Evolve Module 5 & 6

34-3. The nurse is caring for a school-age child after a submersion injury causing the loss of circulatory and respiratory function for over 4 minutes. What assessments by the nurse would be indicated while caring for this child on life support? Select all that apply. A. Listen to breath sounds frequently. B. Monitor the child for hyperthermia during the first 12 hours after rescue. C. Watch for capillary refill to take no more than 2 seconds. D. Check for tachycardia. E. Maintain the body temperature between 36.5 and 37.4° C (97.7 and 99.3° F). F. Position the head midline with the head of the bed at 45 degrees.

A, C, D, E Breath sounds will be checked frequently to detect adventitious lung sounds as well as monitoring the need for suctioning or readjustment of the endotracheal tube. A capillary refill taking no more than 2-3 seconds is a desired goal. Checking for tachycardia is indicated. Maintaining the body temperature between 36.5 and 37.4° C (97.7 and 99.3° F) is desired. The child will be monitored for hypothermia during the early period after resuscitation. Positioning the head midline is done, but the head of the bed should be at 20-30 degrees.

46-7. A 3-week-old neonate has been admitted to the hospital because of an inability to feed well and not growing as expected. What actions should the nurse implement when caring for this infant with suspected heart failure? Select all that apply. A. Allow extra time to feed the infant. B. Hold the infant securely in a supine position during feeding. C. Allow 45 minutes for each feeding to provide the ordered amount of formula. D. Watch for diaphoresis or tachypnea while feeding the infant. E. Encourage the mother to breastfeed, but allow 30 minutes for the total feeding. F. Watch for signs of hunger and irritability soon after the feeding is finished.

A, D, E, F Allowing extra time to feed the infant should help the nurse provide the relaxed environment that this infant needs. Knowing that 30 minutes should be allocated for each feeding helps the nurse with time management. If diaphoresis or tachypnea is seen while the infant is feeding, then the infant may need a feeding tube to conserve energy. Encourage the mother to breastfeed, but allow 30 minutes for the total feeding. Signs of hunger and irritability soon after the feeding is finished may indicate that the feeding did not fill up the infant so that comfort and fullness would be felt. Holding the infant securely in an upright position may provide less stomach compression and improve respiratory effort during the feeding. Allow 30 minutes for each feeding to provide the ordered amount of formula

34-12. During a visit to a pediatrician's office, the mother of a toddler states that he has begun bumping into walls and doesn't have as much energy as he used to. Which question is most important for the nurse to ask initially? A. "Have you noticed your son chewing on anything unusual?" B. "How many hours at night does your son sleep?" C. "How often does your child bump into the walls?" D. "Does anyone else in the house have a neurologic problem?"

A. "Have you noticed your son chewing on anything unusual?" Ingesting unusual objects could provide a source of lead to the child. The lead can cause abnormal neurologic behaviors such as clumsiness and can cause anemia, which can be the reason for his decreased energy. The number of hours he sleeps has nothing to do with the cause but could be related to the anemia, which can cause fatigue. The frequency with which he bumps into the walls is good to know, but the nurse needs to focus on factors affecting ingestion of a toxic/poisonous substance. The nurse needs to focus on the toddler initially, but can ask this later.

45-1. The parent of a child with cystic fibrosis calls the clinic nurse and describes signs and symptoms of tachypnea, tachycardia, dyspnea, pallor, and cyanosis. What does the nurse suspect the child is experiencing? A. A pneumothorax B. Bronchodilation C. Carbon dioxide retention D. Extremely thick sputum

A. A pneumothorax The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the symptoms listed. Carbon dioxide retention would not produce the symptoms listed. An increased viscosity of sputum is characteristic of cystic fibrosis. The described change in respiratory status is potentially due to a pneumothorax (collapsed lung).

45-2. A 4-year-old child needing to use a metered-dose inhaler to treat asthma cannot coordinate her breathing to use it effectively. The appropriate intervention by the nurse is to use which piece of respiratory equipment? A. A spacer B. A nebulizer C. A peak expiratory flowmeter D. An incentive spirometer

A. A spacer The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. This is a measure of pulmonary function not related to medication administration. This item helps patients to increase their lung expansion and to be able to see their progress.

34-7. A child is experiencing a sudden severe nosebleed (epistaxis). Which action should the nurse take to stop it? A. Have the child sit up and lean forward. B. Apply ice under the nose and above the lip. C. Have the child lie down quietly with feet elevated. D. Apply continuous pressure to the nose for at least 1 minute.

A. Have the child sit up and lean forward. The position used to prevent the child from aspirating the blood is to have the child sit up and lean forward. Pressure is indicated and ice is not. Lying down could potentially lead to aspiration. Continuous pressure for 10 minutes is recommended.

46-11. As part of the treatment for congestive heart failure, a child is taking the diuretic furosemide (Lasix). As part of the discharge teaching plan, what should the nurse explain as the function of furosemide (Lasix)? A. It is a diuretic, which means that it eliminates extra fluid from the body. B. It is a beta blocker, which decreases the child's blood pressure. C. It is a form of digitalis that regulates the heart rate and rhythm. D. It is an ACE inhibitor, which regulates the amount of fluid that goes through the kidney.

A. It is a diuretic, which means that it eliminates extra fluid from the body. Furosemide (Lasix) is a diuretic used to eliminate excess water and salt to prevent re-accumulation of the fluid. A beta blocker reduces the heart rate or force. It is used to prevent, manage, or treat angina, hypertension, or arrythmias. An ACE (angiotensin converting enzyme) inhibitor treats high blood pressure. Digitalis is a medication that regulates the heart rate so that each heartbeat is effective.

45-8. The parents of a child who is newly diagnosed with cystic fibrosis ask what is happening within the body that causing effects in multiple organ systems. Which response by the nurse is most accurate? A. Mechanical obstruction is caused by increased viscosity of mucous gland secretions. B. Atrophic changes occurs in the mucosal wall of intestines and alveoli. C. There is decreased activity of the autonomic nervous system. D. The hyperactivity of sweat glands causes major fluid loss.

A. Mechanical obstruction is caused by increased viscosity of mucous gland secretions. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas. Thick mucous secretions are the probable cause of the multi-system involvement. There is an identified autonomic nervous system anomaly, but it is not decreased. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement.

46-4. A child is being watched for possible heart failure. Which sign would alert the nurse that congestive heart failure could be developing? A. Tachypnea B. Bradycardia C. Inability to sweat D. Increased urine output

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

45-10. An infant with a congenital heart defect is receiving palivizumab (Synagis). Teaching by the nurse is correct if what information is discussed with the parents? A. This medication should prevent respiratory syncytial virus (RSV) infection. B. Synagis is known to prevent secondary bacterial infection. C. This drug minimizes the side effects of antiviral agents. D. This medication makes isolation of the infant with RSV unnecessary.

A. This medication should prevent respiratory syncytial virus (RSV) infection. Synagis is a monoclonal antibody specific for RSV. Monthly administration is initiated to prevent infection with RSV. The antibody is specific to RSV but not bacterial infection. Synagis does not decrease the side effects of antiviral agents. This drug will not affect the need to isolate the infant if RSV develops.

34-1. A child needs CPR because of an arrest in the pediatrician's office. What is the initial sequence of actions by the nurse doing CPR? Select all that apply. A. Provide 2 rescue breaths. B. Open the airway. C. Perform 30 chest compressions. D. Place the AED pads on the child.

B, A, C To avoid delays in initiating CPR, the American Heart Association (AHA) recommends the CAB sequence (circulation, airway, breathing) beginning with 30 chest compressions followed by opening the airway and 2 rescue breaths. The early initiation of high-quality chest compressions improves blood flow to vital organs and will improve the chances of survival. The AED pads can be placed after the first round of compressions.

45-11. A 7-month-old with laryngotracheobronchitis is admitted to the pediatric unit. What actions would the nurse expect to take while caring for this infant? Select all that apply. A. Administer nonhumidified oxygen. B. Listen to the lung sounds. C. Keep the crying infant in the crib. D. Assess hydration status. E. Monitor the heart rate after racemic epinephrine is given. F. Encourage the mother to hold the infant if helpful.

B, D, E, F Listening to the lung sounds is essential and needs to be done frequently and after any respiratory treatment. Because of the rapid respirations and drinking because of the illness, the infant could be dehydrated and the status must be checked every few hours. The heart rate increases after racemic epinephrine is given and must be monitored. Encourage the mother to hold the infant if it prevents crying and calms the infant. Humidified oxygen would be given. Prevent the infant from crying as much as possible.

46-8. The nurse is preparing to administer digoxin (Lanoxin) orally to a 9-month-old infant. The nurse checks the dose and prepares to draw up 4 mL of the drug. What are the most appropriate nursing actions? A. Mix the dose with several milliliters of juice to disguise the drug's taste. B. After checking the dosage with another nurse, hold the dose. C. Check the heart rate, and then administer the dose by placing it at the side of the mouth. D. Check the heart rate, and then give the dose by letting the infant suck it through a nipple.

B. After checking the dosage with another nurse, hold the dose. Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. Because it is a potentially dangerous drug, administration guidelines are very precise. Pediatric medication dosages should be checked with another licensed professional before administration. Checking the heart rate and administering the dose by placing it at the back and side of the mouth are correct procedures, but the dosage is too high. Checking the heart rate and administering the dose by letting the infant suck it through a nipple are correct procedures, but the dosage is too high. The dosage is too high and should not be given. The physician must be immediately notified about the dosage error so the infant can receive the dose needed as close to the administration schedule.

34-8. A father phones the pediatrician's office and says his son just knocked out a permanent tooth. What directions should the office nurse give to the father? A. Rinse the tooth in hot water. B. Hold the tooth by crown and not by root area. C. Take the child and tooth to a dentist within 48 hours. D. Take the child to a hospital emergency department if his mouth is bleeding.

B. Hold the tooth by crown and not by root area. The root area should not be touched. Not rinsed, not cleaned, not touched. Rinsing with hot water will destroy the root and thus the viability of the tooth. The current direction from the American Dental Association is to place the tooth in a cool glass of milk (not cold) rather than water and take the child and the tooth to the dentist on an emergency basis. Reimplantation should occur within 30 minutes by the child, parent, or nurse and stabilized by a dentist as soon as possible. The child needs to be seen by a competent dentist, not an emergency room physician, as soon as possible, regardless of whether he is still bleeding.

45-9. Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. What should be part of the discharge teaching by the nurse for the parents? A. Having the infant in the same room with adults at all times B. How to perform infant cardiopulmonary resuscitation C. Reassurance that the infant cannot be electrocuted during monitoring D. Advising that the infant not be left with other caretakers, such as babysitters

B. How to perform infant cardiopulmonary resuscitation CPR is essential for parents and caregivers to know. The monitor is insulated and grounded. The parents should arrange for other caregivers to help out. All need to be taught how to use the monitoring equipment and how to perform CPR. The infant should be nearby, with the monitored alarm loud enough to always be heard.

46-5. The nurse is caring for three children with cardiac conditions who are taking digoxin (Lanoxin). Prior to giving the medication, the nurse would check which lab results because of the risk for digoxin toxicity? A. Hemoglobin and hematocrit B. Potassium and magnesium C. Glucose and phosphorus D. BUN and platelets

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

45-3. The mother of a 20-month-old child tells the nurse that the child has a barking cough at night and has a temperature of 37° C (98.6° F). Suspecting the child has croup, what should the nurse instruct the mother to do? A. Control the fever with acetaminophen, and call if the cough gets worse tonight. B. Try a cool-mist vaporizer at night and watch for signs of difficulty breathing. C. Try over-the-counter cough medicine, and come to the clinic tomorrow if there is no improvement. D. Take the child to the hospital in case epiglottitis occurs.

B. Try a cool-mist vaporizer at night and watch 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. Cough suppressants are not indicated. A barking cough and temperature of 37° C are characteristic of laryngotracheobronchitis (croup) and not epiglottitis. The child does not have a fever that needs to be managed.

45-6. Because absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, the nurse reinforces the physician's orders. Teaching by the nurse is correct if which vitamin supplementation is explained? A. C, D B. A, E, K C. A, D, E, K D. C, folic acid

C. A, D, E, K A, D, E, and K are the fat-soluble vitamins that need to be supplemented. C and folic acid are not fat-soluble. C is not one of the fat-soluble vitamins. D also needs to be supplemented.

46-10. Education for the parents of children with cardiac problems is focusing on the primary therapy for secondary hypertension. Nursing care is correct if which instructions are provided? A. Eat a diet that contains low amounts of salt. B. Reduce body weight to a normal weight. C. Determine and then treat the underlying cause. D. Increase gentle exercise and therefore fitness.

C. Determine and then treat the underlying cause. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be controlled. The low-salt diet, weight reduction, and increased exercise and fitness are usually effective for essential (primary) hypertension.

34-11. A nurse is caring for a 2-year-old child who is unconscious but stable after a car accident. The child's parents are staying at the bedside most of the time. Which nursing intervention is appropriate? A. Suggest that the parents go home until the child is alert enough to know they are present. B. Use ointment on the child's lips, but do not attempt to cleanse the teeth until swallowing returns. C. Encourage the parents to hold, talk, and sing to the child as they usually would. D. Position the child with proper body alignment and the head of bed lowered 15 degrees.

C. Encourage the parents to hold, talk, and sing to the child as they usually would. The parents should be encouraged to interact with their child. Senses of hearing and tactile perception may be intact, and stimulation of these senses is important. It is not recommended to suggest the parents go home until the child is alert. The child may be able to hear that they are present. Oral care is essential in the unconscious child. Mouth care should be done at least twice daily. The head of the bed should be elevated, not lowered.

34-4. Parents bring their diabetic child with suspected ketoacidosis to the emergency room for the second time in 9 months. When interacting with the parents and the child, the nurse understands that which concept will guide further parent teaching? A. This is a somewhat expected outcome and indicates fair diabetic control. B. The parents should know that this condition will stabilize easily in the hospital. C. This is a life-threatening situation that indicates poor management of the diabetes. D. This condition is best treated at a physician's office or clinic when the child is an adolescent.

C. This is a life-threatening situation that indicates poor management of the diabetes. Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement. Diabetic ketoacidosis is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. Any diabetic ketoacidosis indicates poor control of the diabetes. Age of the child has nothing to do with where it should be treated, since it is always a medical emergency.

34-2. A child is being reassessed after treatment for hypovolemic shock. Which patient data should the nurse recognize as an early clinical sign of compensated shock? A. Confusion B. Sleepiness C. Hypotension D. Apprehension

D. Apprehension Apprehension is indicative of compensated shock. Confusion is indicative of uncompensated shock. Sleepiness is not an indication of shock. Hypotension may be a symptom of decompensated shock.

46-3. The nurse is caring for an infant with an acyanotic heart defect. Why must the nurse continue to monitor this infant's mucous membranes, fingers, and toes? A. Because it explains the hemodynamics involved B. Because cyanotic defects are easily identified C. Because that is part of the standardized assessment D. Because children with acyanotic heart defects may have cyanosis if another cardiac problem arises or if the current one becomes worse

D. Because children with acyanotic heart defects may have cyanosis if another cardiac problem arises or if the current one becomes worse Children with traditionally named acyanotic defects may be slightly cyanotic, and children with traditionally classified cyanotic defects may appear pink, although they may eventually become cyanotic. It is most important to document specific assessment findings and let the classification be specified by the cardiologist. The classification does not reflect the path of blood flow within the heart. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Although these components are assessed regularly when an infant has a cardiac problem, the reason is that cyanosis can occur if the cardiac problem becomes worse in some cases.

34-6. The school nurse is called to the cafeteria because a child "has eaten something & is experiencing sudden difficulty breathing." What should be the first action by the nurse? A. Determine what the child has eaten. B. Administer diphenhydramine (Benadryl). C. Move the child to the nurse's office or hallway. D. Have someone call 9-1-1 while staying with the child.

D. Have someone call 9-1-1 while staying with the child. Because the child is in severe respiratory distress, the nurse should remain with the child while someone else calls for emergency medical services. Because severe respiratory distress is occurring, treatment of the response is indicated first. The cause of the response can be determined later. Diphenhydramine will not be effective for this type of allergic reaction. Moving the child will not improve respiratory status.

46-9. The mother of an infant who is to have surgery for a patent ductus arteriosus (PDA) asks what the beneficial effect of performing surgery is. Which statement by the nurse best explains prevention of which complication by performing the surgery? A. Pulmonary infection B. Right-to-left shunting of the blood C. Decreased workload on left side of the 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 congestion can occur. The increased pulmonary vascular congestion is the primary complication. The blood is shunted left to right. The increased pulmonary vascular congestion is the primary complication.

45-4. A teenager with asthma is having pulmonary function tests and asks about the phrase, forced expiratory volume, that the physician used. Which response by the nurse most accurately explains the purpose of the forced expiratory volume (FEV1)? A. It confirms the diagnosis of asthma. B. It determines whether allergy is causing the asthma. C. It identifies what part of the lung is affected by the asthma. D. It assesses the severity of asthma.

D. It assesses the severity of asthma. The forced expiratory volume measures the maximum amount of air that can be forcefully exhaled in the first second. This can provide an objective measure of pulmonary function compared with the child's baseline. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The cause of asthma is inflammation, bronchospasm, and obstruction but not allergy. The FEV does not identify specific structures affected by the asthma.

45-12. The mother of a child with acute streptococcal pharyngitis being treated with antibiotics asks why all of the antibiotic needs to be taken. What is the best response by the nurse? A. It decreases the chance of acquiring otitis media. B. It prevents diabetes insipidus. C. It decreases the chance of nephrotic syndrome. D. It prevents the child from getting acute rheumatic fever.

D. It prevents the child from getting acute rheumatic fever. Children with group A beta-hemolytic streptococcus (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a sequela to group A beta hemolytic streptococcus (GABHS). Diabetes insipidus is not a sequela to GABHS. Children are at risk for glomerulonephritis and not nephrotic syndrome.

45-5. The parents ask why a humidified atmosphere is recommended for their infant with an upper respiratory tract infection. What is the best response by the nurse? A. It liquefies secretions. B. It improves oxygenation. C. It promotes ventilation. D. It soothes inflamed mucous membranes.

D. It soothes inflamed mucous membranes. By humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed. The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation.

46-1. A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. What position would the nurse expect the child to assume? A. Low Fowler's B. Prone C. Supine D. Knee-chest

D. Knee-chest The squatting or knee-chest position decreases the amount of blood returning to the heart and allows the child time to compensate. Low Fowler's position would assist with respiratory issues but would not assist with the need for cardiac compensation. Prone does not offer any advantage to the child. Supine does not offer any advantage to the child.

34-10. A toddler has a deep laceration contaminated with dirt and sand. Before suturing is done, what should the nurse use to irrigate the wound? A. Alcohol B. Hydrogen peroxide C. Povidone-iodine D. Normal saline

D. Normal saline Normal saline is the only acceptable fluid for irrigation listed. The nurse should cleanse the wound with a forced stream of sterile normal saline or sterile water. Alcohol should not be used because it is toxic to the wound. Hydrogen peroxide should not be used because it is toxic to the wound. Povidone-iodine should not be used because it is toxic to the wound.

34-9. A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated and drooling, and is sitting upright in a tripod position. What is the priority action by the nurse? A. Encourage the child to lie down to conserve energy. B. Examine the child's oral pharynx gently. C. Auscultate the lungs while the child is sitting upright. D. Notify a physician immediately but calmly.

D. Notify a physician immediately but calmly. Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency because the child's airway may be so inflamed that it closes, requiring intubation or a tracheostomy. Calmness around the child is important. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Examination of the oral pharynx may cause total obstruction. Preparations should be made in anticipation of an obstruction.

46-13. The nurse is planning care for infants and children with congestive heart failure. Nursing care is correct if the nurse takes which approach? A. Forcing fluids appropriate for the patient's age B. Monitoring respirations during active periods C. Giving larger feedings less often to conserve energy D. Organizing activities to allow for uninterrupted sleep

D. Organizing activities to allow for uninterrupted sleep The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to facilitate a decrease in the child's energy expenditure which is known as clustering care. The child who has congestive heart failure has an excess of fluid. Monitoring of vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings.

34-5. The nurse is watching an 11-month-old feed herself when she begins to choke. What immediate intervention by the nurse is indicated? A. Administer mouth-to-mouth resuscitation. B. Give water by cup to relieve the obstruction. C. Have the toddler lie quietly while a call is placed for emergency help. D. Position the infant in a head-down, face-down position, and administer five quick blows between the shoulder blades.

D. Position the infant in a head-down, face-down position, and administer five quick blows between the shoulder blades. The correct initial sequence of actions for an infant with an obstructed airway is to position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades using the palm. Mouth-to-mouth resuscitation should not be used. This may push the object farther into the child's respiratory system. If the child's airway is obstructed, the water will not be able to pass. This will increase the risk of aspiration. The infant will not be able to lie quietly and needs to receive treatment immediately. Emergency help is called after an attempt is made to remove the obstruction.

46-6. A nurse caring for a child post cardiac catheterization assesses that the distal pulse of the catheter site is weaker and capillary refill less than 3 seconds. What is the most appropriate nursing action? A. Elevate the affected extremity. B. Notify the physician of the observation. C. Apply warm compresses to insertion site. D. Record the assessment finding.

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

45-7. One of the goals for children with asthma is to prevent respiratory infections. Why is this information important for the nurse to include when teaching parents whose children have asthma? A. Respiratory infections trigger exercise-induced asthma. B. Allergen sensitivity is increased in the presence of infection. C. Asthma medication becomes less effective when a respiratory infection is present. D. Respiratory infections can trigger an episode or aggravate the asthmatic state.

D. Respiratory infections can trigger an episode or aggravate the asthmatic state. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. The infection affects the asthma, not the medications.

46-2. The nurse is caring for a child whose cardiac condition is classified as a mixed-blood cardiac defect. What diagnosis would the nurse expect to see on the patient's chart? A. Pulmonic stenosis B. Atrial septal defect C. Patent ductus arteriosus D. Transposition of the great arteries

D. Transposition of the great arteries Transposition of the great arteries allows the mixing of blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow.

46-12. The mother of a child who is to have an echocardiogram asks what the test will do. Which explanation by the nurse is best? A. The procedure uses high-frequency sound waves created by a transducer to produce an image of cardiac structures. B. The heart's electrical impulses are recorded on a screen, and a paper copy is also made. C. Your child's heart vessels are measured with a catheter threaded into the heart. D. Your child's heart structures will be painlessly visualized using sound waves while your child lies quietly on an exam table.

D. Your child's heart structures will be painlessly visualized using sound waves while your child lies quietly on an exam table. This is the clearest explanation without using technical terms. Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, diagnosis can sometimes be made without cardiac catheterization. The explanation is very technical. This is the description of electrocardiography, which is a tracing of the electrical path of the depolarization action of myocardial cells. This is the description of a cardiac catheterization, which is an invasive procedure in which a catheter is threaded into the heart.