Ch 18 & 19 Peds Final

A child is in the emergency department with an asthma exacerbation. Upon auscultation, the nurse is unable to hear air movement in the lungs. What action should the nurse take first?

Administer a beta-2 adrenergic agonist The air movement is so severe that wheezes cannot be heard. The priority treatment is to administer an inhaled short-term bronchodilator (beta-2 adrenergic agonist). The child may require numerous inhalations until bronchodilation occurs and air can pass through the bronchi. Oxygen can be started, but until the bronchi are dilated, no oxygen can get through to the lung fields. An IV would need to be started and IV steroids administered to reduce the inflammation, but the priority is bronchodilation.

Diastolic dysfunction: right sided HF

hepatomegaly, jugular vein distention and periorbital edema.

Pancreatic enzymes are part of the treatment and cystic fibrosis. When should the nurse administer the enzymes?

Before meals and snack with milk

The nurse is planning care for a child with a pneumothorax. The nurse adds the nursing diagnosis, "Risk for injury related to potential dislodgement of chest tube" to the care plan. When writing the care plan, what should the nurse be sure to include as interventions?

Ensure a pair of hemostats are at the bedside. Monitor pulse oximetry readings. Assess lungs as directed by the physician or as the client's condition warrants. Maintain chest tube bottle in an upright position and below the level of the chest.

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of

I'm going to have this hospital worker take a picture of your lungs.

An 8-month-old infant has a ventricular septal defect. Which nursing diagnosis would best apply?

Ineffective tissue perfusion related to inefficiency of the heart as a pump A ventricular septal defect permits blood to flow across an opening between the right and left ventricles. It results in increased pulmonary blood flow, but it does not cause cyanosis. The blood in the left ventricle, which flows back into the right ventricle, is already oxygenated. Anytime there is an opening between the heart's ventricles, the heart is not as effective as a pump because the pressure gradients are changed. A ventricular septal defect will not cause respiratory problems or problems with peripheral circulation.

The nurse is caring for child who present to the emergency department with reports of a fever for 5 days. The nurse notes a diffuse maculopapular rash, reddened cracked lips, erythema of hands, and bilateral conjunctivitis and suspects Kawasaki disease. Which nursing action is priority?

Initiate intravenous access. A child with signs of Kawasaki disease is at risk for dehydration due to a prolonged fever and oral pain. The priority for the nurse is to establish intravenous access to begin IV fluids. Placing the child on a soft diet will be done after ensuring IV access.

When preparing the room for an infant with bronchiolitis, which equipment is most important?

Oxygen tubing and face mask Bronchiolitis is an acute inflammatory process in the bronchioles and small bronchi. The treatment is supportive oxygen therapy, suctioning, and hydration. Rarely is a tracheostomy set needed for care. An infant is not able to use a metered dose inhaler but nebulized bronchodilators may occasionally be needed. Bronchiolitis is most commonly associated with the respiratory syncytial virus (RSV), thus antibiotics would not be warranted in the treatment

A six month old infant who was born premature is being seen for a follow-up examination. The child is to receive an intramuscular injection monthly through the winter and spring season. Which drug would the nurse expect to be ordered?

Palivizumab palivizumab is a monoclonal antibodies for prevention of serious lower respiratory syncytial virus

A nurse is caring for a child with Kawasaki disease. Which assessment finding with the nurse expect to see?

Peeling hands and feet, fever Kawasaki disease is an acute systemic vasculitis. Symptoms begin with very high fevers. One of the signs of Kawasaki disease is appealing hands and feet and and peroneal region. The child is usually tachycardic and laboratory values would indicate increase platelets and decreased hemoglobin. Another classic sign of Kawasaki is a strawberry tongue.

The nurse is caring for a child with thickened pulmonary secretions. Which action(s) would the nurse use to assist the child breathe with less effort? Select all that apply.

Perform chest physiotherapy encourage oral fluids

An infant with tetralogy of fallot it become cyanotic. Which nursing intervention would be the first priority

Place an infant in the knee-chest position

When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover?

Polycythemia The increase amount of RBCs is known as polycythemia.

When caring for a child with congenital heart defect, which assessment finding may be a sign child is experiencing heart failure?

Tachycardia

A five-year-old girl who was already admitted to the hospital for an unrelated condition suddenly becomes irritable, restless and anxious this may be early signs of respiratory distress in a child if accompanied by

Tachypnea

Newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis?

Tetralogy of fallot (disorder with decreased pulmonary blood flow)

The child has been admitted to the hospital with a possible diagnosis of pneumonia. Which finding(s) is consistent with this diagnosis? Select all that apply.

The child's chest x-ray indicates the presence of perihilar infiltrates. The child's white blood cell count is elevated. The child's respiratory rate is rapid. The child is producing yellow purulent sputum.

When assessing a child for the probable cause of acute bronchiolitis, the nurse focuses on which factor

Viral infections

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction?

Wheezing

A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which statement should the nurse make to the girl's mother in response to these findings?

Your daughter has an innocent heart murmur, which is nothing to worry about.

A child is hospitalized with pneumonia. The nurse assesses an increase in the work of breathing and in the respiratory rate. What intervention should the nurse do first to help this child?

Elevate the head of the bed

A nurse is demonstrating to parents how to use normal saline nose drops and how to suction nasal secretions from the nose of an infant. The nurse positions the infant correctly and then performs the procedure. Place the steps below in the order that the nurse would complete them. Use all options.

Instill several drops of saline into one of the infant's nostrils. Compress the sides of the bulb syringe completely. Place the rubber tip of the bulb syringe into the nose. Release the pressure on the bulb syringe. Remove the syringe from the nose and empty the contents.

A nurse is assessing the skin of a 12 year old with suspected right ventricular heart failure. When should the nurse expect to note edema in this child?

Lower extremities

Systolic dysfunction: left sided HF

dyspnea on exertion, increased work of breathing, and feeding difficulties.

The health care provider suspects an infant may have a ventricular septal defect. The parents ask the nurse what diagnostic tests the infant will need to have to determine this diagnosis. For what test(s) should the nurse provide education to the family? Select all that apply.

magnetic resonance imaging (MRI) echocardiogram cardiac catheterization

Which problem based nursing care plan will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot?

Altered cardiopulmonary tissue perfusion risk

Which medication is a respiratory stimulant?

Aminophylline Aminophylline is a respiratory stimulant and bronchodilator that opens the airway of the lungs. It relaxes the smooth muscles around the airways.

A child has been admitted to the pediatric unit with pneumonia. The nurse is preparing to administer the prescribed medication to the child to help reduce the viscosity of the child secretion. Which medication would the nurse most likely give?

Guaifenesin An expectorant reduces viscosity of thickened secretions by increasing respiratory tract fluid.

The nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed?

We can stop the penicillin when her symptoms disappear

The nurse is caring for a child with a history of cystic fibrosis (CF). Which finding will the nurse report to the primary health care provider?

Wheezing The nurse would report wheezing, as this indicates respiratory distress. Clubbing occurs with chronic respiratory illness. It is the result of increased capillary growth as the body attempts to supply more oxygen to distal body parts. Barrel chest refers to the shape the chest takes on in chronic respiratory illness. It takes the shape as chronically the lungs fill with air but are unable to fully expel the air. Delayed puberty is common in clients with cystic fibrosis and does not require reporting at this time.

When caring for a child with Kawasaki disease, the nurse would know that:

management includes administration of aspirin and IVIG. Kawasaki disease is an acute systemic vasculitis. It is the most common form of acquired heart disease in children. The treatment is directed to reduce the inflammation in the walls of the coronary arteries and prevent thrombosis. Children are given high-dose aspirin therapy four times a day and they receive an infusion of IV immunoglobulins (IVIG) to prevent cardiac complications.

What test in a child with cystic fibrosis would help monitor airway function?

pulmonary function

The nurse is caring for an infant whose oxygen saturation levels frequently drop below 90%. Which data is most important to relate to the health care provider?

Blood gases

The student nurse is collecting data on a child diagnosed with cystic fibrosis and knows the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of the symptoms to be

Chronic lack of oxygen

A school nurse is caring for a child with a severe sore throat and fever. What is the nurse's bestrecommendation to the parent?

Have the child be seen by the primary care provider. Children with sore throats and fevers should be seen by their primary care provider to rule out strep throat. This is extremely important due to the fact they may contract an acquired heart disease called rheumatic fever. Taking acetaminophen, resting, and drinking fluids are all good recommendations, but the best recommendation is to see the provider. Going to the emergency room is not necessary at this time.

A hospitalized child suddenly begins reporting "my chest hurts," is tachypneic, and has tachycardia. The nurse auscultates the lung sounds and finds absent breath sounds on one side. After notifying the health care provider, what action would the nurse take first?

prepare for chest tube insertion A pneumothorax is a collection of air in the pleural space. Trapped air consumes space in the pleural cavity causing a partial or complete collapse. The priority symptom a nurse would assess is the decreased or absent lung sounds on the affected side. A pneumothorax can occur spontaneously in a healthy child or it can occur in a child with chronic lung disease, who has been on a ventilator or has had thoracic surgery. Additional symptoms the child would experience would be chest pain, tachypnea, retractions, grunting, cyanosis and tachycardia

The nurse is doing an in-service training with nurses working with families who may be in situations that create high-risk health situations for their children. The nurse explains that children of caregivers with which situation should be tested annually for tuberculosis?

A caregiver whose family is homeless

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is the most accurate regarding the diagnosis of rheumatic fever?

Children who have this diagnosis may have had strep throat Streptococcal infection, romantic fever is a chronic disease of childhood affecting their connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow in subtle.

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks the child seems to have lack of coordination, facial grimaces and repetitive involuntary movements. Based on these symptoms the nurse would suspect what condition?

Chorea Rheumatic fever affects the heart, the central nervous system, skin and subcutaneous tissue. It causes carditis, arthritis, and chorea. Chorea is a disorder characterized by emotional instability, purposeless movements, and muscular weakness. The onset of chorea is gradual, with increasing incoordination, facial grimaces, and repetitive involuntary movements.

The nurse in the pediatric cardiovascular clinic is talking with the father of a five-year-old child who underwent cardiac surgery for a heart defect at the age of three. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder?

Heart failure