OB FINAL
A group of nurses is reviewing the cardiovascular system and its function. Which statement by one of the nurses demonstrates an understanding of a child's cardiovascular system?
"At birth, the infant's right and left ventricle are about the same size."
A nurse is taking the history of a 4-year-old boy who will undergo a cardiac catheterization. Which statement by his mother may necessitate rescheduling of the procedure?
"He seems listless and slightly warm."
The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching?
"I can tape a quarter over the hernia to reduce it."
The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond?
"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately."
The nurse is caring for an infant recently diagnosed with thrush and was prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?
"I will add the nystatin to her bottle four times per day."
The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond?
"It's great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain."
The mother of a young child, who has been treated for a bacterial urinary tract infection, tells the nurse her daughter has a white thick covering over her tongue. The mother states that she "has tried everything to get it off my child's tongue." How should the nurse respond?
"It's not unusual for a fungal infection to occur while taking an antibiotic for an infection. I will let your primary care provider know so we can get it treated."
When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education?
"Most infants do not need surgical repair for this."
The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child is refusing fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate?
"Offer 'magic mouthwash' followed by a popsicle."
The parents of a 2-year-old newly diagnosed with tricuspid atresia ask the nurse, "I don't understand why our child's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is most likely to be understood by the parents?
"The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes."
A physician recommends a gastrostomy for a 4-year-old client with an obstruction. The parents ask the certified wound, ostomy, and continence nurse (CWOCN) what the surgery entails. What is the nurse's best response?
"The surgery creates an opening between the stomach and abdominal wall."
The nurse is discussing the treatment of congenital aganglionic megacolon with the caregivers of a child diagnosed with this disorder. Which statement is the best explanation of the treatment for this diagnosis?
"The treatment for the disorder will be a surgical procedure."
The nurse is preparing a client for surgery and the client asks, "What does it mean when they say they are going to reduce my abdominal hernia?" Which response by the nurse is most appropriate?
"This means the hernia contents will be manipulated back into your peritoneal cavity during surgery."
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 child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful?
"We should not stop this medication abruptly."
The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents ask the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the the nurse?
"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help."
The nurse is caring for a 13-year-old girl with suspected autoimmune hepatitis. The girl inquires about the testing required to evaluate the condition. How should the nurse respond?
"You will most likely have a blood test to check for certain antibodies."
A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which statement should the nurse make to the girl's mother in response to these findings?
"Your daughter has an innocent heart murmur, which is nothing to worry about."
The nurse is reviewing nutritional recommendations with the parents of a teen diagnosed with hyperlipidemia. Which statements indicate an understanding of the recommended diet for this condition? Select all that apply.
-"I should plan to have vegetables with each evening meal served." -"Adding fresh fruits to my child's lunch is a good idea." -"My child loves chicken and I can still serve it but I need to remove the skin."
The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply.
-"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." -"The only treatment for celiac disease is a strict gluten-free diet." -"Gluten is found in most wheat products, rye, barley and possibly oats."
A 4-year-old child is scheduled for an echocardiogram. The nurse is explaining this procedure to the child's parents. Which information would the nurse likely include? Select all that apply.
-"This test uses sound waves to check the heart structures." -"This test should not cause your child any pain."
The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements? Select all that apply.
-"We will be sure to not allow our child to ride a bicycle for at least 2 weeks." -"We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." -"We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed."
The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? Select all that apply.
-16-year-old child with a heart rate of 54 beats per minute -2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning -5-year-old child who developed vomiting and diarrhea, and is difficult to arouse
The nurse is caring for a 1-day-old newborn with patent ductus arteriosus with the following vital signs: pulse 160, respirations 80, oxygen saturation 92%, retractions, and crackles noted in bilateral lungs. Which nursing actions are appropriate at this time? Select all that apply.
-Administer furosemide. -Initiate intravenous access. -Apply oxygen via oxyhood. -Begin indomethacin infusion.
The nurse is educating an adolescent female at risk for hypertension. Which interventions will the nurse recommend? Select all that apply.
-Increase hours of sleep. -Avoid any smoking. -Exercise on a daily basis. -Maintain a healthy weight.
The nurse is caring for a child who is preparing to undergo an exercise stress test. Which interventions will be included in the care?
-Monitor vital signs prior to the start of the test. -Monitor vital signs at completion of the test. -Remind child to verbalize any feelings of discomfort during the test.
The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatments would the nurse expect to administer if ordered? Select all that apply.
-Penicillin -Corticosteroids -Nonsteroidal anti-inflammatory drugs
A nurse manages the interdisciplinary care for a client with pancreatitis. What are recommended interventions for this condition? Select all that apply.
-Providing glycemia control -Positioning the client in a fetal position -Administering analgesics for pain -Keeping the child NPO to rest the pancreas
The child has returned to the nurse's unit following a cardiac catheterization. The insertion site is located at the right groin. Peripheral pulses were easily palpated in bilateral lower extremities prior to the procedure. Which finding should be reported to the child's physician?
-The child's right foot is cool with a pulse assessed only with the use of a Doppler. -The child has a temperature of 102.4° F (39.1° C). -The child is reporting nausea.
The infant has been hospitalized and develops hypercyanosis. The physician has ordered the nurse to administer 0.1 mg of morphine sulfate per every kilogram of the infant's body weight. The infant weighs 15.2 lb (6.81 kg). Calculate the infant's morphine sulfate dose. Record your answer using one decimal place.
0.7
The nurse takes an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant?
100 beats per minute
The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy?
100 to 120/70 to 80 mm Hg
The nurse is caring for a child prescribed vancomycin 15 mg/kg IV every 6 hours for peritonitis. The child weights 45 lb (20.5 kg). How many milligrams will the nurse administer to this child in 24 hours?
1230
A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate?
80 beats/min
The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant's heart rate?
90 to 160 bpm
The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding?
90/64 mm Hg
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 caring for an infant who is experiencing heart failure. What would be the mostappropriate care for this infant?
Administer oxygen.
The nurse is caring for a 10-year-old boy following a cardiac catheterization. Four hours after the procedure, the nurse notes some minor bleeding at the site. Which action would be mostappropriate?
Apply pressure 1 inch above the site.
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 assessing an infant and notes brachial pulses of 2+ and femoral pulses of 1+. Which action will the nurse perform first?
Assess blood pressure in all extremities.
Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition?
Assessing for the presence of femoral pulses
A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection?
Avoid drawing a blood specimen from the right femoral vein before the procedure
What information would be included in the care plan of an infant in heart failure?
Begin formulas with increased calories.
A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note?
Bounding pulse
The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube?
Check for gastric residual before starting feeding by gently aspirating from the tube with a syringe
The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia?
Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL.
When caring for a child that has just had a cardiac catheterization, what is a sign of hypotension?
Cold, clammy skin and increased heart rate
The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?
Digoxin
The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?
Digoxin
The nurse is assessing an infant for peripheral edema. Based on the nurse's knowledge, the nurse would expect edema to occur in which area first?
Face
The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive heart failure. Which clinical manifestation observed during the physical assessment would be consistent with this diagnosis?
Failure to gain weight
A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting?
Feeding problems
A school nurse is caring for a child with a severe sore throat and fever. What is the nurse's bestrecommendation to the parent?
Have the child be seen by the primary care provider.
The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder?
Heart failure
The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. What should the nurse mention in explaining how this diagnostic test works?
High-frequency sound waves are directed toward the heart
On assessment immediately following cardiac surgery, which condition would the nurse expect to find in an infant?
Hypothermia
The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is mostaccurate related to the diagnosis of gastroesophageal reflux?
In this disorder the sphincter that leads into the stomach is relaxed.
A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would mostlikely be seen in a client experiencing polycythemia?
Increased RBC
An 8-month-old infant has a ventricular septal defect. Which nursing diagnosis would best apply?
Ineffective tissue perfusion related to inefficiency of the heart as a pump
The nurse is caring for child who present to the emergency department with reports of a fever for 5 days. The nurse notes a diffuse maculopapular rash, reddened cracked lips, erythema of hands, and bilateral conjunctivitis and suspects Kawasaki disease. Which nursing action is priority?
Initiate intravenous access.
An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse?
It will determine if the heart is enlarged.
A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?
Lower extremities
The nurse is conducting a physical examination of a 7-year-old girl prior to a cardiac catheterization. The nurse knows to pay particular attention to assessing the child's pedal pulses. How can the nurse best facilitate their assessment after the procedure?
Mark the child's pedal pulses with an indelible marker, then document.
A nurse is administering digoxin to a 3-year-old child. What would be a reason to hold the dose of digoxin?
Nausea and vomiting
A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?
Notify the doctor immediately.
A mother calls the doctor's office and tells the nurse that she is concerned because her 4-month-old keeps "spitting up" with every feeding. What would indicate that the child is regurgitating as opposed to vomiting?
Only occurs with feeding
A client's newborn is diagnosed with tetralogy of Fallot. When explaining this condition to the client, which defect would the nurse's description include?
Overriding of the aorta
A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?
Peeling hands and feet and fever
During assessment of an infant diagnosed with tetralogy of Fallot, the nurse notes bluish colored lips and irritability. Which nursing action is priority?
Place in knee-chest position.
What would be the most important measure to implement for an infant who develops heart failure?
Placing the infant in a semi-Fowler's position
When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover?
Polycythemia
A 12-year-old boy has just undergone a liver transplantation and is recovering. After performing a finger stick puncture and assessing the results, the nurse administers a 10% solution of dextrose IV. What is the correct rationale for this intervention?
Prevention of hypoglycemia
The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis?
Projectile vomiting
A parent brings an infant in for poor feeding and listlessness. Which assessment data would mostlikely indicate a coarctation of the aorta?
Pulses weaker in lower extremities compared to upper extremities
Which nursing diagnosis will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot?
Risk for ineffective cardiopulmonary tissue perfusion
A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits?
Semi-Fowler
The nurse assesses a child for clubbing. What would the nurse identify as the initial sign?
Softening of the nail beds
The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding?
Softening of the nail beds
When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?
Tachycardia
A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis?
Tetralogy of Fallot
An adolescent is diagnosed with hepatitis A. Which problem should be considered when planning care?
The adolescent will become fatigued easily.
The nurse is caring for a hosptialized infant with a diagnoses of Tetralogy of Fallot, awaiting surgical intervention. Which assessement finding would the nurse expect?
The child has periods of cyanosis and decreased pulse oxyimetery readings
A school nurse finds a 10-year-old's blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect?
The child will need the blood pressure checked two more times.
A nursing instructor is preparing for a class about the structural and functional differences in the cardiovascular system of infants and children as compared to adults. What would the instructor include in the class discussion?
The heart's apex is higher in the chest in children younger than the age of 7 years.
When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding?
The liver size increases in right-sided heart failure.
A nurse is interviewing a mother who is about to give birth. Which response would alert the nurse for a higher potential for a heart defect in the newborn?
The mother states she has lupus.
A nurse is caring for an infant who just had open-heart surgery and the parents are asking why there are wires coming out of the infant's chest. What is the best response by the nurse?
These wires are connected to the heart and will detect if your infant's heart gets out of rhythm.
A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education?
This is caused by an opening that usually closes by 1 week of age.
A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?
This test that check how blood is flowing through the heart.
A parent is told their infant has a heart defect with a left to right shunt. What is the best way for the nurse to explain this type of shunting to the parent?
This type of shunting causes an increase of blood to the lungs.
The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy, the process of digitalization is done for which reason?
To build the blood levels to a therapeutic level
The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction?
Wheezing
The nurse receives the shift report of multiple pediatric clients. Which pediatric client will the nurse see first?
a toddler with tetralogy of Fallot squatting quietly in the corner of the room
When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the:
child will return with a bulky pressure dressing over the catheter insertion area.
The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks the child seems to have lack of coordination, facial grimaces and repetitive involuntary movements. Based on these symptoms the nurse would suspect what condition?
chorea
After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:
femoral pulse weaker than brachial pulse
When caring for a child with Kawasaki disease, the nurse would know that:
management includes administration of aspirin and IVIG.
The nurse would teach the mother of a boy with tetralogy of Fallot that if the child suddenly becomes cyanotic and dyspneic, the mother should:
place him in a knee-chest position.
In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?
prepare the infant for surgery
