PN108 PrepU Chapter 37

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess?

Strawberry tongue

The parents of a child with a bleeding disorder ask the nurse about appropriate activities and sports that they should encourage the child to participate in. What activity would be the safest for the nurse to suggest?

Swimming

A toddler diagnosed with beta thalassemia presents with hyperbilirubinemia, splenomegaly, hepatomegaly, delayed growth and sexual maturation, and abnormal facial appearance. The nurse interprets these findings as reflecting which category of the disease?

Thalessemia intermedia

A parent asks why their infant with a cyanotic heart defect turns blue. What is the best response by the nurse?

This is due to a decreased amount of oxygen to the peripheral tissue.

A patient with severe chronic anemia is receiving ongoing transfusion therapy. The nurse frequently assesses the patient for what major complication of this therapy?

Toxic iron overload

A 9-year-old girl is admitted to the hospital with a diagnosis of idiopathic thrombocytopenic purpura. When assessing her, a finding you would expect to discover is:

a hemorrhagic rash on the lower extremities.

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

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

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate?

"Because the baby grows rapidly during the first months, he uses up what you gave him."

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

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

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure?

"He gets sweaty when he eats."

The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching?

"I can have the nurse administer the chelation therapy if I am uncomfortable."

The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which statement by the mother indicates a need for further teaching?

"I need to feed him every hour to make sure he eats enough."

A child is to receive oral iron therapy in liquid form three times a day. After teaching the parents about administering the iron, which statement indicates a need for additional teaching?

"She can drink the medicine from a medicine cup."

The nurse is caring for a 2-year-old with sickle cell anemia and describing the acute and chronic manifestations of sickle cell anemia to his mother. Which statement by the mother indicates a need for further teaching?

"The acute manifestations, like splenic sequestration, are most often life-threatening."

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

"The baby seems more comfortable over my shoulder."

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed?

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

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching?

"We will place the liquid in the front of her gums, just below her teeth."

A child abruptly develops miniature petechiae over his legs, along with epistaxis and bleeding into the joints. Laboratory results reveal a platelet count of 20,000/mm3. The child is eventually diagnosed with idiopathic thrombocytopenic purpura (ITP). The mother of the child is distraught and asks the nurse what the course of this disorder typically is. What should the nurse tell the mother?

1 to 3 months

The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally?

150 mL/kg of fluids

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

80 beats per minute.

A nurse is reviewing laboratory test results from several children, looking specifically at their thrombocyte levels. The nurse would identify that the child with which platelet level might be at risk for bleeding? Select all that apply.

80,000 per cubic millimeter 110,000 per cubic millimeter

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

Activity intolerance related to inability of heart to sustain extra workload

A nurse is assessing an 8-year-old child brought to the emergency department by his mother. The child has a history of sickle-cell anemia and reports acute back pain and joint pain. His mucous membranes are dry; skin turgor is poor. Capillary refill is slowed and nail beds are pale. The child is diagnosed with sickle-cell crisis. Which nursing diagnosis would the nurse most likely identify as a priority?

Acute pain related to effects of sickling

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant?

Administer oxygen.

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

Administering oxygen Administering analgesics Maintaining fluid intake

A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify what as a major Jones criterion?

Arthralgia

The nurse is caring for a 10-year-old boy with hemophilia. He asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend?

Baseball

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

Begin formulas with increased calories.

The nurse is caring for a child diagnosed with rheumatic fever. The nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse?

Carefully handle the child's knees, ankles, elbows and wrists when moving the child. Administer salicylates after meals or with milk

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order?

Deferasirox

A nursing student is reviewing information about medications used to treat congestive heart failure in children. The student demonstrates understanding of the information by identifying which drug as prescribed to increase myocardial contractility?

Digoxin

The nurse is administering medications to the child with congestive heart failure. Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?

Digoxin (Lanoxin)

While inspecting the skin of a child, the nurse notes blotchy areas of hemorrhage. The nurse documents these as which of the following?

Ecchymoses

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

Factor VIII

T/F: In hemophilia A, the classic form, only females manifest a bleeding disorder.

False

A nurse is assessing the history of a 7-year-old boy who is suspected of having a cardiovascular disorder. Which of the following findings would tend to indicate a cardiovascular disorder in this child? (Select all that apply.)

Fatigues easily after a short walk home from school A tendency to squat Periorbital edema

Which of the following would the nurse be least likely to assess in a child with a hematologic disorder?

Fever

A boy with hemophilia A is scheduled for surgery. Which precautions would you institute with him?

Handle him gently when transferring him to a stretcher.

A school nurse is caring for a child with a severe sore throat and fever. What action would the nurse recommend to the parent?

Have the child be seen by the primary care provider.

A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help you determine that he is actually taking it daily?

His stools will appear black.

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

Iliac crest

A 4-month-old baby is found to be anemic. Which of the following is the most likely cause of anemia in a child of this age?

Inadequate intake of dietary iron in the mother of the infant during late gestation

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

Intravenous immune globulin

The nurse is collecting data on a child who is noted to be lethargic and have inflammation of both eyes and a strawberry-colored tongue. These clinical manifestations suggest the child would likely have which of the following disorders?

Kawasaki disease

A child with sickle cell anemia comes to the emergency department for evaluation. The nurse suspects that the child is experiencing a vaso-occlusive crisis based on assessment of which of the following? Select all that apply.

Low back pain Fever Distended abdomen

A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding:

Removal or covering of flaking paint on the walls of the home

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority?

Risk for infection

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

Serum potassium level

Which statement is most accurate related to sickle cell disease?

Sickle cell disease is genetically inherited.

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

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

When caring for a child with Kawasaki Disease, which of the following would the nurse expect to include in the child's plan of care? Select all that apply.

Administration of intravenous gamma globulin (IVIG) Administration of high-dose aspirin therapy. Assessing for signs and symptoms of bleeding

An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits?

An enlarged spleen

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, what would the nurse identify as potentially interfering with the accuracy of the results?

Blood transfusion 1 month ago

After teaching the parents of a child diagnosed with sickle cell disease, the nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if the child develops which of the following? Select all that apply.

Chest pain Severe dizziness Sudden change in vision

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

Compression

A child is diagnosed with sickle-cell anemia. Which component of the blood, the one responsible for the transport of oxygen, is defective in this disorder?

Hemoglobin

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe? Select all that apply.

Intravenous immunoglobulin Acetaminophen Aspirin

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

Jerky movements of the face and upper extremities

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

Joints

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority?

Maintaining a fluid intravenous line

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

Tachycardia

For the child diagnosed with iron deficiency anemia, what would the nurse anticipate being done in treating this disorder?

The child would be given ferrous sulfate with orange juice between meals.

T/F: In von Willebrand's disease, girls exhibit unusually heavy menstrual flow.

True

T/F: The primary intervention for beta-thallasemia is a chronic transfusion program of packed white blood cells with iron chelation.

True

A 9-year-old child is diagnosed with von Willebrand's Disease (vWD) with the following characteristics: decreased quantities of all sizes of von Willebrand's factor multimers and decreased activity of von Willebrand's factor. The nurse identifies this as which type of vWD as being involved

Type I

The nurse is caring for a client who has leukemia. Which of the following nursing interventions should the nurse implement to decrease the likelihood of bleeding or injury? Select all that apply:

Use a soft, sponge-type brush or gauze strips to give oral care. Use mouthwash composed of hydrogen peroxide and saline solution. Apply pressure to sites of injections or venipunctures.

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?

nitiate pain assessment with a standardized pain scale.

When planning care for a child with idiopathic thrombocytopenic purpura, the nurse plans to teach her:

not to pick or irritate her nose.

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

petechiae.

The nurse is caring for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is:

slightly yellow sclerae

An infant girl is prescribed digoxin. The nurse would teach her parents that the action of this drug is to:

slow and strengthen her heartbeat.

Some children with iron-deficiency anemia may be prescribed iron dextran by injection. This should be injected

via Z-track technique.

A 3-year old female is brought to the emergency department by her parents. Assessment reveals bruising and bleeding from the nose and mouth. The nurse suspects which of the following?

von Willebrand disease