Peds Exam #3

Parent Parents Non-Relatives

84% of victims were abused by a ______ or ________ Sexual Abuse victims are most likel to be abused by _____________

B C E

A child is brought to the clinic for an evaluation. The nurse suspects that the child has leukemia based on assessment of which of the following? Select all that apply. A) Weight gain B) Splenomegaly C) Lymphadenopathy D) Increased platelet count E) Elevated leukocyte count

A C

A child with heart failure is receiving digoxin therapy and will be discharged home on that therapy. After teaching the parents about the drug, the nurse determines that the teaching was successful when the parents identify which of the following as a sign of digoxin toxicity? Select all that apply. A) Vomiting B) Anorexia C) Constipation D) Increased heart rate E) Blurred vision

A B D E

A child with stage III rhabdomyosarcoma develops tumor lysis syndrome. Which of the following would be most appropriate to include when providing care to this child? Select all that apply. A) Monitoring serum chemistry levels B) Managing electrolytes using oral and IV solutions specific to electrolyte needs C) Starting exchange transfusion or apheresis to decrease number of WBCs D) Administering allopurinol or rasburicase to reduce uric acid production E) Monitoring intake and output; providing dialysis if renal failure occurs

C

A five year old is diagnosed with malignancy and is receiving chemotherapy and has a WBC of 2,000, platelet of 400,000, Hg 11 gm/dL. Which of the following is the priority care? A) Assess airway B) Provide developmentally appropriate toys C) Private room D) Monitor for bleeding, bruising

A D

A group of nursing students is reviewing information about child abuse and neglect and the effects on children. The students demonstrate understanding of the information when they identify which of the following as accurate? Select all that apply. A) The effects of abuse are manifested in multiple ways. B) Most abused children exhibit signs that are readily apparent. C) Abused children may experience a fear of failure but are motivated to achieve. D) Vulnerability to abuse depends on the child's age and sex. E) Evidence of abuse is often clear-cut.

C

A mother call the office about her son, a 15 year old complaining of pain in his legs that is dull, aching, and constant at night. Choose the best RN response. A) This sounds like bone cancer, I will schedule an appointment for an examination B) This sounds like growing pains C) What activities is he involved in? D) Is there any family history of cancer?

A B C

A nurse is caring for a child diagnosed with medulloblastoma. Which of the following would the nurse expect to include as part of the child's plan of treatment? Select all that apply. A) Complete surgical resection B) Radiation therapy C) Chemotherapy in high-risk cases D) Use of biologic response modifiers E) Use of preoperative anticonvulsant therapy

A D

A nurse is caring for an infant who is experiencing heart failure. Which of the following would the nurse most likely include in the infant's plan of care? Select all that apply. A) Administering diuretic therapy B) Providing large, less frequent feedings C) Restricting fluid intake D) Administering oxygen therapy E) Placing the infant in a prone position

A B C

A nurse is reading a journal article about congenital heart defects. Which of the following would the nurse expect to be discussed in the article related to defects associated with increased pulmonary blood flow? Select all that apply. A) Patent ductus arteriosus B) Ventricular septal defect C) Endocardial cushion defect D) Tricuspid atresia E) Tetralogy of Fallot

A C D

A nurse is talking with a child who is dying and his parents. Which of the following would be most effective in promoting appropriate communication? Select all that apply. A) Maintain eye contact with the child and family. B) Use medical terminology to emphasize the seriousness. C) Allow time for questions from the parents and the child. D) Encourage the use of play for the child to express his feelings. E) Distract the family from sharing their stories and sadness.

A B E

A pediatric nurse is conducting a class for a group of nursing students about children with cancer. The nurse explains that the S/S of childhood cancer are different from those associated with cancer in adults. Select all that apply. A) Pain r/t compression filtration or obstruction caused by tumor B) Secretion of a substance by the tumor that interferes with normal organ function C) Changes in bowel or bladder habits with rectal bleeding D) Unusual Lumps or non-healing wounds E) Alterations caused by tumor metabolism or cell death

C

A pediatric nurse is mentoring a new pediatric palliative care RN. Which of the following responses by the new RN demonstrates a need for further teaching? A) Any child that has a potential for decreased life expectancy may benefit from palliative care B) Pediatric palliative care starts out with a curative focus C) Pain management goals include using the smallest amount of medication while decreasing pain D) We could plan to have the patient's prom at the hospital.

Bacterial Repair

ASD (Atrial Septal Defect) Treatment: Medical: b______ endocarditis prophylaxis Repair, as child gets older may see activity intolerance and dyspnea, most dont need r_______

Acquired

A________ Cardiovascular Disorder Infection (rheumatic fever, Kawasaki disease) Autoimmune response, familial tendencies

Abusive Head Trauma

Acceleration-deceleration injury Causes tearing of brain tissue and bridging veins It can be associated with contact with a hard or stationary surface Usually seen in infants less than a year of age

4

Acute Lymphocytic Leukemia Peak age of onset ____ years

B C E

After teaching a group of nursing students about congenital heart disease, the instructor determines that the teaching was successful when the students identify which of the following as a factor associated with development of this condition? Select all that apply. A) Postmaturity B) Alcohol ingestion during pregnancy C) Maternal diabetes D) Family history of atherosclerotic heart disease E) Genetics

A C D

After teaching a group of nursing students about the core principles of palliative care, the instructor determines that the teaching was successful when the students identify which of the following as a core principle? Select all that apply. A) Respect for the child's preferences and choices B) Provision of episodic care C) Acknowledgment of caregiver concerns D) Development of supportive systems for policy making E) Implementing the use of discipline-specific resources

Hypoplastic Left Heart Syndrome

Also called single ventricle Left sided cardiac structures are underdeveloped Uniformly FATAL if untreated 3 Stage repair, surgery is palliative not curative

C

An 11-year-old boy has come to the school nurse more than 15 times for somatic complaints during the first quarter of school year and has subsequently left school after each visit. Which action by the school nurse would be most appropriate? A) Talk to the student's teacher. B) Make an unannounced home visit on a day the child is not in school. C) Contact the child's parents to discuss the situation. D) Keep a log of the child's attendance and continue to monitor the situation.

Palliative Care

Any child who has a condition that may affect life expentancy could benefit from p_____ c_____

TGV (Transposition of the Great Vessels)

Aorta rises from right ventricle Pulmonary artery rises from left ventricle Result is two seperate and parallel circulations Clinical Signs: Cyanosis always present Murmurs if other associated defects

Brain Tumors

B____ T______ remain the leading cause of cancer-related death in children

Anticipatory

Bereavement support for family a_____ and after death

3

Bites multiple or greater than ____mm is suspected abuse pattern

Battle Sign

Bruising behind the ear Can mean a skull fracture Usually due to squeezing or pulling or ear

Diuretics (Lasiz, Diuril)

CHF Med Decreases total body water by increasing urine output

Digoxin

CHF Med generally given BID improves contractility and slows heart rate

Congenital

C_____ Cardiovascular Disorder Child born with structural defect of heart Anatomic Problem leads to abnormal function 90% of cardiac problems in children are a result of this type of heart defect

Vital Signs BP Intracardiac Comfort Fluid

Care for the Child After Heart Surgery: Monitor ___ _____ and A/V pressures Intra-arterial monitoring of ___ I_____ monitoring Respiratory Needs Rest, c______, and pain management F____ management Progression of activity

Adjust Cope Discharge

Care of the Family and Child With CHD: Help family ______ to the disorder Education of family Help family ____ with effects of the disorder Prepare child and family for surgery D_____ teaching Address concerns for child's future

Mass One Flank

Clinical Manifestations of Wilm's Tumor: Most common presenting sign is swelling or m_____ within the abdominal area Firm, nontender, confined to o____ side, deep within the f_____

Postpericardiotomy Syndrome

Clinical Manifestations: fever, increased WBCs, pericardial friction rub, pericardial and pleural effusion Occurs in the immediate postop period but also later DAYS 7 to 21 POSTOP Etiology Unknown May require pericardiocentesis or pleurocentesis

Malaise Pallor Gingival Nasal Infection Nausea Lymphadenopathy Loss ICP Disturbances

Clinical Presentation of Leukemias: Anemia: M____, fatigue, p_____ Thrombocytopenia: g______, cutaneous, or n____ bleeding Neutropenia: fever, recurrent i______ Hepatosplenomegaly: abdominal pain, n______,vomiting Bone Pain L_________ Anorexia, weight l_______ Central Nervous System Involvement : increased _____, headache, vomiting and visual _______

Coarctation of the Aorta

Clinical Signs: blood pressure high in arms than in legs, High pulse pressure in carotid and radial pulses, Low pulse pressure in femoral and pedal pulses, Warm upper body cool lower body Diagnosis: usually no murmur, Upper extremity BP at least 20mmHg greater than Lower extremity BP Echo

Repaired Angioplasty Propylaxis Hypertension

Coarctation of the Aorta: Life threatening if not r______ Treatment- Surgery (removal of stenotic area), Balloon a______ SBE p_______ Complications: re-stenosis, residual h_______, CV disease as adult

Fever Headaches Lymphadenopathy Loss Neurological

Common and Presenting Signs/Symptoms of Cancer: F____ Pain Fatigue H____ L_______ Pallor Purpura Weight L______ N______ changes Mass or Swelling

Decreased Frequent Stress 20 Overload

Congestive Heart Failure in Children Nursing Management: D______ energy expenditure, frequent rest periods, small f____ feedings, minimize crying, prevent cold s_____, soft nipples Provide adequate nutrition: high caloric formulas > ____ kcal/oz Avoid fluid o_______ Administer meds to enhance cardiac function

Tachycardia Extremeties Gallop Cardiomegaly Tachypnea Distress Periorbital Hepatomegaly

Congestive Heart Function in Children: Impaired Myocardial Function - t_______, fatigue, weakness, restlessness, pallor, cool e_____, decreased BP, g____ rhythm (3rd Heart Sound), decreased urine output, c_________ Pulmonary Congestion - t_______, dyspnea, respiratory d______, exercise intolerance, poor feeding Systemic Venous Congestion- peripheral and p_________ edema, weight gain, ascites, h______

Mongolian Spots

Darkened areas of skin, look like bruising, stay consistent Look at past documentation to verify

Cyanosis Pulmonary Rare Hypoxemia Paraoxysmal

Decreased Pulmonary Blood Flow Defects (Tetralogy of Fallot and Tricuspid Atresia) C______ Decreased p________ vascularity Heart Failure r_____ H_______ Polycythemia Clubbing P_______ hypercyanotic spells

Tetralogy of Fallot Tricuspid Atresia

Decreased Pulmonary Blood Flow Defects: ____ ___ ______ ____ ______

Chest X-Ray

Diagnostic Test: Cardiac size and shape Status of lungs

Echocardiogram

Diagnostic Test: Records intercardiac structures and their motion Estimates pressures in the heart Can determine cardiac output and blood flow Ejection Fraction

BNP

Diagnostic Test: Stretch of the heart Shows Heart Failure Occur

ECG

Diagnostic Test: Tests of conduction system

Cardiac Catheterization

Diagnostic/Interventional Test: Diagnostic- measures pressures, cardiac output, O2 sats withing chambers, visualizes heart structures to determine any abnormalities, evaluates blood flow through the heart Interventional- TGV, ASD, PDA, PAD, recurrent coarc, conduction disorders

NOT 100 Anorexia Bradycardia

Digoxin If vomits after dosing do _____ repeat the dose Do NOT give if infant's heart rate <____ bpm Monitor for toxicity- Nausea/Vomiting, a_____, listlessness, b________, dysrhythmias

Leukemia

Disease involving the blood-forming tissues of the bone marrow, spleen, and lymph nodes Specifically it is the distorted and uncontrolled proliferation of white blood cells Most common childhood cancer

Nutritional Edema Diaphoresis Clubbing

Evaluation of Cardiovascular Function Objective: General Appearance- Activity, Mood, N______ status, e_____ Poor weight gain Skin - cyanosis, d_______ Fingernails- c________, cyanosis

CHD Sudden Feeding Tachypnea Hungry Picky Intolerance

Evaluation of Cardiovascular Function Subjective: Family history of c_____, s______ death Mother's pregnancy Infant's f______ pattern: profuse sweating, fatigue, t_______, irritability, reflux, always h_______ Child's feeding pattern : p_____ or slow eater History of frequent URI, respiratory difficulties Exercise i______, fatigue

Hematopoiesis

Formation and development of the various blood cells from the undifferentiated, pluripotent stem cell Process includes proliferation, differentiation, and maturation of cells into 2 distinct cell lines: lymphoid and myeloid

Acute Myelogenous Leukemia

Frequency increases in late adolescence Most common type of leukemia in adults May present with life-threatening sepsis or hemorrhage Gingival Hypertrophy Extramedullary Infiltration

Torn Frenulum

From very aggressive feeding with bottle or spoon Precursor injury to abuse, shows frustration

Diuretics

Given to lessen the workload on the heart by removing extra fluids the heart has to pump, ultimately DECREASING PRELOAD

Congestive Heart Failure

Heart is unable to maintain sufficient output to meet body's needs Primarily seen in children with LEFT TO RIGHT SHUNTS and Coarctation of the Aorta

Consider (the unique situation of the child) Honesty (use the d words, realize that it is alright to not have all the answers, avoid euphemisms, avoid words such as gone away or went on a trip) Involve (let the child know what is happening if possible) Listen (let the child talk through what is on their mind) Do it over (and over again)

Helping Children Cope with Grief Remember C H I L D

Medical Behavior

History: Obtain a good ______ history Question patient or family about medications Ask about child's ________

Right Increased Decreased

Increased Pulmonary Blood Flow Increased blood volume on the ______ side of the heart ________ pulmonary blood flow ________ systemic blood flow

Acyanotic Weight Failure Feeder

Increased Pulmonary Blood Flow Defect Characteristics: A______ Increased pulmonary vascularity Poor _____ gain Heart f______ frequent Late permanent pulmonary vascular change can occur Poor f_____ due to faitgue

VSD (Ventricular Septal Defect) ASD (Atrial Septal Defect) PDA (Patent Ductus Arteriosus)

Increased Pulmonary Blood Flow Defects ____ ____ ____

Lyphoid

L_____ Cells = b-cells and t-cells

Myeloid

M____ Cells = red blood cells, monocytes, granulocytes, and platelets

Hemorrhage Chemotherapy BP Turgor

Malignancy High Risk for Fluid-Volume Deficit: R/T increased chance of h_____ from poor platelet production, nausea and vomiting from c_______. Goal: Child will not develop a fluid-volume deficit or become dehydrated during the course of therapy Outcome: No evidence of hemorrhage is present, pulse and B___ remain normal for age group; Skin t_____ is good, mucous membranes are moist. Vomiting does not occur more than once per day.

WBCs 38 Erythema

Malignancy High Risk for Infection: R/T nonfunctioning ______ and immunosuppressive therapy Goal: the child will not develop an infection during course of therapy. Outcome: Child's temp will remain below ___ C.; No documented sources of infection.; No areas of e_______ or drainage present on skin.

Tumors Tolerable

Malignancy Pain: R/T Invasion of leukocytes or t_____, side effects of ctx or radiation, surgical intervention Goal: Child will experience a tolerable degree of pain during course of illness Outcome: Child states that pain is t_________, utilize pain scales

Regimen Diagnosis Anxiety

Malignancy Parenteral and Child Anxiety: R/T New diagnosis and treatment r______ Goal: Parents and child demonstrate reduced anxiety about diagnosis and treatment regimen Outcome: Parent and child if age appropriate voice understanding of d_____ and current treatment regimen; Absense of S/S of a_____ in parents and child

Acute Lymphocytic Leukemia

Malignant cell line involved is the immature lymphocyte, the lymphoblast

ASD (Atrial Septal Defect)

May occur anywhere along septum- most common is mid-septum near FORAMEN OVALE, small hole Children with it are often asymptomatic, as child gets older may see activity intolerance and dyspnea Diagnosis if L to R shunt is large, hear diastolic murmur

VSD (Ventricular Septal Defect)

Most common form of CHD May occur anywhere along the septum most common is midseptal defect below aortic valve Clinical Signs: May be asymptomatic intially CHF Failure to Thrive Frequent URI Fatigue Poor Feeding

Mandated Reporting

Must contact authorities when you have reasonable cause to suspect that a child seen in the course of professional duties has been abused or neglected Or When you have reason to believe the child has been threatened with abuse or neglect and that abuse or neglect of the child will occur

Buttocks Abdomen

Normal bruising tends to occur over bony prominences do not occur on backs, b______ or a_________

Diagnosis Suffering Opportunities Advocacy

Nurse Role in Palliative Care: Anticipating possible side effects or symptoms according to d________ Preventing s_______ Treating to reduce symptoms and suffering Promoting o_______ between parents/child/siblings/family for living fully A_____ of child's goals, preferences, and desires

Premature Asymptomatic CHF Machinery

PDA (Patent Ductus Arteriosus) Increased incidence in p______ infants Clinical Signs: If small may be a________, if large S/S of c_______ more apparent with anything that puts increased stress on heart Diagnosis: classic m_______ type murmur

Loop Marks

Patterned injury which is caused by being whooped with a folded cord or belt. Diagnostic of inflicted injury Difficult to tell how old the injury is When they are present on the arms they often are defensive wounds

PDA (Patent Ductus Arteriosus)

Persistent patency of normal fetal structure between the left pulmonary artery and the descending aorta Normally should close after birth because of increased arterial O2 sats and decreased prostaglandins when no placenta If stays open, direction of flow changes after birth because of increased pressure and resistance in aorta, causing increased blood flow to lungs

Gastrointestinal Liver Electrolyte Rashes Neutropenia

Potential Side Effects of Chemotherapy: G_______: nausea, vomiting, diarrhea, constipation, impaired l____ function, pancreatitis, anorexia, and e_____ imbalances Skin/Mucosal: muscositis, stomatitis, r_____ Hematologic: anemia, n______ and thrombocytopenia Immunosuppression Other: Pulmonary, renal, neurological, or cardiac damage, possible sterility

Osteogenic Sarcoma

Primary malignant tumor of bone Most common bone tumor and 6th most common malignancy in pediatrics Peak incidence is in the 2nd decade of life due to the rapid bone growth occuring during this time S/S pain that is dull, aching, and constant that worsens at night

Right Atrium Right Ventricle Pulmonary Artery Lungs Pulmonary Veins Left Atrium Left Ventricle Aorta

Put the following in the order of blood flow in a normal newborns heart starting with the inferior/superior vena cava. 1) Lungs 2) Left Atrium 3) Aorta 4) Pulmonary Veins 5) Pulmonary Artery 6) Right Ventricle 7) Left Ventricle 8) Right Atrium

Onset Blue Match

Red Flags of Abusive Head Trauma: When the history involves a sudden o______ of symptoms: I was holding him and he started seizing I went to check on him and he looked b_____ I was giving him his bottle and he started breathing funny When the injury does not m______ the history

Alcohol Domestic Disabilities Low Premature

Risk Factors for Maltreatment: Poverty Drug and A______ Abuse D_______ Violence Children with D________ L_____ birth weight babies P_______ Babies

Cerebral Subdural Retinal Fractures

Short Falls: Do NOT CAUSE: C______ edema Extensive S_______ bleeds Extensive R_______ Hemorrhages Multiple F_____

Foramen Ovale

Shunts oxygenated blood from R atrium to L atrium, Closes 24 hours after birth

Pulmonary Artery Outgrow Closure Conduction

Surgical Treatment of VSD (ventricular septal defect): Palliative: _____ _____ band -narrows the pulmonary artery thereby decreases blood flow to the lungs and decreases CHF, Child will eventually _______ PA band and require corrective surgery Corrective: ______ of VSD with patch- complications of corrective surgery include _______ problems (possibilityof complete heart block), residual VSD, plus complications related to open heart surgery

Genital History Bilateral Infant

Suspicious Bruising: Bruising in the g______ area Bruising that does not match the h________ B______ bruising Bruising on an i______

Intensity Decreases

TET spells may arise without warning after a predictable precipitating event to decide whether a child is having a TET spell, auscultate the heart, the _______ of the cardiac murmur ______ during a spell

Dehydration Air Shunt Decreased BP Stenosis

Tetralogy of Fallot Preoperative Management- prevent d______, No a____ in IV lines Treatment- blalock-taussig s______ (palliative if child to small for repair lots of TET spells) May have d______ or absent pulse in affected arm, no b___ in that arm Open Heart Surgery- VSD closure and correct pulmonic s_____

Clubbing TET Harsh Lower Polycythemia

Tetralogy of Fallot Clinical Signs: Cyanosis and c______ Paroxysmal Hypercyanotic Spells, T____ Spells Diagnosis: H_____ systolic murmur at l_____ left sternal border ECG, chest x-ray, echo CBC-p_________

Ventricular Stenosis Hypertrophy Overriding

Tetralogy of Fallow Consists of Four Defects: V________ septal defect Pulmonary s________ (right ventricular outflow obstruction) Right ventricular h________ O_______ aorta

A

The nurse is caring for a child who has been pronounced brain dead. The family has made the decision to donate the child's organs. Ventilator support continues while waiting for organ procurement. The child's aunt asks the nurse, "Why is the ventilator still on?" Which response by the nurse would be most appropriate? A) "The ventilator is supplying oxygen to the organs that will be donated soon; it is not to preserve life." B) "The ventilator is keeping the child alive until it is time to procure the organs for donation." C) "The ventilator is in place to make the child comfortable until the organ donation team is ready." D) "The ventilator is supplying the brain with oxygen so the nerve cells will survive."

A

The nurse is caring for a family who just experiences the death of a child. Which intervention would be the priority at this time? A) Facilitate the grieving process by assessing grief and assisting family members to acknowledge the loss by expressing grief B) assist the parents in end of life decisions such as funeral arrangments C) Refer the family to a support group D) Refer the family to a counselor

B

The nurse is caring for a terminally ill child who is preparing to return home and attend school half-days. The patient is excited about returning to school and seeing friends. Which of the following nursing interventions is the most beneficial for this patient? A) Ask the patient if attending school is a wise decision. B) Prepare the patient for the questions and reactions of friends, teachers, and other students. C) Inform the patient of the many dangers that school can pose at this time. D) Tell the patient you are happy for them.

A C E

The nurse is providing care to a child who has undergone a cardiac catheterization and is being discharged. Which of the following would the nurse include in the teaching plan for the parents? Select all that apply. A) Inspecting the catheterization site daily for the first week B) Applying pressure on the bandage if a small amount of blood is noted C) Using a sponge bath or shower for the first 2 days D) Returning to school in about a week after the procedure E) Reporting an increase in numbness in the affected extremity

A B D

The nurse is providing care to a child with cancer who is receiving monoclonal antibodies as part of the treatment plan. The nurse notifies the primary health care provider to report assessment of which of the following as a possible side effect? Select all that apply. A) Fever B) Rigors C) Joint pain D) Hypotension E) Neutropenia

B

The nurse is providing palliative care to a 5-year-old child. When developing the child's plan of care, the nurse understands that a child of this age views death as which of the following? A) Separation B) Temporary state C) Irreversible D) Permanent

B

The nurse suspect that a child has developed bacterial endocarditis, Which lab would support this? A) Increased hemoglobin B) Increased SED rate C) Increased leukocyte count D) Increased C-reactive Protein

Multimodal Palpate Bowel Vital signs Chemotherapy

Therapeutic Management of Wilm's Tumor: M______- surgery and chemotherapy, based on clincal stage and histologic pattern Preoperative Concern - do not p______ abdomen, because manipulation of the mass may cause dissemination of cancer cells in the body Post-operative Concern - monitor GI activity, b____ sounds and movements, distention, v______; observe for s/s of infection, especially during c_______ Support family and patient

True

True/False Causes of most childhood cancers are unknown and for the most part they cannot be prevented

Indomethacin

Used to close PDA Inhibits the synthesis of prostaglandin

Systolic Sternal Spontaneously

VSD Diagnosis: S______ murmur heard at left s_______ border Treatment: Small VSD may close s________ (1st 2 years of life) Medical: tx of CHF, SBE prophylaxis Surgical: palliative, corrective

5000 to 10000

WBC Children Lab Value _____ __ ______

Wilms Nephroblastoma 3 4 Dominant

W_____ Tumor: N_____ most common, intra-abdominal and kidney tumor of childhood Peak incidence between ___ and ____ years of age Increased incidence among siblings and identical twins In familial cases, mode of inheritance is autosomal d________ Associated with congenital anomalies

Coarctation of the Aorta

What are children with Turner Syndrome at risk for?

Thorough History

What is the 1st step in identifying children who are neglected?

MRI Myelography

What tests is indicated based on signs and symptoms of spinal cord tumors?

A B E F G

When caring for an 8 year old child experiencing grief from a siblings death, which of the following would be appropriate responses? Select all that apply. A) Would you like some crayons and paper? B) I know your brother has died, How are you feeling? C) I know you are sad, but your brother is in a better place, free from suffering D) Your brother has gone away, I know you must be scared E) You should know that this did not happen because of anything you did F) Are you thinking about hurting yourself? G) It's fine if you don't want to talk about this for awhile

B

Which of the following is a true statement regarding child maltreatment? A) RNs must report abuse if they see their neighbor spank their child B) RNs must report suspected neglect C) RNs only have to report abuse if 2 parents stories are conflicting D) RNs will be held accountable if suspected abuse is not found, after reported

B D E F G

Which of the following would be expected with an infant with unrepaired Ventricular Septal Defect (VSD) Select all that apply A) Cyanosis B) Poor Weight Gain C) BP in upper extremity 20 mmHg higher than in lower extremity D) Systolic murmur heard at left sternal border E) Pulmonary artery band procedure scheduled F) Order for SBE prophylaxis G) Treatment of congestive heart failure

A

While interviewing an adolescent boy with depression, he reveals to the nurse that he has considered hurting himself. Which response by the nurse would be most appropriate? A) "Tell me exactly how you would hurt yourself." B) "Why would you want to hurt yourself." C) "Do your parents know that you want to hurt yourself?" D) "Have you discussed this with anyone else?"

Increased

______ Pulmonary Blood Flow Abnormal connection between two sides of heart- either the septum or the great vessels Increased blood volume on the RIGHT side of the heart

Dustus Venosus

shunts oxygenated blood from umbilical vein to inferior vena cava