a donor."
A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?
These wires are connected to the heart and will detect if your infant's heart gets out of rhythm. 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.
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?
Iliac crest Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?
aspirin IV immunoglobulin Management of the child with Kawasaki disease includes a high dose of IV immunoglobulin therapy to relieve the symptoms and prevent coronary artery abnormalities, along with aspirin to control inflammation and fever.
A nurse is providing care to a child with Kawasaki disease. Which medication(s) would the nurse expect the health care provider to prescribe? Select all that apply.
esophageal atresia (EA) A maternal history of polyhydramnios is usually present in one-third of cases of EA and in some cases of tracheoesophageal fistula (TEF).
A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate?
nonsterioidal anti-inflammatory drugs (NSAIDs) Medications used in the treatment of rheumatic fever include penicillin, NSAIDs, and corticosteroids.
A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers?
epoetin alfa Epoetin alfa is a colony-stimulating factor used to stimulate production of red blood cells.
A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered?
Serum potassium level Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug.
A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?
steatorrhea constipation diarrhea failure to thrive Classic symptoms of celiac disease include steatorrhea, constipation, diarrhea, failure to thrive, weight loss, abdominal distention or bloating (not a sunken abdomen), and anemia (not polycythemia).
A group of nursing students are reviewing information about celiac disease. The students demonstrate understanding of this disorder when they identify which classic symptoms? Select all that apply.
80 beats/min 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 provider 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?
The catheter will be placed in the femoral artery A cardiac catheterization can be performed via the right side of the heart or the left side. If the catheter is going through the right side it would be inserted into the femoral vein and threaded to the right atrium. If it is going to the left side the catheter would be threaded through the femoral artery to the aorta. The child will need to lie still for 4 to 6 hours with the leg outstretched after the procedure to prevent bleeding.
A nurse is providing education to a family about cardiac catheterization. What information would be included in the education?
Gastroenteritis Outbreaks of gastroenteritis routinely occur in day care centers, schools, institutions for the handicapped, and other places where overcrowding is prevalent and hygiene is inadequate. Typical signs and symptoms include diarrhea, nausea, vomiting, and abdominal pain.
A parent brings a 2-year-old child to the health clinic with reports of diarrhea, vomiting, and abdominal pain. The father tells the nurse that he is a single parent and his child is enrolled in a local day care center. Based on this information, what gastrointestinal condition might the nurse suspect?
Pulses weaker in lower extremities compared to upper extremities 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.
A parent brings an infant in for poor feeding and listlessness. Which assessment data would mostlikely indicate a coarctation of the aorta?
Factor VIII The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.
A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?
Check for gastric residual before starting feeding The nurse should check for gastric residual before starting feeding by gently aspirating from the tube with a syringe or positioning the tube below the level of the stomach with only the barrel of the syringe attached. The client should be positioned with his or her head elevated 30° to 45° and the formula should be allowed to flow with gravity, not plunged unless the tube is clogged. After feeding, the nurse should flush the tube with a small amount of water, unless contraindicated, and leave the G-tube open for 5 to 10 minutes after feeding to allow for escape of air.
The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube?
Digoxin 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 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?
Apply pressure 1 inch above the site. If bleeding occurs after a cardiac catheterization, apply pressure 1 inch above the site to create pressure over the vessel, thereby reducing the blood flow to the area. The nurse should first apply pressure and then notify the physician if this measure is ineffective or the bleeding increases. The child should maintain the leg in a straight position for about 4 to 8 hours.
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 mostappropriate?
fever Crohn disease may affect any area of the digestive tract. It causes acute and chronic inflammation. It may also cause abscesses and fistulas. Inflammation and abscesses can cause fever. An increasing temperature could be the manifestation of the inflammation worsening or the development of an abscess and subsequent infection.
The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child?
Effortless vomiting just after the child has eaten The child with GER usually gains weight and feeds well. It must be determined if there are underlying symptoms or complications that might suggest GERD. In the child with GERD, almost immediately after feeding, the child vomits the contents of the stomach. The vomiting is effortless, not projectile in nature. The child with GERD is irritable and hungry, but may refuse to eat. Aspiration after vomiting may lead to respiratory concerns, such as apnea, wheezing, cough, and pneumonia. Failure to thrive and lack of normal weight gain occurs. Symptoms seen in the older child may include heartburn, nausea, epigastric pain, and difficulty swallowing.
The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?
"The treatment for the disorder will be a surgical procedure." Treatment of congenital aganglionic megacolon involves surgery with the ultimate resection of the aganglionic portion of the bowel.
The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?
"She loves hot dogs, and we always cut hers up into small pieces." Commercially canned creamed soups, cold cuts, frankfurters, and pudding mixes generally contain wheat products and should not be included in the diet of the child with celiac syndrome
The nurse is reinforcing dietary teaching with the caregiver of a child diagnosed with celiac disease. The caregivers make the following statements. Which statement indicates a need for further teaching regarding the dietary restrictions for the child with celiac disease?
A thickened, elongated muscle causes an obstruction at the end of the stomach Pyloric stenosis is characterized by hypertrophy of the circular muscle fibers of the pylorus, with a severe narrowing of its lumen. The pylorus is thickened to as much as twice its size, is elongated, and has a consistency resembling cartilage. As a result of this obstruction at the distal end of the stomach, the stomach becomes dilated.
The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is mostaccurately related to the diagnosis of pyloric stenosis?
"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate
11.0 to 13.0 seconds The nurse would identify a prothrombin time of 11.0 to 13.0 seconds as normal for a healthy child. A result of 21.0 to 35.0 seconds would be the expected range for partial thromboplastin time and activated partial thromboplastin time.
The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding?
"Babies with esophageal atresia have an inability to swallow amniotic fluid causing the excess buildup." Review the maternal history for polyhydramnios. Often this is the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Esophageal atresia is an underlying cause of polyhydramnios.
The nurse is talking with a woman in her second trimester of pregnancy who has been diagnosed with polyhydramnios. The physician has ordered an ultrasound be performed to check for the presence of esophageal atresia. Which statement by the woman indicates an understanding of the relationship between these conditions?
"ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason."
The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's bestresponse?
placing the infant in a semi-Fowler position 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.
What would be the most important measure to implement for an infant who develops heart failure?
