unit 3 exam

A nurse is providing discharge instructions for a client who has congestive heart failure. Which of the following client statements indicates to the nurse that the teaching was effective?

"I plan to slow down if I am tired the day after exercising."

A nurse is providing teaching to the parents of a child who has streptococcal pharyngitis about ways to prevent disease transmission. Which of the following responses by the parents indicates an understanding of the teaching?

"We'll discard the toothbrush and buy another."

A nurse is reinforcing teaching to the parents of a child who has cystic fibrosis and has a prescription for pancrelipase (Pancrease) capsules. Which of the following should the nurse include in the teaching?

. Administer the medication with meals and snacks.

A nurse is collecting data from an infant. Which of the following is a clinical manifestation of pyloric stenosis?

. Projectile vomiting after feedings.

Which child with respiratory distress should the nurse see first?

A 12 month old who has a mild cry, is pale in color, has diminished breath sounds bilaterally with an oxygen saturation of 92%

A nurse is caring for a child who has rheumatic fever. When obtaining the childs medical hx from a parent, the nurse would recognize the significance in which of the following data as the source of the childs infection?

A sibling who had a sore throat 3 weeks ago.

A nurse is caring for an infant who has a tracheoesophageal fistula. Which of the following findings are associated with this diagnosis? (Select all that apply.)

A. Coughing.B. Apnea.D. Cyanosis.E. Frothy sputum.

A nurse is admitting a toddler who has RSV. Which of the following actions should the nurse take?

Keep the thermometer in the toddlers room

A nurse is planning care for a child with cystic fibrosis and a prescription to receive chest physiotherapy. Which of the following actions should the nurse take?

Administer albuterol prior to CPT.

A nurse is collecting data from an infant. Which of the following is clinical manifestation of a large patent ductus arteriosus?

Machinery-like murmur

A nurse is caring for a pre-school age child who has a epiglottis with a barking cough. Which of the following is an appropriate nursing action?

Apply O2.

A home health nurse is teaching parents about endotracheal suctioning. Which of the following should the nurse include in the teaching?

Apply suction for less than 10 seconds.

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration's. This suggests which of the following

Asthma

A nurse is caring for an 8 year old child who has acute rheumatic fever. Which of the following assessments is the priority immediately after admission?

Auscultating the rate of the childs heart sounds.

A nurse is providing education for a child who has a new dx of asthma. Which of the following should the nurse include in the teaching?

Avoid triggers that cause an attack.

A nurse is caring for a school aged patient with mild persistent asthma. Which of the following is an expected finding? (Select all that apply).

B. Daytime symptoms occur twice a week.D. Minor limitations occur with normal activity.E. Peak expiratory flow is greater than or equal to 80% of the predicted value.

A nurse is monitoring an infant who is 3 months old and has sneezing, coughing, nasal congestion, intermittent fever, and apneic spells. This nurse should recognize these findings are associated with which of the following diagnoses?

Bronchiolitis

A nurse is caring for a child who has Kawasaki disease. Which of the following systems should the nurse monitor in response to this diagnosis?

Cardiovascular

A nurse is completing a history and physical on a 3 year old child who is admitted for a surgical repair of Tetralogy of Fallot (TOF). Which of the following manifestations of the condition should the nurse expect? (Select all that apply)

Cyanosis Systolic Murmur

A nurse is caring for a toddler who has an acute laryngotracheobronchitis and has been placed in a cool mist tent. Which of the following findings indicates that the treatment has been effective?

Decreased stridor

B2 agonists such as Albuterol are often prescribed for a child with a severe asthma attack. What is their action?

Dilate the bronchioles

What does the therapeutic management of cystic fibrosis (CF) patient include?

Encourage medication compliance.- Providing a high protein, high calorie diet.- Encourage exercise

An infant is being prepared for surgical repair of a ventricular septal defect. Which of the following problems will be prevented by closing the defect?

Failure to thrive.

A nurse is monitoring a child for manifestations of hemorrhage following a tonsillectomy. Which of the following findings is a manifestation of this postoperative complication?

Frequent swallowing

A nurse is assessing a 3 year old child who has aortic stenosis. Which of the following findings should the nurse include? (Select all that apply).

Hypotension. Weak pulses. Murmur.

A nurse is teaching the mother of a 5 year old child who has CF about pancreatic enzymes. The nurse should understand that further teaching is necessary when the mother states which of the following?

I will give my son the enzymes between the meals.

A nurse caring for a child who has tetralogy of Fallot and notes that the child is easily fatigued. The nurse understands that the etiology of the fatigue is which of the following?

Inadequate oxygenation for supporting energy metabolism

To facilitate digestion and absorption of nutrients, the nurse teaches the child with cystic fibrosis that she needs to take:

Pancreatic Enzymes

A nurse is admitting a child who has suspected epiglottitis. Which of the following actions should the nurse take first?

Place the child on droplet precautions

A nurse is planning care for a child with suspected epiglottis. Which of the following is an appropriate action for the nurse to take?

Place the client in an upright position.

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child in to the clinic since these are symptoms suggestive of which of the following?

Pneumothorax

A nurse in an emergency department is assessing a 3-year-old child who has high fever, severe dyspnea, and is drooling. Which of the following actions is the nurse's priority?

Prepare for nasotracheal intubation

A nurse is providing teaching to a parent of a child who has acute group A B-hemolytic streptococci. Which of the following information should the nurse include in the teaching?

Replace the child's toothbrush after 24 hours on abx.

Which of the following drugs is usually given first in the emergency treatment of a acute, severe asthma episode?

Short-acting B agonists

A nurse is caring for a client who has a suspected dx of cystic fibrosis. Which of the following dx test will confirm the dx?

Sweat chloride test.

Which of the following would be a sign of respiratory distress in a 2 month old?

Tachypnea

A nurse is providing caring for an infant who has congenital heart defect. Which of the following defects is associated with the pulmonary blood flow?

Tetralogy of Fallot

A nurse is presenting an in-service about the use of postural drainage for infants who have cystic fibrosis. Which of the following positions should the nurse identify as being contraindicated for the infant?

Trendelenburg.

The healthcare provider is caring for an infant with a diagnosis of a congenital heart defect. The baby's pulse is 158 and the RR is 74. Which of the following is the best position for the baby to be placed?

Upright in an infant seat

A nurse is providing teaching to the parents of a 1 week old infant who has a prescription for home O2 and telemetry monitoring. Which of the following statements by the parent indicates a need for further teaching?

We will rotate the probe of the pulse oximeter every 24 hours

A nurse in a PACU is admitting a client who is postoperative following a tonsillectomy. Which of the following actions should the nurse plan to take to prevent aspiration?

Withhold fluids until the client demonstrates a gag reflex

A nurse is teaching an adolescent about the appropriate use of his asthma medications. Which of the following should the client be instructed to take as needed before exercise?

albuterol

a nurse is caring for an infant. what are clinical manifestations of coarctation of the aorta? select all that apply?

weak femoral pulses cool skin of lower extremeties heart failure

A nurse is caring for a child who has a tracheostomy. After suction the tracheostomy, the nurse should expect which of the following findings to determine that the procedure was effective?

clear breath sounds

a nurse is assessing an infant. what should the nurse recognize as clinical manifestations of heart failure? select all that apply?

cool extremities peripheral edema nasal flaring

a nurse is caring for a child who is suspected of having rheumatic fever. What manifestations supports this diagnosis? select all that apply

erythema marginatum (rash) elevated C reactive protein

A nurse is caring for a child who has influenza. The nurse should identify that which of the following statements by the parent indicated the child has an increased risk for Reye's Syndrome?

i give my child aspirin to reduce his fever

A nurse is planning care for a child who has asthma. Which of the following intervention should be included in the plan of care? Select all that apply

place the child in upright posistion monitor oxygen status administer bronchodilators