ATI DYANMIC CARDIO IMMUNE
A nurse in a provider's office receives a phone call from the guardian of an infant who just vomited after the administration of digoxin. Which of the following actions should the nurse take first? · ✔ A. Tell the guardian that a repeat dose of medication should not be given · B. Verify the prescribed medication regimen · C. Determine if the infant has been exposed to others who are ill · D. Ask the guardian about the infant's urinary output
A
A nurse is assessing a 2-month-old infant who has a ventricular septal defect. Which of the following findings should the nurse report to the provider? · A. Weight gain of 1.8 kg (4 lb) · B. Heart rate of 125/min · C. Soft, flat fontanel · D. Systemic murmur
A
A nurse is caring for a 4-month-old infant who has tetralogy of Fallot and experiences a hypercyanotic spell. Which of the following actions should the nurse take? • A. Place the infant in knee-chest position • B. Begin CPR • C. Prepare to intubate the infant • D. Administer IV adenosine
A
A nurse is caring for a child who has bacterial endocarditis. The child is scheduled to receive moderate-term antibiotic therapy and requires a peripherally inserted central catheter (PICC). Which of the following statements should the nurse include when teaching the child's parent? · A. "The PICC line will last for several weeks with proper care." · B. "The public health nurse will rotate the insertion site every 3 days." · C. "You will need to ensure the arm board is in place at all times." · D. "Your child will go to the operating room to have the line placed."
A
A nurse is caring for an infant who has tetralogy of Fallot and is experiencing a hypercyanotic episode. Which of the following actions should the nurse take? • A. Place the infant in a knee-chest position • B. Initiate a fluid restriction • C. Provide oxygen by nasal cannula • D. Administer acetaminophen
A
A nurse is providing teaching to the parent of an infant who has heart failure and a new prescription for digoxin elixir. Which of the following pieces of information should the nurse include? · A. Withhold the medication if the infant's heart rate is less than 110/min · B. Mix the medication in 120 mL (4 oz) of infant formula · C. Expect the infant to vomit frequently while taking this medication · D. Double the dose if the infant has increased edema
A
A nurse is assessing a 6-month-old infant who had a cardiac catheterization with right femoral entry to diagnose a possible congenital heart defect. Which of the following findings should the nurse report to the provider? • A. Cool toes on the right foot • B. Weak pedal pulses on both feet • C. Positive Babinski reflex on both feet • D. Erythema on the right foot
a
A nurse is caring for a group of infants with congenital heart defects. For which of the following defects should the nurse expect to observe cyanosis? • A. Transposition of the great arteries • B. Ventricular septal defect • C. Coarctation of the aorta • D. Patent ductus arteriosus
a
A nurse is assessing a child who has a ventricular septal defect. Which of the following findings should the nurse expect? • A. Diastolic murmur • B. Murmur at the left sternal border • C. Cyanosis that increases with crying • D. Widened pulse pressure
B
A nurse is assessing a 6-month-old infant following a cardiac catherization. Which of the following findings should the nurse report to the provider?
BP 86/40 mmHg
A nurse at a clinic is preparing to administer immunizations to a 5-year-old child. Which of the following immunizations should the nurse plan to give?
Diphtheria, tetanus, and pertussis (DTaP)
A nurse is planning care for a child who has meningococcal meningitis. Which of the following isolation precautions should the nurse plan to implement?
Droplet precautions
A nurse is preparing to administer recommended immunizations to a 2-month-old infant. Which of the following immunizations should the nurse plan to administer?
Haemophilus influenzae type B (HiB) and inactivated polio virus (IPV)
A nurse is teaching the parents of a child who has rheumatic fever. Which of the following statements by a parent indicates an understanding of the teaching? • A. "My child may take aspirin for his joint pain." • B. "My child will need a blood transfusion prior to discharge." • C. "I will need to wear a gown when I'm in my child's room." • D. "I will apply lotion to my child's peeling hands."
a
An 18-month-old toddler who has Kawasaki disease (KD). The child is receiving intravenous immune globulin (IVIG). The guardian asks the nurse to administer the child's scheduled measles, mumps, and rubella (MMR) vaccine before discharge. Which of the following responses should the nurse provide? • A. "Your child will not be able to receive the MMR vaccine for at least 3 months after discharge." • B. "I cannot administer routine vaccines to children while they are in the hospital." • C. "Your child can receive the MMR vaccine once his fever is gone." • D. I can administer the measles and rubella vaccines, but I cannot administer the mumps vaccine."
a
A nurse is preparing a client for cardiac catheterization. Which of the following pieces of information should the nurse give the client before the procedure? (Select all that apply.) • A. "You'll have to lie flat for several hours after the procedure." • B. "You'll receive medication to relax you before the procedure." • C. "You'll feel a cool sensation after the injection of the dye." • D. "You'll have to keep your leg straight after the procedure." • E. "You'll have to limit the amount of fluid you drink for the first 24 hr."
a b d
A nurse is providing teaching to the guardian of a child who has Kawasaki disease. Which of the following statements by the guardian indicates an understanding of the teaching? (Select all that apply.) • A. "My child will likely be irritable for the next few weeks." • B. "I will notify my child's doctor if the skin on her hands or feet begins to peel." • C. "I will ensure my child does not receive any live vaccines for at least 18 months." • D. "I will keep a record of my child's temperature until she has no fever for several days." • E. "My child will have joint stiffness primarily at the end of the day."
a c d
A nurse is assessing a school-aged child who is 30 minutes postoperative following a cardiac catheterization using the left femoral artery. Which of the following findings should the nurse identify as the priority to report to the provider? · A. The child rouses to verbal stimuli · B. The pulse strength of the child's left popliteal artery site is decreased · C. The child's respiratory rate is 20/min · D. The child rates his pain at the catheter insertion site at a 7 on a scale of 0 to 10
b
A nurse is planning care for an infant who has heart failure. Which of the following interventions should the nurse include in the plan to meet the nutritional needs of the infant? (Select all that apply.) · A. Offer the infant a feeding every 2 hr · B. Allow 30 min to complete each feeding · C. Gradually increase the caloric density of the formula · D. Position the infant semi-upright during feedings · E. Provide gavage feeding if respiratory rate exceeds 80/min
b c d e
A nurse is assessing a 6-month-old infant following a cardiac catheterization. Which of the following findings should the nurse report to the provider? • A. Temperature 37.5°C (99.5°F) • B. Apical pulse rate 140/min • C. BP 86/40 mmHg • D. Respiratory rate 32/min
c
A nurse at a screening clinic is assessing a client who reports a history of a heart murmur related to aortic valve stenosis. At which of the following anatomical areas should the nurse place the stethoscope to auscultate the aortic valve? • A. Fifth intercostal space just medial to the midclavicular line • B. Second intercostal space to the left of the sternum • C. Fifth intercostal space to the left of the sternum • D. Second intercostal space to the right of the sternum
d
A nurse is caring for a child who has tetralogy of Fallot. Which of the following laboratory values should the nurse expect to find? • A. Platelet count of 20,000/mm^3 • B. WBC 4,000/mm^3 • C. Thyroid stimulating hormone 7.0 microunits/mL • D. RBC 6.8 million/uL
d
