practice questions for test 3
the nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. which statement made by the parents indicates a need for further instructions? A. a balance of rest and exercise is important B. i can apply lotion or powder to the incision if it is itchy C. activities in which my child could fall need to be avoided for 2-4 weeks D. large crowds of people need to be avoided for at least 2 weeks after surgery
B
the nurse understands that which information collected during the assessment of a child recently diagnosed with glomerulonephritis is most often associated with the diagnosis? A. child fell off a bike onto the handlebars B. nausea and vomitting for the last 24 hours C. urticaria and itching for 1 week before diagnosis D. streptococcal throat infections 2 weeks before diagnosis
D
A 2-year-old child is being discharged home and will have palliative surgery for tetralogy of Fallot at a later date. The mother wants to know about how much physical activity she can allow for the child. The nurse's best answer is "Allow the child to regulate her activity." "Keep her on complete bedrest." "Limit her activities to a few hours." "Keep the child from crying."
"Allow the child to regulate her activity." Although a child requiring surgery for tetralogy of Fallot may have a need for additional services, such as supplemental oxygen at home, the child should be able to play and move about in the environment to meet both physiological and developmental needs.
A 7-year-old client is diagnosed with rheumatic fever. The physician orders throat cultures of all family members. The nurse explains that: "Family members can carry streptococcus and be asymptomatic." "The child must have infected others." "Rheumatic fever is familial." "Family members can carry the virus for rheumatic fever."
"Family members can carry streptococcus and be asymptomatic." Rheumatic fever is an inflammatory response of collagen tissue after experiencing a streptococcal infection. Some members of the family may be asymptomatic carriers.
the nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. the nurse should use which most appropriate method to assess the urine output? A. weighing the diapers B. inserting a foley catheter C. comparing intake with output D. measuring the amount of water added to formula
A
the nurse is reviewing a health care providers prescription for a child with sickle cell anemia who was admitted to the hospital for the treatment of vast-occlusive crisis. which prescription documented in the childs record should the nurse question? select all that apply A. restrict flid intake B. position for comfort C. avoid strain on painful joints D. apply nasal oxygen at 2 L/minute E. provide a high calorie, high protein diet F. give mereperidine 25 mg intravenously every 4 hours for pain
A and F
A school-age child is admitted with a suspected acyanotic heart disease. After learning that the heart defect is a congenital disorder, the parents ask the nurse how they could have missed the problem all these years. The nurse's response should include the information that: Acyanotic heart disease may be asymptomatic. The child would only be cyanotic with great exertion. The parents should have recognized the symptoms associated with an acyanotic heart defect. The parents were probably ignoring the symptoms and hoping they would go away.
Acyanotic heart disease may be asymptomatic. Older children with acyanotic congenital heart disease may be asymptomatic, or manifest exercise intolerance, chest pain, arrhythmias, syncope, or sudden death.
A client is diagnosed with rheumatic fever and receiving salicylate therapy. Which evaluation would indicate a therapeutic response to this treatment? Alleviation of chorea. Increase in red blood cell count. Decrease in blood pressure. Alleviation of elevated temperature and arthralgia.
Alleviation of elevated temperature and arthralgia. Aspirin therapy is given to control joint inflammation and reduce fever.
After a pediatric client has a cardiac catheterization, which intervention would have the highest priority in the immediate postoperative period? Encourage intake of small amounts of fluid. Teach the parents signs of congestive heart failure. Monitor the site for signs of infection. Apply direct pressure to entry site for 15 minutes.
Apply direct pressure to entry site for 15 minutes. Direct pressure on wound site helps to form clot and reduce bleeding. Hemorrhage can be life-threatening in the immediate postoperative period.
the nurse reviews the record of a child who is suspected to have glomerulonephritis and expects to note which finding that is associated with this diagnosis? A. hypotension B. brown-colored urine C. low urinary specific gravity D. low blood urea nitrogen level
B
Which evaluation would indicate a toxic dose of digoxin? Tachycardia and dysrhythmia. Headache and diarrhea. Bradycardia and nausea and vomiting. Tinnitus and nuchal rigidity.
Bradycardia and nausea and vomiting. Signs of digoxin toxicity include bradycardia, arrhythmia, nausea, vomiting, anorexia, dizziness, headache, weakness and fatigue.
a 10 year old child with hemophilia A has slipped on the ice and bumped his knee. the nurse should prepare to administer which prescription? A. injection of factor X B. intravenous infusion of iron C. intravenous infusion of factor VIII D. intramuscular injection of iron using the z track method
C
on assessment of a child admitted with a diagnosis of acute stage kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? A. cracked lips B. normal appearance C. conjunctival hyperemia--red eyes D. desquamation of the skin
C
the clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis. the nurse expects to note documentation of which clinical manifestation specifically found in this disorder? A. pallor B. hyperactivity C. exercise intolerance D. GI disturbances
C
the nurse is monitoring an infant with congenital heart disease closely for signs of heart failure. the nurse should asses the infant for which early sign of heart failure? A. pallor B. cough C. tachycardia D. slow and shallow breathing
C
the nurse is providing home care instructions to the parents of a 10 year old child with hemophilia. which sport activity should the nurse suggest for this child? A. soccer B. basketball C. swimming D. field hockey
C. swimming -children with hemophilia need to avoid contact sports and to take precautions such as wearing elbow and knee pads and helmets with other sports
A toddler has been diagnosed with an acyanotic cardiac defect. Which assessment data would most likely indicate congestive heart failure? Heart murmur. Cardiac volume overload. Anuria. Excitability.
Cardiac volume overload. Congestive heart failure may occur when the amount of blood passing from left to right side of the heart overloads the pulmonary system.
Which assessment data will be most indicative of a potential complication of Kawasaki's disease? Dermatitis of extremities. Strawberry tongue, erythema of mouth. Change in blood pressure, pulse, skin color. Fever over 5 days, bilateral conjunctivitis.
Change in blood pressure, pulse, skin color. Cardiac involvement is the most serious complication. The other signs and symptoms are diagnostic indicators of Kawasaki's disease.
A child has been diagnosed with tetralogy of Fallot and is taking Prostaglandin 1 (Alprostadil). The child is very cyanotic, weak, and has moist respirations. Which evaluation would indicate a therapeutic response to this drug? Cyanosis does not increase. Blood pressure lowers. Respirations increase. Temperature drops.
Cyanosis does not increase. Prostaglandin 1 helps maintain ductus arteriosus open and thereby allows for mixing of blood. If the ductus arteriosus closes, cyanosis would increase.
a child with rheumatic fever will be arriving in the nursing unit for admission. on admission assessment the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? A. has the child complained of back pain? B. has the child complained of headaches? C. has the child had any nausea of vomitting? D. did the child have a sore throat or fever within the last 2 months
D
lab studies are performed for a child suspected to have iron deficiency anemia. the nurse reviews the lab results knowing that which results indicate this type of anemia? A. elevated hemoglobin level B. decreased reticulocyte count C. elevated red blood cell count D. red blood cells that are microcytic and hypochromic
D
the nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. which statement made by the parent indicates the need for further instructions? A. i will not mix the medication with food B. i will take my childs pulse before administration C. if more than one dose is missed i will call the health care provider D. if my child vomits after medication administration, i will repeat the dose
D
the nurse reviews the lab results for a child with suspected diagnosis of rheumatic fever knowing that which lab study would assist in confirming the diagnosis? A. immunoglobin B. RBC C. WBC D. anti-streptolysin O titer
D
the nurse analyzes the lab results of a child with hemophilia. the nurse understands that which result will most likely be abnormal in this child? A. platelet count B. hematocrit level C. hemoglobin level D. partial thromboplastin time
D. PTT -it refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins -abnormal lab results in hemophilia indicate a prolonged partial thromboplastin time. the platelet count, hemoglobin level, and hematocrit level are normal in hemophilia
a health care provider has prescribed oxygen as needed for an infant with heart failure. in which situation should the nurse administer the oxygen to the infant ? A. during sleep B. when changing the infants diapers C. when the mother is holding the infant D. when drawing blood for electrolyte level testing
D. because the baby will be crying
the clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. which if identified by the parents as a precipitating factor, indicates the need for further instruction? A. stress B. trauma C. infection D. fluid overload
D. fluid overlaod
The laboratory finding that would be seen in the cyanotic heart disease client but not in the acyanotic heart disease client would be a(an): Elevated pO2. Elevated hemoglobin. Decreased hematocrit. Decreased pCO2.
Elevated hemoglobin. Chronic hypoxemia leads to polycythemia.
A client is admitted with a diagnosis of "rule out rheumatic fever." Based on Jones criteria, the nurse assesses for: Polyarthritis and dental caries. Fever, headache, and low red blood cell count. Chorea, muscle weakness, and decreased erythrocyte sedimentation rate. Erythema, polyarthritis, and elevated antistreptolysin-O (ASO) titer.
Erythema, polyarthritis, and elevated antistreptolysin-O (ASO) titer. Jones criteria is a protocol to assist in identifying rheumatic fever. It consists of major symptoms, minor symptoms, and supporting evidence. Erythema, polyarthritis, and elevated ASO titer are among the major and minor symptoms and supporting evidence.
The nurse is developing a discharge plan for a family with a toddler who has undergone a successful repair of a ventricular septal defect (VSD). The parents question why the child is being sent home on antibiotics when no infection is present. The nurse would explain to the parents this is prophylactic to prevent the complication of: Infective endocarditis. Pulmonary embolism. Cerebrovascular accident. Gastritis.
Infective endocarditis. Infective endocarditis is the most common complication of the cardiac surgery. Children may need prophylactic antibiotic therapy for specific conditions as recommended by the American Heart Association.
A toddler with Kawasaki's disease is ordered to receive aspirin therapy. Typical administration of aspirin for Kawasaki's disease would include which of the following principles? High doses of aspirin should be given while fever is high. Length of aspirin therapy is related to child's response. Aspirin dose increases after fever is gone. Aspirin dosage is unrelated to platelet count.
Length of aspirin therapy is related to child's response. Aspirin therapy is ordered 80 to 100 mg/kg/day until fever drops. Then aspirin is continued at 10 mg/kg/day until platelet count drops. Aspirin is used as an anti-pyretic and anti agglutination drug.
A newborn with possible hypoplastic left heart disease is to be admitted to the nursing unit. Which drug should be available for use? Digitoxin (Crystodigin). Prostaglandin E1 (Prostin VR). Morphine. Testosterone (Andro).
Prostaglandin E1 (Prostin VR). Prostaglandin E1 prevents closure of ductus arteriosus and thereby allows for mixing of oxygenated and unoxygenated blood until palliative surgery can be done.
The mother asks the purpose of aspirin therapy in a child with rheumatic fever. The nurse explains that the purpose is to: Provide comfort and reduce temperature. Prevent cardiac complications. Hasten recovery. Prevent the development of chorea.
Provide comfort and reduce temperature. Aspirin is an antipyretic and an analgesic. It does not prevent complications, hasten recovery, or relate to the development of chorea.
An infant who has a congenital heart defect comes into the clinic with parental complaints of irritability, pallor, and increased cyanosis that began quickly over the last 30 minutes. As the nurse assesses the infant, the parent asks why the child's color is bluish. The best response by the nurse is, "Skin color is: Related to the time of day." Related to brain function." Related to hemoglobin level and oxygen saturation." Unrelated to your child's condition."
Related to hemoglobin level and oxygen saturation." The hemoglobin molecule carries oxygen. The oxyhemoglobin gives the skin the pink color. In the absence of oxyhemoglobin, the skin color darkens.
The nurse is developing a discharge teaching plan for the family of a child with Kawasaki's disease. Which of the following is the first priority? Teaching parents to administer aspirin and watch for side effects. Recommending the child avoid contact sports. Monitoring the child's temperature and notifying the doctor if it is over 98.6 degrees F. Establishing home schooling for 6 months.
Teaching parents to administer aspirin and watch for side effects. Aspirin is an anti-inflammatory and antipyretic. The child may experience bleeding and G.I. upset as side effects.
In assessing children with congenital heart defects, the nurse would expect to see clubbing of the fingers and toes in the child diagnosed with: Transposition of the great vessels. Atrial septal defect. Coarctation of the aorta. Patent ductus arteriosus.
Transposition of the great vessels. Clubbing of the fingers and toes occurs in cyanotic heart defects, such as transposition of the great vessels.
A child is being seen in the ambulatory clinic for a sore throat diagnosed as caused by group A beta hemolytic streptococcus. The nurse provides care with the understanding that the risk of developing rheumatic fever is greatest: Two weeks later. Prior to the administration of an antibiotic. Once the child has begun antibiotic therapy. With the onset of the strep infection.
Two weeks later. Rheumatic fever often follows 2 weeks after a streptococcal infection regardless of treatment.
A 3-month-old child was diagnosed with transposition of the great vessels. The mother cannot stop sobbing and tells the nurse she feels guilty about her child's condition. The nurse's best response is to: Agree that a teratogenic stressor could cause this. Disagree with her feeling quilt. Use therapeutic listening and support. Talk about the wonderful technology available for cures.
Use therapeutic listening and support. At this stage of grieving, the mother needs someone to listen and validate that her feelings are respected. Information will not be heard or remembered.
the nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. which instruction should the nurse tell the parents? A. administer the iron at mealtimes B. administer the iron through a straw C. mix the iron with cereal to administer D. add the iron to formula for easy administration
administer the iron through a straw -an oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because the iron stains the teeth -child should always brush teeth after administration
