quiz 2 modules

Which are correct interventions for treating rheumatic​ fever?

Tell child and family that the chorea is temporary and related to the disease Administer antibiotics and​ anti-inflammatory medications as per order. Relate plan for secondary prophylaxis to caregivers.

Following a heart transplant for heart​ failure, a child has been placed on several medications to prevent rejection. These medications include cyclosporins and a corticosteroid. The nurse must be aware that medications to prevent rejection can lead to which​ complications?

Immunosuppression Coronary Artery Disease Renal Dysfunction

The nurse has given discharge instructions to a​ 14-year-old child and his family following treatment for cardiomyopathy. Which statement by the child would indicate that the teaching has been​ effective?

"I will not be able to play on the football team this year"

when educating the parents of a child with hemophilia, which statements indicate an understanding of their instructions?

- "at home, if my child has any pain, I will give him acetaminophen." - "My child must always have replacement factor with him" - "When my daughter has her menstrual period, she should expect the bleeding to be heavy."

in discharge planning for a client with hemophilia, what statements will best explain the care at home?

- "before you child goes home, you should remove any throw rugs in the living areas" - "a teacher at your child's school should be trained to help care for your child." - "the medical bracelet is an important way to let others know about your disorder."

the nurse caring for a client who has disseminated intravascular coagulation (DIC) secondary to sepsis identifies which treatments as priorities?

- administration of fresh frozen plasma - administration of antibiotics - administration of heparin for anticoagulation

When the nurse is planning care for a child with hemophilia, which interventions take into consideration the special needs of this child?

- assessment of the environment for any tripping hazards - elevation of any joints affected by hemarthrosis - blood specimens obtained by finger-stick instead of venipuncture

aspects of discharge care and teaching for ITP

- avoid aspirin, aspirin-containing drugs, and NSAIDs - advise no contact sports until thrombocytopenia and ITP improve - ask the family if they want to incorporate any cultural and religious practices into the child's care - educate about IV anti-D immunoglobulin

When assessing an 18-year-old with disseminated intravascular coagulation (DIC), which assessment data would the nurse immediately report to the health care provider?

- capillary refill of 5 sec - blood pressure of 68/32 mmHg - heart rate of 180 beats/min

treatment interventions of DIC

- control bleeding by placing pressure dressing on areas of bleeding - maintain skin integrity by turning client every 2 hours - administer blood products as ordered

treatment options for severe ITP

- corticosteriods - IV immune globulin - platelet infusions

supportive therapies for DIC

- fresh frozen plasma and platelet transfusions - anticoagulation therapy ie heparin - clotting factor replacement

Desmopressin (DDAVP) is indicated to treat which diseases?

- hemophilia A - von Willebrand disease

discharge teaching for children with hemophilia or von willebrand disease

- wear a med id bracelet or tag to alert others about their condition - school-age children may learn to give themselves factor replacement infusions - use only an electric razor for shaving

When assessing a client, the nurse would recognize which symptoms as clinical manifestations of thrombocytopenia?

-bleeding gums after client brushes teeth - frequent episodes of epistaxis (nosebleeds) - small pinpoint red or purple spots on the skin - occult or frank blood in stools

Matching Cause --> Type of Anemia

Increased Destruction of Cells= Sickle Cell disease Decreased Production of Cells = Aplastic Anemia Loss of Cells through Hemmorhage or Chronic Blood Loss = Trauma Increased Destruction of Cells = Hereditary spherocytosis Loss of Cells through Hemmorhage or Chronic Blood Loss = Cow milk intolerance Increased destruction of Cells = Thalassemias Loss of Cells through Hemorrhage or Chronic Blood Loss= Menorrhagia Decreased Production of Cells = Iron deficiency anemia

The nurse is caring for a​ 6-year-old client with hereditary spherocytosis. The client received a splenectomy 6 months ago. After a​ splenectomy, the client is at risk for which​ condition?

Infection

The​ nurse's assignment for the shift includes caring for a child with infective endocarditis. To provide quality​ care, the nurse is reviewing the etiology of this disease process. Which statement is most​ accurate?

Infective endocarditis is caused by a bacteria or fungus.

Callie Lozano has been diagnosed with a thalassemia. Which is an important part of her nutritional​ plan?

Supplement with folic acid

A child has been diagnosed with hypertrophic cardiomyopathy. Which would the nurse anticipate will be part of the treatment​ plan? Select all that apply:

A beta blocker An implantable defibrillator A left ventricular assist device (LVAD)

The nurse is caring for a child with infective endocarditis. Which intervention would be most effective for the treatment of this disease​ process?

Administer ordered antibiotics

Which of the following is not a part of discharge care and teaching for rheumatic​ fever?

After recovering from rheumatic​ fever, all children should be encouraged to be active in sports.

Which are aspects of the pathophysiology of aplastic​ anemia?

Anemia develops from lack of red blood cells Thrombocytopenia develops from lack of platelets Neutropenia develops from lack of white blood cells

​Five-year-old Ella Minton is recovering from rheumatic fever. She appears to have no heart effects or damage. Which treatment options do you expect will be implemented for​ Ella?

Antibiotics as secondary prophylaxis until the age of 21

Which are aspects of assessment for aplastic​ anemia?

Assess for​ pallor, hypoxia,​ fatigue, activity intolerance. Assess for​ bruising, petechiae, purpura. Assess for​ fever, mouth and skin lesions.

A child has received IVIG for the treatment of Kawasaki disease. The nurse informs the​ child's family that any immunizations with a live virus vaccine should be postponed for how​ long?

At least 11 months

The nurse is caring for a​ 9-year-old client diagnosed with thalassemia. The nurse recognizes which findings on assessment as a distinctive sign of this specific​ disorder?

Bronzed skin

Which group is most likely to be affected by hereditary​ spherocytosis?

Children of northern European descent

Which are parts of discharge care and teaching for Kawasaki​ disease?

Clients might need medical care for head injuries that would be minor in other children. For children who have received​ IVIG, any immunization for live virus vaccines should be postponed for at least 11 months. Fever may recur and if it​ does, treatment should be sought

the nurse explains the disease to the parents of a child recently diagnosed with hemophilia A. What statement about the pathophysiology is most accurate?

Clotting factor VIII is low

hypotension DIC or ITP

DIC

oozing of blood from skin DIC or ITP

DIC

prolonged PT DIC or ITP

DIC

prolonged PTT DIC or ITP

DIC

Organ dysfunction (DIC or ITP)

DIC - disseminated intravascular coagulation

Matching: Condition --> Treatment option

Dilated Cardiomyopathy = Digoxin Endocarditis = Meticulous oral care Dilated Cardiomyopathy = Diuretics Hypertrophic Cardiomyopathy = Implantable defibrillators Kawasaki Disease = Corticosteroids Hypertrophic Cardiomyopathy = LVAD Endocarditis = IV Antibiotics Kawasaki Disease = Intravenous Immunoglobulin G (IVIG) Dilated Cardiomyopathy = Antihypertensives Kawasaki Disease = Aspirin

The nurse is caring for a​ 17-year-old client with mild iron deficiency anemia. Which interventions would be​ appropriate?

Encourage dried fruits in diet Limit cow milk in diet Encourage meats, fish, and poultry in diet

Which aspects of discharge care and teaching are appropriate for​ thalassemias?

Encourage genetic counseling to determine risks of disease for future children. Teach caregivers that the use of deferoxamine will turn the urine reddish brown in color.

Ten-year-old Peyton Kent has been brought in with these​ symptoms: low-grade chronic​ fever, fatigue,​ malaise, joint​ pain, and headaches. He has been recovering the last few months from cardiac surgery to install a prosthetic valve. What are these clinical manifestations most likely associated​ with?

Endocarditis

Matching: Condition --> Assessment Factor

Endocarditis = Observe for signs of infection Cardiomyopathy = Monitor for dysrhythmias Kawasaki Disease = Evaluate for murmurs Cardiomyopathy = Monitor for chest pain Endocarditis = Observe for signs of embolus Kawasaki Disease = Assess for signs of dehydration Cardiomyopathy = Assist with echocardiogram Kawasaki Disease = Assess skin as rash resolved Cardiomyopathy = Assist with electrocardiogram

The nurse is caring for an​ 8-year-old client with aplastic anemia. After reviewing the​ records, which intervention would be​ appropriate?

Enforce strict hand hygiene and screen visitors for infection

When caring for a​ 15-year-old client with​ anemia, the nurse recognizes which signs and symptoms of​ anemia?

Fatigue Dizziness Pallor

An​ 8-month-old infant has been diagnosed with cardiomyopathy. Which signs and symptoms would the nurse expect to find on​ assessment?

Fatigue Jugular venous distention An audible murmur

The nurse is documenting the assessment of a child with rheumatic fever. Which assessment finding would the nurse be most concerned​ about?

Heart murmur

The nurse is caring for a​ 14-year-old female client with iron deficiency anemia. Which interventions can assist the client in obtaining normal iron​ levels?

Help the client pick iron-rich foods Assess client compliance with iron supplements

The nurse is caring for a child with a recent diagnosis of infective endocarditis. The​ child's mother appears very upset and asks the nurse what can be done to help her son. Which would be the best response by the​ nurse?

High-dose antibiotics will help kill the bacteria that are causing the problem

6 yr old Adina Feldspar has been brought to the hospital for testing. After recently receiving the MMR vaccine, she has been bleeding in the nose and mouth, bruising easily, and having prolonged bleeding after a minor scrape. Which condition should you expect to be ruled out first? (as in what are doctors most likely to test for first)

ITP

GI bleeding DIC or ITP

ITP

bleeding in the mouth or nose DIC or ITP

ITP

intracranial hemorrhage DIC or ITP

ITP

seizures (DIC or ITP)

ITP

vomiting DIC or ITP

ITP

Fourteen-year-old Tory Kendrick is in the hospital to be treated for a sickle cell disorder crisis. His symptoms are pain and dehydration. What interventions should you take​ immediately?

IV opioids and salie flush bolouses

Matching Type of Anemia --> Tx option

Iron deficiency = limit cow milk aplastic anemia = treat toxin with antidote sickle cell anemia = oxygen for hypoxia aplastic anemia = control infection iron deficiency anemia = eat iron-rich foods aplastic anemia = prevent falls sickle cell = warm blankets aplastic = immunosuppressents sickle cell = heat packs aplastic = dialysis sickle cell = normal saline fluid boluses iron deficiency = oral iron supplement

​Eleven-year-old Jenna​ O'Reilly is of northern European descent. She has always been a healthy​ child, but in recent months she has manifested​ fatigue, listlessness,​ pallor, and occasional dizziness. She has no other symptoms. Which of the following is the most likely diagnosis for​ her?

Iron deficiency anemia

The nurse is caring for a​ 9-year-old client with iron deficiency anemia. When providing discharge teaching about iron​ supplements, what information should the nurse give to the​ caregivers?

Iron supplements can cause constipation Iron supplements can cause nausea on an empty stomach Give with orange juice to increase absorption

The nurse is providing discharge teaching for an​ 8-year-old client with spherocytosis. Which information needs to be provided for the​ caregivers?

Keeping the child out of school when there are outbreaks of illness

Which are treatment options for hypertrophic​ cardiomyopathy?

Left ventricular assist device Beta Blockers Implantable defibrillators

The nurse is caring for an​ 8-year-old client with​ beta-thalassemia major. When doing discharge​ teaching, the nurse should provide which information for the​ caregivers?

Maintain regular evaluations of hemoglobin levels

Which treatment options are appropriate for beta-thallasemia

Monthly transfusion of packed RBC Splenectomy Bone marrow transplant

Which are correct statements concerning treatment of patients who have received a heart​ transplant?

Most transplant recipients require other surgeries and medical bridging interventions. The client shows few outward signs of chronic rejection. Antirejection medications can cause problems such as immunosuppression and hypertension.

The nurse is caring for a​ 6-year-old client whose bone marrow is suppressed. When the client develops a​ fever, the nurse suspects which​ complication?

Neutropenia

The nurse is caring for a​ 14-year-old female client diagnosed with anemia. Which risk factors for anemia in clients of this age group should the nurse be aware​ of?

Onset of menses Poor intake of iron-rich foods Prone to eating disorders

​Four-year-old Timothy Tanaka has been diagnosed with Kawasaki disease. Which of the following should be an intervention in your plan of​ care?

Oral hygiene to keep mouth moist

​Seven-year-old Peter Reilly has been diagnosed with aplastic anemia. What is an important part of discharge care to discuss with his​ parents?

Talk to them about the use of a helmet during active play.

What is the main goal of discharge care and teaching for hereditary​ spherocytosis?

Teach the family and child to do as much as possible to be aware of and prevent signs of infection.

The nurse is caring for an​ 8-year-old client with aplastic anemia. Which interventions will assist the client in recovering from​ thrombocytopenia?

Place the client on fall risk precautions Limit venipuncture and needle sticks Provide padding to bed rails

The nurse is caring for a​ 5-year-old client with hereditary spherocytosis. What is the primary goal of nursing care for this​ client?

Preventing infection

Which are part of discharge care and teaching for families of children with​ endocarditis?

Prophylaxis, if​ indicated, should be strictly followed. Echocardiograms will be needed to evaluate valvular function. Electrocardiogram will be used to monitor for resulting dysrhythmias.

Which of the following is not an intervention in the care of a heart transplant​ recipient?

Relate plan for secondary prophylaxis to caregivers.

The nurse is caring for a​ 6-year-old client with thalassemia. The client is diagnosed with splenomegaly. Which medical treatment should the nurse anticipate for the​ client?

Removal of the spleen by surgical procedure

Characteristics of Rheumatic fever?

Repeated streptococcal infections increase the risk The age of most children affected is between 5-15 It is almost nonexistent in the U.S

Nursing assessment of a​ school-age child reveals inflamed​ joints, rash on the​ trunk, and aimless movements of the extremities. The nurse recognizes these findings as characteristic of which acquired cardiac​ disease?

Rheumatic fever

The nurse is caring for a​ 10-year-old client with thalassemia who has had a splenectomy. Which nursing diagnosis would be appropriate for this​ client?

Risk for sepsis

What is the main nursing diagnosis for hereditary​ spherocytosis?

Risk for sepsis related to asplenia

Matching type of anemia = intervention

Sickle cell = patient controlled analgesia thalassemia = deferoxamine as indicated sickle cell = moist heat thalassemia = supplement with folic acid sickle cell = anti-inflammatory meds hereditary spherocytosis = influenza vaccine thalassemia = administer packed RBCs

The nurse is giving discharge instructions for a child with minor valve damage from rheumatic fever. What should the nurse include in the​ teaching?

The child may require surgery in the future. The child will be at risk of developing an embolus as an adult. The child will require secondary prophylaxis.

The nurse is caring for a​ 10-year-old client with aplastic anemia who was admitted for thrombocytopenia. The nurse should teach the caregivers about which​ precautions?

The child should wear a helmet when biking Install stair and window guards Seek medical care for even minor head injuries

The nurse has received report on patients for the night shift and is reviewing the charts. What information would be most important for the nurse to ensure had been reported to this​ child's health care​ provider? Temperature​ 99.2°F (37.3°C) Blood pressure​ 126/84 mmHg Heart rate 78​ beats/min Oxygen saturation​ 98% Client is a​ 6-year-old male recently diagnosed with cardiomyopathy. No previous history of hospitalizations. Had a mild heart murmur at birth that had resolved by the age of 2. Alert and​ orientated, follows​ commands, hands and feet cool to the​ touch, lung sounds clear to auscultation​ bilaterally, cardiac dysrhythmia​ noted, hypoactive bowel sounds in all four​ quadrants, equal strength in all extremities.

The dysrhythmia

The family of a​ 10-year-old child has just been informed of the​ child's need for a heart transplant. To help determine the​ family's readiness for this​ procedure, the nurse must consider which​ factors?

The family's needs The child's opinion Compliance with health care regimens The family's support system

​Seven-year-old Shala Mohamed is being released from the hospital after being treated for rheumatic fever. Which of the following should be part of the discharge teaching you provide to her​ mother?

The plan for secondary​ prophylaxis, based on cardiac involvement

A​ 4-year-old child with infective endocarditis will be discharged in 2 days. When completing the discharge​ plan, which should the nurse​ include?

The use of prophylactic antibiotics

In the treatment of hereditary​ spherocytosis, what is a positive effect of the removal of the​ spleen?

Treats the excessive hemolysis

Caregivers of children with aplastic anemia must learn to recognize the signs of bleeding. Which symptoms are signs of​ bleeding?

Unexplained bruising Stools that are tarry in color Bleeding gums

A​ 7-year-old child has experienced no heart effects from an episode of rheumatic fever. When discussing secondary prophylaxis with the​ child's parents, how long would the nurse tell them that this would be​ required?

Until age 21

Desmopressin (DDAVP) increases which available clotting factor?

VIII- which is low in patients with hemophilia A and von Willebrand disease

What is an accurate description of disseminated intravascular coagulation?

a condition that causes a child to bleed excessively at the same time that the blood is trying to clot

nursing diagnosis for ITP

bleeding and hemorrhage from idiopathic immune process

DIC

disseminated intravascular coagulation

x- linked recessive (most common type)

hemophilia A

decrease in clotting factor 8

hemophilia A (classic)

autosomal recessive

hemophilia C

decrease in clotting factor 11

hemophilia C

ITP

idiopathic thrombocytopenic purpura

The diagnosis of rheumatic fever is being ruled out for a child. The nurse is obtaining a history from the​ child's parents. Which would be the most significant finding for this​ diagnosis?

the child had strep for 3 weeks

the most important message to impart to parents of a child with DIC

the child must never be left alone int he hospital room

what is the pupose of desmopressin (DDAVP) in treatment for hemophilia and von Willebrand disease?

to increase the relase of stored factor 8 and vWF

4 yr old Tyler James has been diagnosed with disseminated intravascular coagulation (DIC). he is not in shock. which of the following would most likely be part of your treatment plan for him?

treatment of underlying cause

autosomal dominant bleeding d/o

von Willebrand Disease

gene on chromosome 12

von Willebrand disease