EXAM3 FH

- Peak is taken 30 minutes - 1 hour AFTER THE FIRST DOSE - Trough taken 30 minutes - 1 hour BEFORE THE THIRD DOSE - Q: You are required to take the peak, the first dose was given at 9am when will you obtain the peak?

- Ans: 9:30-10:00 am

A nurse has a family of a different culture what is the first thing the nurse will do

- Ans: i put to assess her own culture/beliefs first (not too sure) - This goes back to culture practices from exam 1 so look over this

- Scenario of a toddler with a pot belly and you are explaining to parents why is the child's stomach is the way that it is

- Ans: the child's stomach muscles are weak

63.) The nurse notes that a 16-year-old male client is refusing visits from his classmates. Further assessment reveals that he is concerned about his edematous facial features. Based on the assessment findings, the nurse should plan interventions related to which nursing diagnosis? A.) social isolation B.) altered health maintenance C.) knowledge deficit D.) ineffective coping

A.) social isolation

65.) A nurse is assessing a 6-month-old infant. The nurse recognizes the posterior fontanel usually closes at which age? - The posterior fontanel closes first which is between 6-8 weeks of birth A.) 6 to 8 weeks B.) 8 to 10 months C.) 4 to 6 months D.) 10 to 12 weeks

A.) 6 to 8 weeks

41.) Baby Jane has an order for 500 cc D10W to run for 8 hours. The administration set yields 60 gtts/cc. The IV should be regulated to run at ______ gtts/min. A.) 63 B.) 47 C.) 125 D.) 82

A.) 63

A pediatric client is to begin digoxin therapy. The nurse is aware that which of the following labs is most necessary to evaluate prior to beginning the medication? A.) Potassium * B.) Calcium C.) BUN and creatinine D.) Digoxin level *

A.) Potassium *

A 8 year old has been diagnosed with congestive heart failure is receiving digoxin to enhance myocardial function. What is the priority nursing assessment prior to administering the medication? A.) apical pulse - Before giving the dose you take the apical pulse for a full minute - You need to make sure it's an appropriate apical pulse rate based on their developmental stage (for a 8 year old it should be above 80) B.) high pitched cry C.) liver function studies D.) pupillary response

A.) apical pulse

45.) When caring for a child that has just had a cardiac catheterization, which of the following would indicate a sign of complications? A.) decreased heart rate and diminished pedal pulse - Check the temperature, color, sensation, and pulses on the child's extremities and compare. Report any changes to the physician or nurse practitioner - With diminished pedal pulses it indicates oxygenated blood is not being delivered to extremities - With the surgery the HR was supposed to improve B.) syncope and tachypnea (^ respirations) C.) cold clammy skin and increased heart rate D.) diaphoresis and tachycardia (^ HR)

A.) decreased heart rate and diminished pedal pulse

The nurse expects a 2-year-old child to exhibit which behavior?

A.) display possessiveness with toys - Toddlers are egocentric, a normal part of their development. This makes it difficult for them to share. As they are developing a sense of self (who they are as a person), they may see their toys as an extension of themselves. - Learning to share occurs in later toddlerhood. Toddlers also like dramatic play and play that recreates familiar activities in the home.

33.) In planning anticipatory guidance for parents of a beginning school-age child, it is most important for the nurse to include which of the following? A.) give the child responsibility around the house B.) teach the child sex education at home C.) expect stormy behavior D.) teach the child to read and write

A.) give the child responsibility around the house

57.) Anxiety and fear of procedures and treatments in a hospitalized adolescent can be reduced significantly if the nurse A.) gives clear explanations before any procedures B.) uses drawings to explain procedures C.) plans a hospital tour with the adolescent and parents (maybe) D.) allows the adolescent the right to refuse to participate

A.) gives clear explanations before any procedures

61.) The nurse is teaching a 14-year-old who has new asthma diagnosis. The most appropriate nursing response regarding long term asthma medication treatment is? A.) inhaled steroids help to decrease inflammation B.) albuterol via nebulizer should be used daily - It should not because it is only used for emergency only C.) prelone is used only for asthma maintenance D.) singulair can be given for acute asthma exacerbations

A.) inhaled steroids help to decrease inflammation

46.) A 2-year-old child with Tetralogy of Fallot has an acute oxygen desaturation to 86% while having an IV placed. The first action by the nurse should be A.) place the child in knee-chest position B.) complete the IV insertion and call the physician C.) call an emergency code D.) start oxygen at 6 liters per cannula

A.) place the child in knee-chest position

32.) A child with congestive heart failure is placed on a low sodium, high potassium diet. Which of the menus below would be most appropriate? A.) turkey chili with pinto beans, carrot and raisin salad, apple juice B.) shrimp and macaroni casserole, celery sticks, orange juice C.) grilled hot dog, with mustard, oven fries, ad low fat milk D.) cheese nachos, avocado and sliced tomato, ginger ale

A.) turkey chili with pinto beans, carrot and raisin salad, apple juice

A child is admitted to the ER with status asthmaticus. Which of the following is a priority intervention?

Administer short acting B2 agonsists via nebulizer

59.) Which of the following outcomes is the primary criterion for evaluating the resolution of ineffective airway clearance? A.) clear airway sounds (maybe) B.) regular respirations C.) ability to cough effectively D.) resolved coughing

C.) ability to cough effectively

38.) Paula weighs 60 lbs and 4 ounces. She is to receive 20 mgs per kilogram of ampicillin in a 24-hour period. What is the maximum amount she can receive? A.) 1208 B.) 548 C.) 274 D.) 247

B.) 548

The nurse is auscultating the lungs of a lethargic, irritable 6 year old boy and hears wheezing. The nurse will most likely be including which teaching point if the child is suspected of having asthma A.) We're going to go take a look at your lungs to see if there are any sores on them B.) I'm going to have this hospital worker take a picture your lungs - He is still a preschooler so teaching will have to be broken down into simple directions C.) I'm going to hold your hand while the phlebotomist gets blood from your arm D.) I'm going to have the respiratory therapist get some of the mucous from your lungs

B.) I'm going to have this hospital worker take a picture your lungs

48.) The mother of a child diagnosed with acute streptococcal pharyngitis asks the nurse about her child returning to school. Which of the following is the appropriate response by the nurse? Your child can return to school A.) if no complications develop B.) after taking antibiotics for a full 24-hour period - Educate parents that children may return to daycare or school after they have been receiving antibiotics for 24 hours; they are considered non contagious at that point C.) after taking antibiotics for 3 days D.) when the sore throat is better

B.) after taking antibiotics for a full 24-hour period - Educate parents that children may return to daycare or school after they have been receiving antibiotics for 24 hours; they are considered non contagious at that point

54.) Which nursing intervention is therapeutic when caring for a hospitalized toddler? A.) insert a urinary catheter if bedwetting occurs during the hospitalization B.) allow the toddler to choose a colored band-aid after an injection C.) do not allow any toys to be brought in from the child's home D.) give abstract explanations to the child before any procedure E.) require parents to leave the room when performing invasive procedures

B.) allow the toddler to choose a colored band-aid after an injection

***A three year old with a diagnosis of ventricular septal defect has been admitted for a cardiac catheterization. All of the nursing care below is appropriate in the post catheterization period except: A.) administer fluids and foods as tolerated B.) assess pulses distal the popliteal and dorsalis pedal pulse C.) monitor branchial pulse for rate and rhythm for 1 full minute D.) perform range of motion exercises to all extremities This question was asked but instead of "EXCEPT" it was asking what is the 1st thing you will do

B.) assess pulses distal the popliteal and dorsalis pedal pulse

40.) The nurse caring for a child who has had a heart catheterization is aware that the child's activity level is A.) restricted to sitting in a chair for 4 hours after the procedure B.) bed rest with the affected extremity straight for 4 to 8 hours, subject to hospital policy and physician's orders - Maintain bed rest in the immediate post procedure period. Ensure that the child maintains the extremity in a straight position for approximately 4 to 8 hours, depending on the approach used C.) unrestricted because this is a minor procedure D.) restricted to being up and about with no exercise, lifting, or other activity, which would increase heart rate

B.) bed rest with the affected extremity straight for 4 to 8 hours, subject to hospital policy and physician's orders - Maintain bed rest in the immediate post procedure period. Ensure that the child maintains the extremity in a straight position for approximately 4 to 8 hours, depending on the approach used

55.) A nurse in an outpatient department is assessing a 2-year-old with cardiovascular disease. Which of the following assessments suggests presence of congenital heart disease? Some of the defects may result in significant hypoxemia, the sequelae of which include clubbing, polycythemia (excess amount of red blood cells), exercise intolerance, hypercyanotic spells, brain abscess, and cerebrovascular accident (CVA) A.) precordial chest wall expansion B.) clubbing of toes and fingers * C.) thready pulse (irregular pulse) * D.) edema in all lower extremities

B.) clubbing of toes and fingers *

56.) A mother brings her 10-year-old and 3-year-old daughters to the pediatrician's office because the younger girl complains of dysuria. The physician orders a catheterization to obtain a urine specimen. The nurse should take which of the following actions? A.) involve the girl's older sister in explaining the procedure B.) describe the procedure to the child in short, concrete terms while talking calmly C.) show the child a diagram of the urinary system D.) allow the child to play with the equipment during the procedure

B.) describe the procedure to the child in short, concrete terms while talking calmly

29.) The nurse is caring for a child with a diagnosis of bronchiolitis who is being managed at home. Which of the following strategies to foster adequate ventilation would be best for the nurse to suggest to the family? A.) installing an attic fan B.) raising the head of the child's bed - The child has the bronchioles inflamed, so you want to make sure they are able to have their lungs fully expanded to allow the lungs to breathe better. C.) administering oxygen therapy D.) having the child take a walk twice a day

B.) raising the head of the child's bed

47.) The parents of an 8-year-old girl tell the nurse that their daughter wants to join the soccer team. The nurse's suggestions regarding participation in sports at this age should include which of the following? A.) organized sports, such as soccer, are not appropriate at this age B.) sports participation is encouraged if the sport is appropriate to the child's ability C.) participation in sports should be limited, at this age, to prevent injuries D.) competition is detrimental to the establishment of a positive self image

B.) sports participation is encouraged if the sport is appropriate to the child's ability

***64.) A child is admitted to the pediatric unit with exacerbation of bronchial asthma. The nurse would expect to find which of the following? A.) the child is coughing up thick mucus - He would not be able to cough up anything if he has bronchial constriction B.) the child is not talkative and does not respond to questions C.) respirations with rales and rhonchi and inspiratory wheezing D.) peripheral cyanosis at fingers and around lips

B.) the child is not talkative and does not respond to questions

52.) A child with asthma is receiving an aminophylline drip and corticosteroids as part of their treatment regimen. The child has refused meals, stating, "My stomach feels sick" and is not sleeping well. Which of the following might the nurse think? A.) the child may want more attention B.) the child may be developing theophylline toxicity C.) the child may want mom to bring food from home D.) the child needs their nutrition

B.) the child may be developing theophylline toxicity

51.) The child with diabetes plays on a softball team. Team usually stops for pizza after the games. Her mother asks, "Is there any way my child can eat with the team?" Which of the following is the most appropriate response for the nurse to make? A.) let the child go with the team, but encourage her not to eat pizza B.) there are fast food exchange lists available for diabetic children C.) it would be best if the child ate at home where her diet can be controlled D.) fast foods are unhealthy for growing children especially if they are diabetic

B.) there are fast food exchange lists available for diabetic children

53.) Baby Jane, age 10 months, has congestive heart failure. The doctor has written an order for Lanoxin 0.5 mg PO qd. The stock medication of Lanoxin on the unit contains 50 micrograms/ml. Based on your conversions of the amount to administer, what would be the most appropriate action to take? A.) give the medication as ordered B.) withhold the medication and call the doctor to modify the order C.) have another nurse check the calculation with a calculator D.) check the pulse, if in sage range for age, give the medication

B.) withhold the medication and call the doctor to modify the order

20.) Calculate the safe dose range of acetaminophen for an infant who weighs 9 lbs in mls. Acetaminophen is available as 80 mg/0.8 ml. The safe dose range is 10 mg to 15mg/kg/dose q6 hour

C.) 0.4 ml to 0.6 ml

37.) Calculate the 24 hour maintenance fluid requirement for a child who weighs 32 lbs. A.) 2560 mls B.) 116 mls C.) 1163 mls D.) 1728 mg

C.) 1163 mls

50.) The nurse is assessing a 6-month-old healthy infant who weighed 7 pounds at birth. The nurse should expect the infant to now weigh approximately how many pounds? A.) 25 B.) 10 C.) 15

C.) 15

28.) The recommended dose of ampicillin is 100 mg/kg/24 hours. Mary weighs 20 lbs and 12 ounces. What is the maximum amount of ampicillin she can receive in 24 hours? Round Kg to nearest tenth. A.) 931 B.) 914 C.) 943 D.) 909

C.) 943

15.) The nurse in the outpatient clinic instructs the mother of a school aged diagnosed with asthma how to prevent future asthmatic attacks. The nurse is most concerned if the mother states which of the following? A.) My son plays the tuba in the grade school band B.) My son participates in after school activities 3 days a week C.) My son loves to help his dad rake leaves - There are triggers to the child raking leaves is an example D.) My son walks 1 mile to school every day with his friends

C.) My son loves to help his dad rake leaves

17.) The nurse is assessing a male adolescent client's knowledge of contraception. The teen states, "I have all the info I need." What is the best response by the nurse? (not on exam) A.) You need to visit with your guidance counselor B.) Do you know how to apply a condom? C.) Tell me what you know about birth control D.) Teen pregnancy should not be taken lightly

C.) Tell me what you know about birth control

62.) The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is which of the following? A.) notify the physician B.) place her in Trendelenburg position C.) apply direct pressure above catheterization site If bleeding occurs after a cardiac catheterization, apply pressure 1 in above the site to create pressure over the vessel, thereby reducing the blood flow to the area D.) apply a new bandage with more pressure

C.) apply direct pressure above catheterization site

42.) Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations regarding administration of this drug should include which of the following? A.) administer pancreatic enzymes between meals if at all possible B.) do not administer pancreatic enzymes if the child is receiving antibiotics C.) enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole D.) decreased dose of pancreatic enzymes if the child is having frequent, bulky stools

C.) enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole

36.) The nurse working with a child with laryngotracheobronchitis is offering the child tiny medicine cups of fluid and giving stickers and prizes for meeting goals related to intake of fluid. All this effort on the part of the nurse to get the child to drink more fluid is because the fluid is needed to (Croup is also referred to as laryngotracheobronchitis because inflammation and edema of the larynx, trachea, and bronchi occur as a result of viral infection) A.) maintain fluid balance B.) keep kidneys functioning C.) loosen secretions D.) prevent tachypnea

C.) loosen secretions

60.) The nurse is doing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. The nurse should interpret this as a(n): - Anterior fontanel closes last which takes months compared to the posterior fontanel that closes within weeks of birth - Anterior fontanel closes between 12-18 months A.) finding requiring a referral B.) normal finding, but requires rechecking in 1 month C.) normal finding D.) abnormal finding

C.) normal finding

30.) An 8-month-old is seen in the well-child clinic. Which of the following behaviors would the nurse expect to see? A.) feeds self with a spoon B.) says one word clearly C.) plays peek-a-boo D.) walk independently

C.) plays peek-a-boo

39.) A child with diabetes has joined a softball team. Her mother is unsure if the softball coach should be told about the child's condition. The nurse's response to this concern should be which of the following? A.) hyperglycemia can be treated promptly with a simple carbohydrate if symptoms are recognized by the coach B.) the child's coach might discuss her condition with other faculty members C.) the coach should be aware of manifestations of hypoglycemia D.) child would be dropped from the team if school officials learn about her condition

C.) the coach should be aware of manifestations of hypoglycemia

44.) The community nurse is teaching a group of adolescent mothers about snacks to include in their toddler's diets. Which would be most appropriate for the nurse to recommend? A.) hamburgers, fries and pizza B.) six servings of fruit juice and milk - Risk for obesity; is not good for them to take in that much juice C.) yogurt, cheese and bread with peanut butter if no known allergies D.) hot dogs, peanuts and carrot sticks - Choking hazard

C.) yogurt, cheese and bread with peanut butter if no known allergies

19.) The recommended dose of ampicillin is 20 mg to 30mg/kg/24 hours. Mary weighs 150 lbs. The safe therapeutic range (mgs/24 hours) the client should receive it ____ to _____ mgs A.) 1633 to 2045 mgs B.) 1363.5 to 2045 mgs C.) 1363.60 to 2054 mgs D.) 1363.6 to 2045.4 mgs

D.) 1363.6 to 2045.4 mgs

34.) An infant weighs 10 lbs and 4 ounces. How many calories does the infant need in a 24-hour period? A.) 750 B.) 1248 C.) 365 D.) 558

D.) 558

16.) Based on the nurse's understanding of the action of Lasix with Lanoxin (DIGOXIN) therapy in children with CHF. Which of the following is accurate? A.) Children have a decreased probability of experiencing side effects from Lanoxin B.) Children will have a higher than normal pulse rate C.) Children will have a decreased urinary output - Laxis is a diuretic that removes fluids and electrolytes (sodium, chloride, potassium) out the body. it is used to manage edema associated w/ HF and hypertension D.) Children are more likely to have symptoms of digitalis toxicity - You want to make sure you check the potassium level

D.) Children are more likely to have symptoms of digitalis toxicity

43.) All of the nursing diagnoses below are appropriate for the postoperative care plan of a child who has cardiac surgery. Which one should be given priority? *********** A.) Fluid volume deficit related to nausea and vomiting B.) Alteration in comfort: pain r/t surgical procedure C.) Altered nutrition: less than body requirements r/t post-op discomfort D.) Ineffective breathing pattern r/t chest incision E.) High risk for infection r/t surgical incision

D.) Ineffective breathing pattern r/t chest incision

An important nursing consideration when caring for a 10-month-old infant hospitalized with respiratory syncytial virus (RSV)/bronchiolitis would be which of the following?***** A.) Encourage the infant to drink 8 ounces of formula every 4 hours B.) Administer cough syrup - Cough syrup causes the secretions to thicken C.) Administer antibiotics - You will never treat a VIRUS with an ANTIBIOTIC D.) Place the infant in a mist tent - We want to put them in a cool mist not warm humidifier, allowing them to rest

D.) Place the infant in a mist tent

26.) All of the following points to be included in the teaching plan for a child who is to receive Digoxin 125 mg PO BID at home after discharge from the hospital. Which one should be questioned?*******(double check the answer *) A.) If a missed dose has been less than 1 hours, give the medication* - The nclex book shows that is ok to give if it was missed less than 4hrs B.) Vomiting may be a sign of digoxin toxicity - This is true C.) The interval between the two doses should be 12 hours - This is true D.) Siblings should check the brachial pulse every 4 hours using a stethoscope * - You would check for s/s throughout the day but you will take the pulse for 1 full minute before actually administering

D.) Siblings should check the brachial pulse every 4 hours using a stethoscope

14.) A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents? A.) Surfactant is used to reduce episodes of periodic apnea B.) Your baby needs this medication to fight a possible respiratory tract infection C.) The drug keeps your baby from requiring too much sedation D.) Surfactant improves the ability of your baby's lungs to exchange oxygen carbon dioxide

D.) Surfactant improves the ability of your baby's lungs to exchange oxygen carbon dioxide

25.) A 15-month-old toddler who is being dropped off at nursery school, throws himself onto the floor, kicks, and screams, "no! no!" Which of the responses by the mother should the nursery school nurse recommend the mother change in the future? A.) The mother gives the toddler lots of hugs and kisses B.) The mother turns her back on the child while he is kicking and screaming ( this is incorrect) C.) After the tantrum is over, the mother states, "I am so proud of you when you act like a big boy." D.) The mother states, "Honey, why are you so upset? You want some candy?"

D.) The mother states, "Honey, why are you so upset? You want some candy?"

35.) A 17-month-old is being seen by the primary care provider. His birth weight was 2.9 kg. His current weight is 14 lbs and 3 ounces. The most appropriate nursing response is ***** A.) the current weight is above the 50% percentile B.) the birth weight is above the 90% percentile C.) the toddler is meeting the normal benchmark for weight D.) a toddler should have tripled their birth weight - The toddler is underweight (he is supposed to be 8.7 kg)

D.) a toddler should have tripled their birth weight - The toddler is underweight (he is supposed to be 8.7 kg)

58.) Which approach by the nurse to a newly admitted toddler, who is not acutely ill, and to his mother would probably be best? A.) getting acquainted with the toddler before discussing his likes and dislikes with the mother B.) hold the toddler while asking the mother questions about his habits C.) leave the toddler with the play lady in the playroom while interviewing the mother D.) have the mother hold the toddler while questioning her about his habits

D.) have the mother hold the toddler while questioning her about his habits

21.) The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing for A.) glucose is needed four times a day B.) ketone is needed when blood glucose is 180 mg/dl or higher when measured before three consecutive meals C.) glucose is needed before administration of insulin D.) ketones is needed during an illness and when blood glucose is 240 mg/dl or higher when illness is not present

D.) ketones is needed during an illness and when blood glucose is 240 mg/dl or higher when illness is not present

49.) A toddler who has had surgery before is being prepared for a corrective surgical procedure. The child's mother expresses concern about the child's psychological adaptation to surgery. While planning for the postoperative care, the nurse recognizes that the child is likely to have which greatest concern based on the child's age? A.) body image changes B.) anticipated pain C.) communication difficulties D.) separation from parents

D.) separation from parents

18.) The nurse is providing nourishment for a child with cystic fibrosis (CF). Which of the following factors should she keep in mind?*********** A.) Most fruits and vegetables are not well tolerated B.) Diet should be high in easily digested carbohydrates and fats - Remember the pancreas duct is occluded with the mucus so pancreatic enzymes are not able to be secreted to help with the digestion of carbs, fats etc C.) Diet should include custards and meats D.) Fats and proteins must be greatly curtailed

Diet should be high in easily digested carbohydrates and fats

An 11 year old boy has recently been diagnosed with diabetes. The nurse's teaching plan for daily injections should be based on which of the following?

He is old enough to give most of his own injections

Which of these statements by the parent of a child with asthma indicates the need for further teaching?

If he takes medications for a while, he will outgrow his asthma

During the summer, many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise?

Increased food intake

A three year old with a diagnosis of ventricular septal defect has been admitted for a cardiàc catheterization. All of the nursing care below is appropriate in the post catheterizatic period except: A.) administer fluids and foods as tolerated B.) assess pulses distal the popliteal and dorsalis pedal pulse C.) monitor apical pulse for rate and rhythm D.) perform range of motion exercises to all extremities Maintain bed rest in the immediate post procedure period. Ensure that the child maintains the extremity in a straight position for approximately 4 to 8 hours

Perform range of motion except uses to all extremities

In a child diagnosed with congestive heart failure (CHF), which plan of care would be more appropriate in helping to control the symptoms that are related to this condition?

Primitive fluid restriction

Parents ask the nurse whether it is common for their school age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school age children provides A.) Opportunity to become defiant B.) Time to establish a one on one relationship with the opposite sex C.) Time to remain dependent on their parents for a longer time D.) Security as they gain independence from their parents

Security as they gain independence from their parents

A 4 year old child is admitted with drooling and inflamed epiglottis. During the assessment, the nurse identifies which of the following symptoms as indicative of an increase in respiratory distress?

Tachypnea

11.) The school nurse observes a group of preschool children in the playroom. The nurse recognizes which of the following activities as appropriate behavior for a 5 year old boy? A.) The boy holds and cuddles a large stuffed animal B.) The boy plays with a large truck with another child C.) The boy works on a puzzle with several other children D.) The boy talks on a toy telephone and imitates his father

The boy talks on a toy telephone and imitates his father

23.) While working in a pediatric clinic, the nurse is asked to evaluate the health status of school age children. The priority information in determining the general health status of school age children is A.) pre-determined genetic factors B.) percentile on the weight and height growth chart C.) outcomes of psychosocial evaluation D.) results of a Denver developmental screening test

percentile on the weight and height growth chart