Peds Exam 4

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).

1, 2, 4, 6 TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. 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 ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 6

The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indica- tion that the child may be experiencing airway obstruction? 1. The child exhibits nasal flaring and bradycardia. 2. The child is leaning forward, with the chinthrust out. 3. The child has a low-grade fever and complains of a sore throat. 4. The child is leaning backward, supporting him- self or herself with the hands and arms.

2. The child is leaning forward, with the chinthrust out.

The mother of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not pre- scribe antibiotics. Which response should the nurse make? 1. "The child may be allergic to antibiotics." 2. "The child is too young to receive antibiotics." 3. "Antibiotics are not indicated unless a bacterial infection is present." 4. "The child still has the maternal antibodies from birth and does not need antibiotics."

3. "Antibiotics are not indicated unless a bacterial infection is present."

A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consis- tently crying and trying to climb out of the tent. Which is the most appropriate nursing action? 1. Tell the mother that the child must stay in the tent. 2. Place a toy in the tent to make the child feel more comfortable. 3. Call the health care provider and obtain a prescription for a mild sedative. 4. Let the mother hold the child and direct the cool mist over the child's face.

4. Let the mother hold the child and direct the cool mist over the child's face.

Surgical closure of the ductus arteriosus would do which of the following? 1. Stop the loss of unoxygenated blood to the systemic circulation 2. Decrease the edema in legs and feet 3. Increase the oxygenation of blood 4. Prevent the return of oxygenated blood to the lungs

4. Prevent the return of oxygenated blood to the lungs

The child with nephrotic syndrome is at risk for developing: A. skin breakdown. B. an antigen-antibody reaction. C. pathologic fractures. D. urinary stasis

A Rationale: Good skin care especially important during periods of marked edema.

The nurse is caring for a 12-year-old who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action related to this? A) Request a psychological consultation. B) Ask the child why the child does not have pain. C) Praise the child for the ability to withstand pain. D) Encourage continued bravery as a coping strategy.

A) Request a psychological consultation.

A child has a chronic cough, no retractions but diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? A. Asthma B. Pneumonia C. Croup D. Foreign body aspiration

A. Asthma

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of A. pneumothorax. B. bronchodilation. C. carbon dioxide retention. D. increased viscosity of sputum.

A. pneumothorax.

The nurse is aware that a common physiologic adaptation of children with tetralogy of Fallot is: A.Clubbing of fingers B.Slow, irregular respirations C.Subcutaneous hemorrhages D.Decreased red blood cell count

A.Clubbing of fingers

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? a. Atrial septal defect b. Tetralogy of Fallot c. Ventricular septal defect d. Patent ductus arteriosus

ANS: B Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

A nurse is admitting an infant with asthma. What usually triggers asthma in infants? a.Medications b.A viral infection c.Exposure to cold air d.Allergy to dust or dust mites

ANS: B Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease.

Which clinical manifestation would be the most suggestive of acute appendicitis? a.Rebound tenderness b.Bright red or dark red rectal bleeding c.Abdominal pain that is relieved by eating d.Abdominal pain that is most intense at McBurney point

ANS: D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain localizes to the right lower quadrant at McBurney point. Rebound tenderness is not a reliable sign and is extremely painful to the child. Bright red or dark red rectal bleeding and abdominal pain that is relieved by eating are not signs of acute appendicitis.

While child with nephrotic syndrome is being treated, s/he should not receive A. antihistamines B. immunizations C. diuretics D. analgesics

B. immunizations Rationale: pt. is compromised while on steroids (immunosuppressive therapy)

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend A. controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing C. trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement. D. bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.

B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will assist in opening up the child's airways.The child does not have a temperature and, therefore, does not need management with acetaminophen. Cough suppressants are not indicated by symptom, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend A. controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. C. trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement. D. bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.

B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.

When caring for a 3 year old with tetralogy of Fallot, the nurse expects to see fatigue and poor activity tolerance. This is caused by: A.Poor muscle tone B.Inadequate oxygenation of tissues. C.Restricted blood flow leaving the heart D.Inadequate intake of food.

B.Inadequate oxygenation of tissues. The child's fatigue results from left to right shunting that occurs with tetralogy of Fallot. This shunting causes poorly oxygenated blood to circulate through the body. Poor muscle tone and inadequate food intake can result from this condition, but these are effects, not causes. Restricted blood flow leaving the heart is associated with aortic stenosis.

The mother of a child with a congenital cardiac defect asks the nurse why her child squats after exertion. The nurse should reply that this position: A.Reduces muscle aches B.Increases cardiac efficiency C.Enhances the pull of gravity D.Decreases blood volume in the extremities

B.Increases cardiac efficiency When the child squats, blood pools in the lower extremities because of flexion of the hips and knees; less blood returns to the hear, enabling the heart to beat more effectively.

An infant with tetralogy of Fallot becomes cyanotic and dyspneic after a crying episode. To relieve the cyanosis and dyspnea, the nurse should place the infant in the A.Orthopneic position B.Knee-chest position C.Lateral Sims' position D.Semi-Fowler's position

B.Knee-chest position Flexing the hips and knees decreases venous return to the heart from the legs; when venous return to the heart is decreased, the cardiac workload is decreased.

A nurse is teaching the parents of a child with tetralogy of Fallot about hypercyanotic spells ("tet spells"). When a spell occurs, the parents should: A.Call the physician immediately B.Use a calm, comforting approach C.Lay the child in the supine position D.Take the child to the nearest emergency dept.

B.Use a calm, comforting approach

The parents of a baby who just under went repair of a hypospadius are questioning if the surgery was a success. The nurse explains that the success of the surgery is measured by : A. The cosmetic appearance of the penis B. Maintaining a stable blood pressure in the child C. Observing a straight stream of urine D. His ability to void without discomfort

C. Observing a straight stream of urine

The treatment of choice for nephrotic syndrome is: A. diuretics B. antibiotics C. analgesics D. steroids

D Rationale: Steroids; to reduce proteinuria and consequently edema. Oral prednisone is initially given. Dosage is reduced for maintenance therapy, which continue for 1 to 2 months.

A 3 day old infant is diagnosed with hypospadias. His parents are very upset and have been willing listeners as the RN has explained this problem to them. The nurse explained that in hypospadias, the physical problem is primarily : A. Ambiguous genitalia B. Urinary incontinence C. Ventral curvature of the penis D. Altered location of the urethral meatus

D. Altered location of the urethral meatus

For a child with recurring nephrotic syndrome, which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care? A. Muscle coordination B. Sexual maturation C. Intellectual development D. Body image

D. Body image

What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? A. Barrel chest B. Wheezing C. Thermal instability D. Nasal flaring and retractions

D. Nasal flaring and retractions

Congenital heart defects have traditionally been divided into acyanotic and cyanotic defects. The nurse knows which information about this system in clinical practice? A. Helpful because it explains the hemodynamics involved B. Problematic because cyanosis is rarely present in children C. Helpful because children with cyanotic defects are easily identified D. Problematic because children with acyanotic heart defects may experience cyanosis

D. Problematic because children with acyanotic heart defects may experience cyanosis Children with traditionally named acyanotic defects may become cyanotic, and children with traditionally classified cyanotic defects may be pink at times. The classification does not reflect the blood flow within the heart. Cardiac defects are best described by their actual pathophysiologic processes and mechanisms. Children with cyanosis may be easily identified, but that does not aid diagnosis. Cyanosis is present when children have defects in which there is mixing of oxygenated and unoxygenated blood.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent A. otitis media. B. diabetes insipidus. C. nephrotic syndrome. D. acute rheumatic fever

D. acute rheumatic fever

One of the goals for children with asthma is to prevent respiratory tract infection because infections A. lessen effectiveness of medications. B. encourage exercise-induced asthma. C. increase sensitivity to allergens. D. can trigger an episode or aggravate asthmatic state.

D. can trigger an episode or aggravate asthmatic state.

A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to: A. examine the child's oropharynx and report the assessment to the healthcare provider. B. make the child lie down and rest quietly. C. auscultate the child's lungs and make preparations for placement in a mist tent. D. notify the healthcare provider immediately and be prepared to assist with a tracheostomy or intubation.

D. notify the healthcare provider immediately and be prepared to assist with a tracheostomy or intubation. Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.Examination of the oropharynx may cause total obstruction and should not be done when a child manifests signs indicating potential epiglottitis.The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety.Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out.

A one month old infant is admitted for confirmation of the diagnosis of ventricular septal defect. During the initial admission assessment, the nurse would expect to find: A.Bradycardia at rest B.Bounding peripheral pulses C.An activity related cyanosis D.A murmur at the left sternal border.

D.A murmur at the left sternal border. This murmur is the most characteristic finding in children with VSD

What congenital heart defect causes cyanosis in children? A.Atrial septal defect B.Coarctation of the aorta C.Ventricular septal defect D.Transposition of the great vessels

D.Transposition of the great vessels With transposition of the great vessels, the pulmonary artery is attached to the left ventricle and the aorta is attached to the right ventricle. The child is cyanotic because blood reaches the tissues from the right ventricle before being oxygenated by the lungs. In atrial septal defect and ventricular septal defect, blood is shunted from the left side of the heart to the right side through patent openings. Because the blood travels from left to right, it's oxygenated and doesn't produce cyanosis. Coarctation of the aorta is a narrowing of the aorta that decreases the circulation of oxygenated blood to the body. With this condition, the child won't be cyanotic unless cardiac output drops.

When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia? a. 25% b. 50% c. 75% d. 100%

a. Sickle cell anemia is inherited in an autosomal recessive pattern. If both parents have sickle cell trait (one copy of the sickle cell gene), then for each pregnancy, a 25% chance exists that their child will be affected with sickle cell disease. With each pregnancy, a 50% chance exists that the child will have sickle cell trait. Percentages of 75% and 100% are too high for the children of parents who have sickle cell trait.

The school nurse is informed that a child with human immunodeficiency virus (HIV)will be attending school soon. Which is an important nursing intervention? a. Carefully follow universal precautions. b. Determine how the child became infected. c. Inform the parents of the other children. d. Reassure other children that they will not become infected.

a. Carefully follow universal precautions. Universal precautions are necessary to prevent further transmission of the disease. It is not the role of the nurse to determine how the child became infected. Informing the parents of other children and reassuring children that they will not become infected is a violation of the child's right to privacy.

Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? a. Explain hospital schedules such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is young, to her room and hospital facility.

a. Explain hospital schedules such as mealtimes. School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years, the child and parents should be oriented to the environment.

The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron-deficiency anemia is common during toddlerhood? a. Milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by age 1 month. d. Dietary iron cannot be started until age 12 months.

a. Milk is a poor source of iron. Children between the ages of 12 and 36 months are at risk for anemia because cow's milk is a major component of their diet and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the

Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process? a. Normal adult hemoglobin is replaced by abnormal hemoglobin. b. There is a lack of cellular hemoglobin being produced. c. There is a deficiency in the production of globulin chains. d. The size and depth of the hemoglobin are affected.

a. Normal adult hemoglobin is replaced by abnormal hemoglobin Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron-deficiency anemia affects the size, depth, and color of hemoglobin.

The nurse is planning care for an adolescent with AIDS. Which is the priority nursinggoal? a. Preventing infection b. Preventing secondary cancers c. Restoring immunologic defenses d. Identifying source of infection

a. Preventing infection Because the child is immunocompromised in association with HIV infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the child's normal developmental needs. Preventing secondary cancers is not currently possible. Current drug therapy is affecting the disease progression; although not a cure,these drugs can suppress viral replication, preventing further deterioration. Case finding is not a priority nursing goal.

The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot? a. Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy d. Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

a. Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy Tetralogy of Fallot has these four characteristics: pulmonic stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not atrial stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy, is present in tetralogy of Fallot. Tetralogy of Fallot has right ventricular hypertrophy, not left ventricular hypertrophy, and an atrial septal defect, not aortic hypertrophy.

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because of which reason? a. Regression is seen during hospitalization. b. Developmental delays occur because of the hospitalization. c. The child is experiencing urinary urgency because of hospitalization. d. The child was too young to be "potty-trained."

a. Regression is seen during hospitalization. Regression is expected and normal for all age groups when hospitalized. Nurses should assure the parents this is temporary and the child will return to the previously mastered developmental milestone when back home. This does not indicate a developmental delay. The child should not be experiencing urinary urgency because of hospitalization and this would not be normal. Successful "potty-training" can be started at 2 years of age if the child is ready.

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

a. Separation anxiety The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age-group.

A nurse is caring for four patients; three are toddlers and one is a preschooler. Which represents the major stressor of hospitalization for these four patients? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

a. Separation anxiety The major stressor for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group.

In assessing children with congenital heart defects, the nurse would expect to see clubbing of the fingers and toes in the child diagnosed with: a. Transposition of the great vessels. b. Atrial septal defect. c. Coarctation of the aorta. d. Patent ductus arteriosus.

a. Transposition of the great vessels. Clubbing of the fingers and toes occurs in cyanotic heart defects, such as transposition of the great vessels.

Which condition in a child should alert a nurse for increased fluid requirements? a.Fever b.Mechanical ventilation c.Congestive heart failure d.Increased intracranial pressure (ICP)

a.Fever Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. Respiratory rate influences insensible fluid loss and should be monitored in the mechanically ventilated child. Congestive heart failure is a case of fluid overload in children. Increased ICP does not lead to increased fluid requirements in children.

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections? a.They are safer. b.They are less expensive. c.Respiratory secretions are dried. d.A more comfortable environment is produced.

a.They are safer. Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but cool-mist vaporizers present decreased risk for burns and growth of organisms.

A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child? a. None, this is an emergency and the child should not participate in care. b. Allow the child to hold the digital thermometer while taking the child's blood pressure. c. Ask the child if it is OK to take a temperature in the ear. d. Have parents wait in the waiting room.

b. Allow the child to hold the digital thermometer while taking the child's blood pressure. The nurse should allow the child to hold the digital thermometer while taking the child's blood pressure. Unless an emergency is life threatening, children need to participate in their care to maintain a sense of control. Because emergency departments are frequently hectic, there is a tendency to rush through procedures to save time. However, the extra few minutes needed to allow children to participate may save many more minutes of useless resistance and uncooperativeness during subsequent procedures. The child may not give permission, if asked, for a procedure that is necessary to be performed. It is better to give choices such as, "Which ear do you want me to do your temperature in?" instead of, "Can I take your temperature?" Parents should remain with their child to help with decreasing the child's anxiety.

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

b. Complete obstruction If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis.

Chelation therapy is begun on a child with b-thalassemia major. What is the purpose of this therapy? a. Treat the disease b. Eliminate excess iron c. Decrease risk of hypoxia d. Manage nausea and vomiting

b. Eliminate excess iron A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine (an iron-chelating agent) is given with oral supplements of vitamin C to increase iron excretion. Chelation therapy treats the side effect of the disease management. Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

What is an appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler? a. Provide for privacy b. Encourage parents to room in c. Explain procedures and routines d. Encourage contact with children the same age

b. Encourage parents to room in A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Encouraging contact with children the same age would not substitute for having the parents present.

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

b. Epiglottitis

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping or that the siblings lack understanding.

What measure of fluid balance status is most useful in a child with acute glomerulonephritis? a. Proteinuria b. Daily weight c. Specific gravity d. Intake and output

b. daily weight A record of daily weight is the most useful means to assess fluid balance and should be kept for children treated at home or in the hospital. Proteinuria does not provide information about fluid balance. Specific gravity does not accurately reflect fluid balance in acute glomerulonephritis. If fluid is being retained, the excess fluid will not be included. Also proteinuria and hematuria affect specific gravity. Intake and output can be useful but are not considered as accurate as daily weights. In children who are not toilet trained, measuring output is more difficult.

Which best describes acute glomerulonephritis? a.Occurs after a urinary tract infection b.Occurs after a streptococcal infection c.Associated with renal vascular disorders d.Associated with structural anomalies of genitourinary tract

b.Occurs after a streptococcal infection Acute glomerulonephritis is an immune-complex disease that occurs after a streptococcal infection with certain strains of the group A â-hemolytic streptococcus. Acute glomerulonephritis usually follows streptococcal pharyngitis and is not associated with renal vascular disorders or genitourinary tract structural anomalies.

A child is standing playing with toys and suddenly collapses. Attempts to engage the child in conversation are met with no response. Skin color indicates cyanosis. A preliminary assessment of the environment presents no specific issues. Based on this information, you would suspect that the child is? a.Experiencing seizure activity b.Potential aspiration of foreign body c.Potential allergic reaction d. traumatic injury

b.Potential aspiration of foreign body A child who is in severe respiratory distress as a result of foreign body aspiration will not be able to speak, become cyanotic and collapse. This would be considered a medical emergency. Playing with a toy may potentially lead to aspiration if the toy parts are smaller than the child's airway. Within that age group, it is likely that the child may place items in his/her mouth. There is nothing to suggest seizure activity, allergic reaction or traumatic injury.

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. Which response by the nurse is most accurate? a) "SCA is not inherited." b) "All siblings will have SCA." c) "There is a 25% chance of a sibling having SCA." d) "There is a 50% chance of a sibling having SCA."

c) "There is a 25% chance of a sibling having SCA." SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, there is a 25% chance that each subsequent child will have the disorder.

What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)? a. Reduce blood pressure b. Lower serum protein levels. c. Minimize excretion of urinary protein. d. Increase the ability of tissue to retain fluid.

c. The objectives of therapy for the child with MCNS include reducing the excretion of urinary protein, reducing fluid retention, preventing infection, and minimizing complications associated with therapy. Blood pressure is usually not elevated in minimal change nephrotic syndrome. Serum protein levels are already reduced as part of the disease process. This needs to be reversed. The tissue is already retaining fluid as part of the edema. The goal of therapy is to reduce edema.

Which is caused by a virus that primarily infects a specific subset of T lymphocytes,the CD4+T cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

c. Acquired immunodeficiency syndrome (AIDS) AIDS is caused by the human immunodeficiency virus (HIV), which primarily attacks the CD4+T cells.

Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

c. Adequate dosage will turn the stools a tarry green color. The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced, then gradually increased as the child develops tolerance. Liquid preparations of iron stain the

Emma, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

c. At this age children often need the comfort and reassurance of familiar toys from home. Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

8. Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries

c. Atrial septal defect ANS: C Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higherpressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. Pulmonicstenosis is an obstruction to blood flowing from the ventricles. Tricuspid atresia results in decreasedpulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

A 12 year old child is in the urgent care clinic with a complaint of fever, headache, and sore throat. A diagnosis of group A beta-hemolytic streptococcus *GABHS pharyngitis is established with a rapid strep test, and oral penicillin is prescribed. The nurse knows which of the following statements about GABHS is correct? a. children with a GABHS infection are less likely to contract the illness again after the antibiotic regimen is completed b. a follow up throat culture is recommended following the completion of antibiotic therapy c. Children with a GABHS infection are at increased risk for the deelopment of rheumatic fever and glomerulonephritis d. Children with a GABHS infection are at increased risk for the development of rheumatoid arthritis in adulthood.

c. Children with a GABHS infection are at increased risk for the development of rheumatic fever and glomerulonephritis

The nurse is teaching parents of an infant about the causes of iron-deficiency anemia.Which statement best describes iron-deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of an infant's emaciated appearance. c. Clinical manifestations are similar regardless of the cause of the anemia. d. Clinical manifestations result from a decreased intake of milk and the pretermaddition of solid foods.

c. Clinical manifestations are similar regardless of the cause of the anemia. In iron-deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlyingcause. Usually the hematopoietic system is not depressed in iron-deficiency anemia. The bone marrow produces red cells that are smaller and contain less hemoglobin than normal red cells. Children who are iron deficient from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories, but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, the nurse should prepare which medication for immediate administration? a. Diphenhydramine (Benadryl) b. Dobutamine (Dobutarex) c. Epinephrine (Adrenalin) d. Calcium chloride (calcium chloride)

c. Epinephrine (Adrenalin) After the first priority of establishing an airway, administration of epinephrine is the drug of choice. Diphenhydramine, an antihistamine, is usually not used for severe reactions. Dobutamine and calcium chloride are not appropriate drugs for this type of reaction.

Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a.Risk for Injury related to malignant process and treatment b.Fluid Volume Deficit related to excessive losses c. Fluid Volume Excess related to decreased plasma filtration d.Fluid Volume Excess related to fluid accumulation in tissues and third spaces

c. Fluid Volume Excess related to decreased plasma filtration Glomerulonephritis has a decreased filtration of plasma, which results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration.

During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staffs attention. Now the nurse observes that Eric appears to be settled in and unconcerned about seeing his parents. The nurse should interpret this as which of the following? a. He has successfully adjusted to the hospital environment. b. He has transferred his trust to the nursing staff. c. He may be experiencing detachment, which is the third stage of separation anxiety. d. Because he is at home in the hospital now, seeing his mother frequently will only start the cycle again.

c. He may be experiencing detachment, which is the third stage of separation anxiety. Detachment is a behavioral manifestation of separation anxiety. Superficially it appears that the child has adjusted to the loss and transferred his trust to the nursing staff. Detachment is a sign of resignation, not contentment. Parents should be encouraged to be with their child. If parents restrict visits, they may begin a pattern of misunderstanding the childs cues and not meeting his needs.

The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia? a. Sickle-shaped cells carry excess oxygen. b. Sickle-shaped cells decrease blood viscosity. c. Increased red blood cell destruction occurs. d. Decreased adhesion of sickle-shaped cells occurs.

c. Increased red blood cell destruction occurs. The clinical features of sickle cell anemia are primarily the result of increased red blood cell destructionand obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child? a. Stimulate appetite b. Detect evidence of edema. c. Minimize risk of infection. d. Promote adherence to the antibiotic regimen.

c. Minimize risk of infection. High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

A nurse is preparing to complete an admission assessment on a 2-year-old child. The child is sitting on the parent's lap. Which technique should the nurse implement to complete the physical exam? a. Ask the parent to place the child in the hospital crib. b. Take the child and parent to the exam room. c. Perform the exam while the child is on the parent's lap. d. Ask the child to stand by the parent while completing the exam.

c. Perform the exam while the child is on the parent's lap. The nurse should complete the exam while the child is on the parent's lap. For young children, particularly infants and toddlers, preserving parent-child contact is the best means of decreasing the need for or stress of restraint. The entire physical examination can be done in a parent's lap with the parent hugging the child for procedures such as an otoscopic examination. Placing the child in the crib, taking the child to the exam room, or asking the child to stand by the parent would separate the child from the parent and cause anxiety.

Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolongedbleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon-shaped

c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two mostcommon forms of the disorder are factor VIII deficiency, hemophilia A or classic hemophilia; and factorIX deficiency, hemophilia B or Christmas disease. The inheritance pattern is X-linked recessive. Thedisorder involves coagulation factors, not platelets, and does not involve red cells or the Y chromosomes.

A chest radiograph film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" The nurse's response should be based on knowledge that the x-ray film will show: a. bones of chest but not the heart. b. measurement of electrical potential generated from heart muscle. c. permanent record of heart size and configuration. d. computerized image of heart vessels and tissues.

c. permanent record of heart size and configuration. A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated from heart muscle. Echocardiography will produce a computerized image of the heart vessels and tissues by using sound waves.

Which statement made by a parent indicates an understanding about treatment of streptococcal pharyngitis? a."I guess my child will need to have his tonsils removed." b."A couple of days of rest and some ibuprofen will take care of this." c."I should give the penicillin three times a day for 10 days." d."I am giving my child prednisone to decrease the swelling of the tonsils."

c."I should give the penicillin three times a day for 10 days."

Which therapeutic management should the nurse prepare to initiate first for a child with acute diarrhea and moderate dehydration? a.Clear liquids b.Adsorbents, such as kaolin and pectin c.Oral rehydration solution (ORS) d.Antidiarrheal medications such as paregoric

c.Oral rehydration solution (ORS) ORS is the first treatment for acute diarrhea. Clear liquids are not recommended because they contain too much sugar, which may contribute to diarrhea. Adsorbents are not recommended. Antidiarrheals are not recommended because they do not get rid of pathogens.

An infant is brought to the emergency department with dehydration. Which physical assessment finding does the nurse expect? a.Weight gain b.Bradycardia c.Poor skin turgor d.Brisk capillary refill

c.Poor skin turgor Clinical manifestations of dehydration include poor skin turgor, weight loss, lethargy, and tachycardia. The infant would have prolonged capillary refill, not brisk.

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is: a.not necessary because of child's age. b.not necessary because colostomy is temporary. c.necessary because it will be an adjustment. d.necessary because the child must deal with a negative body image.

c.necessary because it will be an adjustment.

The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a.poor appetite. b.increased potassium intake. c.reduction of edema. d.restriction to bed rest.

c.reduction of edema. This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 lb in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.

A child is being treated for burns in the emergency room. The parents have provided information relative to the origin of the burn event but the patterns of injury are not consistent with their description. The nurse would suspect that: a. the parents are too upset to provide information at this time, so additional questions can be answered later. b. the child may have not told the parents the truth about the event. c.there may be a potential for abuse and as such requires follow up. d.there is no real concern as the burn injuries are minimal and non life threatening.

c.there may be a potential for abuse and as such requires follow up. Anytime burn pattern injuries do not correlate with the provided information of the event, there is a potential for suspecting abuse. As such the nurse should be cognizant of this fact and follow up accordingly. Being upset would be a reasonable parent response but the physical evidence should coincide with the provided description. Suspecting that the child (victim) is not telling the truth would not be a concern unless additional evidence would be presented that would support that conclusion. Even if the burn injuries are not considered to be life-threatening, health care providers take the issue of suspected abuse very seriously and it must be reported and followed through as part of professional practice guidelines.

A child with β-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine (Desferal) therapy. The child's parents ask the nurse what deferoxamine does. The most appropriate response by the nurse is a) "The medication helps to prevent blood transfusion reactions." b) "The medication stimulates red blood cell production." c) "The medication provides vitamin supplementation." d) "The medication helps to prevent iron overload."

d) "The medication helps to prevent iron overload."A side effect of hypertransfusion therapy is often iron overload. Deferoxamine is an iron-chelating drug that binds excess iron; therefore, it can be excreted by the kidneys.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. The nurse should explain that this is a) a symptom of iron deficiency anemia. b) an adverse effect of the iron preparation. c) an indicator of an iron preparation overdose. d) a normally expected change due to the iron preparation.

d) a normally expected change due to the iron preparation.

What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome? a. Low specific gravity b. Decreased hemoglobin c. Normal platelet count d. Reduced serum albumin

d. Total serum protein concentrations are reduced, with the albumin fractions significantly reduced. Specific gravity is high and proportionate to the amount of protein in the urine. Hemoglobin and hematocrit are usually normal or elevated. The platelet count is elevated as a result of hemoconcentration.

The physician suggests that surgery be performed for patent ductus arteriosus to prevent which of the following complications? a. Pulmonary infection b. Right-to-left shunt of blood c. Decreased workload on left side of heart d. Increased pulmonary vascular congestion

d. Increased pulmonary vascular congestion A patent ductus arteriosus (PDA) allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary vascular congestion can occur.

The nurse is recommending how to prevent iron-deficiency anemia in a healthy, term,breastfed infant. Which should be suggested? a. Iron (ferrous sulfate) drops after age 1 month b. Iron-fortified commercial formula by age 4 to 6 months c. Iron-fortified infant cereal by age 2 months d. Iron-fortified infant cereal by age 4 to 6 months

d. Iron-fortified infant cereal by age 4 to 6 months Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. The mother can supplement the breastfeeding with iron-fortified infant cereal. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated. Providing iron-fortified commercial formula by age 4 to 6 months should be done only if the mother is choosing to discontinue breastfeeding.

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? a. Atrophic changes in the mucosal wall of the intestines b. Hypoactivity of the autonomic nervous system c. Hyperactivity of the apocrine glands d. Mechanical obstruction caused by increased viscosity of exocrine gland secretions

d. Mechanical obstruction caused by increased viscosity of exocrine gland secretions Children with cystic fibrosis have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas. Thick mucous secretions are the probable cause of the multiple body system involvement, not atrophic changes in the intestinal mucosal walls. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The apocrine, or sweat, glands are not hyperactive. The child loses a greater amount of salt due to abnormal chloride movement.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints

d. Painful swelling of hands and feet; painful joints A vasoocclusive crisis is characterized by severe pain in the area of involvement. If in the extremities,painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vasoocclusive phenomena.

What does the surgical closure of the ductus arteriosus do? a. Stop the loss of unoxygenated blood to the systemic circulation b. Decrease the edema in legs and feet c. Increase the oxygenation of blood d. Prevent the return of oxygenated blood to the lungs

d. Prevent the return of oxygenated blood to the lungs ANS: D The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood(from the aorta) will return to the lungs through the pulmonary artery. The aorta carries oxygenated blood to the systemic circulation. Because of the higher pressure in the aorta, blood is shunted into the pulmonary artery and the pulmonary circulation. Edema in the legs and feet is usually a sign of heart failure. This repair would not directly affect the edema. Increasing the oxygenation of blood would not interfere with the return of oxygenated blood to the lungs.

Which age group should the pediatric nurse recognize as being vulnerable to events that lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children

d. School-age children When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected to different extents by loss of power, are not as significantly affected as are school-age children.

Which is considered a mixed cardiac defect?- a. Pulmonic stenosis- b. Atrial septal defect- c. Patent ductus arteriosus- d. Transposition of the great arteries

d. Transposition of the great arteries

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is: a. low Fowler's. b. prone.- c. supine.- d. squatting.

d. squatting. The squatting or knee-chest position decreases the amount of blood returning to the heart and allows the child time to compensate.

Which therapeutic management treatment is implemented for children with Hirschsprung disease? a.Daily enemas b.Low-fiber diet c.Permanent colostomy d.Surgical removal of affected section of bowel

d.Surgical removal of affected section of bowel Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. The colostomy that is created in Hirschsprung disease is usually temporary.

The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn? a.Absence of a urethral opening is noted. b.Penis appears shorter than usual for age. c.The urethral opening is along the dorsal surface of the penis. d.The urethral opening is along the ventral surface of the penis.

d.The urethral opening is along the ventral surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias refers to the urethral opening, not to the size of the penis. Urethral opening along ventral surface of penis is known as epispadias.