Week 5 327 PEDs

An early sign of congestive heart failure in an infant is: Select one: a. Tachypnea b. Increased urine output c. inability to sweat d. bradycardia

a. Tachypnea (Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic. Urine output usually will be decreased due to decreased kidney perfusion.)

Which of the following is considered a mixed cardiac defect? Select one: a. Pulmonic Stenosis b. Patent ductus arteriosis c. Atrial septal defect d. Transposition of the great arteries

d. Transposition of the great arteries (Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow. Transposition of the great arteries allows the mixing of blood in the heart.)

You are assessing a newborn with a heart murmur. As part of your assessment you obtain four extremity blood pressures. The blood pressure in the upper extremities is 20mmHG greater than the pressure in the lower extremities. The femoral pulses are also weak. You recognize this grouping of symptoms as which congenital heart defect? Select one: a. Coarctation of the Aorta b. Tetrology of Fallot c. Patent Ductus Arteriosis d. Hypoplastic Left Heart Syndrome

a. Coarctation of the Aorta

The most important nursing intervention related to congenital hypothyroidism is: Select one: a. early identification of the disorder b. helping parents deal with future prospects for the child c. facilitation of parent-child bonding d. initiating referrals for cognitive development

a. early identification of the disorder (Early diagnosis is imperative. Because brain growth is complete by 2 to 3 years old, the deficiency must be detected, and replacement therapy begun as soon as possible. The parent-infant attachment is important for all infants. With appropriate intervention, the child may not have any developmental deficit. With appropriate intervention, the child may not have any developmental deficit.)

Nursing care of the infant or child with congestive heart failure would include: a. organizing activities to allow for uninterrupted sleep b. forcing fluids appropriate to age c. monitoring respirations during periods of activity d. giving larger feedings less often to conserve energy

a. organizing activities to allow for uninterrupted sleep (The child who has congestive heart failure has an excess of fluid. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to facilitate a decrease in his or her energy expenditure. The child often cannot tolerate larger feedings.)

A nurse is providing teaching to the parents of a school-age child who has type 1 IDDM about management of hypoglycemia. Which of the following responses by the parents indicates an understanding of the teaching? a. "I will give my child 2 units of regular insulin" b. "I will make sure the child drinks 240mL (8 ounces) of milk, as soon as possible" c. "I will check my child's urine for glucose twice daily" d. "I will insist that my child lies down to rest for 30 minutes"

b. "I will make sure the child drinks 240mL (8 ounces) of milk, as soon as possible" (Administering additional insulin could worsen the child's hypoglycemia and lead to neurologic effects such as seizures, shock, and coma.)

The cardiac surgeon recommends surgery to close a Patent Ductus Arteriosis to prevent: a. Pulmonary infection b. Increased pulmonary congestion c. decreased workload on the left side of the heart d. Right to left shunt

b. Increased pulmonary congestion (The increased pulmonary vascular congestion is the primary complication. The shunt of blood is left to right. The increased pulmonary vascular congestion is the primary complication. Patent ductus arteriosus (PDA) allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary congestion can occur.)

When discussing a child's precocious puberty with the parents, the nurse should tell them that: a. heterosexual interest may also be advanced b. dress and activities should be appropriate to chronological age c. the child is not yet fertile d. appearance of secondary sexual characteristics doesn't proceed in the usual order

b. dress and activities should be appropriate to chronological age (Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age. Because of the early sexual maturation of the child, both family and child require extensive teaching. Included in this is the information that the child should be engaged in activities according to chronologic age. The secondary sexual characteristics proceed in the usual order.)

You are reviewing the thyroid test results for a patient who is complaining of fatigue, dry skin and constipation. Which of the following suggests juvenile hypothyroidism? Select one: a. Low TSH (thyroid stimulating hormone) b. Elevated T3 or T4 c. Elevated TSH (thyroid stimulating hormone) d. Normal TSH (thyroid stimulating hormone)

c. Elevated TSH (thyroid stimulating hormone) (Elevated TSH is the pituitary gland's way of trying to stimulate the thyroid gland to produce more thyroid hormone)

You are admitting a patient and note the presence of exopathlamos, weight loss, and increased pulse. You recognize this group of symptoms as __________ and a nursing intervention as ________________________. Select one: a. Hashimoto's disease, replace thyroid hormone b. Congenital adrenal hyperplasia: supplement cortisol c. Graves' disease: encourage rest and increase calorie intake d. Diabetes Insipidus: replace ADH (antidiuretic hormone)

c. Graves' disease: encourage rest and increase calorie intake

A nursing is assessing a child who has a ventricular septal defect. Which of the following findings should the nurse expect? a. Cyanosis that increases with crying b. Widened pulse pressure c. Murmur at the left sternal border d. Diastolic murmur

c. Murmur at the left sternal border (A VSD is an acyanotic heart defect. A systolic murmur can be best heard at the lower left sternal border. Sound is transmitted in the direction of blood flow, so any backflow of blood from the left to the right ventricle through the septal defect is best heard in this area)

Which of the following is NOT a symptom of Kawasaki's Disease? Select one: a. Fever > 38C for greater than 5 days b. Red conjunctiva without drainage c.Koplik spots on the buccal mucosa d. Edematous, peeling hands and feet e. Strawberry tongue

c.Koplik spots on the buccal mucosa (this is a symptom of measles)