Chapter 37 (PEDS)
The parents of a child with heart failure ask the nurse, "How will the digoxin he is getting help?" Which response by the nurse would be most appropriate? a) "Digoxin helps to open up the blood vessels to improve blood flow." b) "The drug will lower his blood pressure so the heart won't work so hard." c) "The drug will help to remove the extra fluid in his body." d) "Digoxin helps to improve the heart's ability to contract ."
"Digoxin helps to improve the heart's ability to contract ."
The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which of the following responses by the mother would lead the nurse to suspect that the child is experiencing heart failure? a) "He does not seem short of breath." b) "He seems to have a normal appetite." c) "He does not seem sick." d) "He gets sweaty when he eats."
"He gets sweaty when he eats."
A 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? a) "She needs to take the drug for the full 14 days." b) "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years." c) "We can stop the penicillin when her symptoms disappear." d) "If she needs dental surgery, we might need additional medication."
"We can stop the penicillin when her symptoms disappear."
You have a pediatric patient prescribed digoxin for treatment of CHF. The patient has recently begun taking the maintenance dose daily. You are aware that the therapeutic range of digoxin is: a) 0.2-8ng/mL b) 0.8-3ng/mL c) 0.8-2ng/mL d) 0.6-1ng/mL
0.8-2ng/mL
The nurse clarifies to the parents of a 4-year-old child recovering from rheumatic fever, that the child will need to receive oral doses of penicillin or monthly injections of Bicillin for a minimum of _____ year(s). a) 10 b) 2 c) 1 d) 5
5
The nurse is explaining possible side effects of corticosteroids to the caregiver of a child diagnosed with rheumatic fever. The caregiver comments, "I don't understand what hirsutism means." The nurse would be correct in explaining that hirsutism is which of the following? a) A "moon face" appearance b) Abnormal hair growth c) Repetitive movements d) Facial grimaces
Abnormal hair growth
A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which of the following would the nurse be least likely to include to manage a bleeding episode? a) Administer factor VIII replacement. b) Apply direct pressure to the area. c) Elevate the injured area such as a leg or arm. d) Apply heat to the site of bleeding.
Apply heat to the site of bleeding.
A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify which of the following as a major Jones criterion? a) Carditis b) Erythema marginatum c) Arthralgia d) Subcutaneous nodules
Arthralgia
In caring for the child with rheumatic fever which medication would the nurse likely administer? a) Dilantin b) Aspirin c) Tylenol d) Insulin
Aspirin
Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor? a) Stuart factor b) Antihemophilic factor c) Proconvertin d) Christmas factor
Christmas factor
A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which of the following would the nurse include as an adjunctive measure to control bleeding? a) Exercise b) Lowering extremities c) Heat d) Compression
Compression
The nurse is caring for a 10-year-old girl with iron toxicity. Which of the following would the nurse expect the physician to order? a) Desferal b) Edentate calcium disodium c) Dimercaprol d) Succimer
Desferal
The nurse is administering medications to the child with congestive heart failure. Large doses of which of the following medications are used initially in the treatment of CHF to attain a therapeutic level? a) Digoxin (Lanoxin) b) Albuterol sulfate c) Ferrous sulfate d) Furosemide (Lasix)
Digoxin (Lanoxin)
The care provider has ordered the drug furosemide (Lasix) to treat a child diagnosed with congestive heart failure. The nurse knows that this drug will be used to: a) Slow the heart rate b) Increase vasodilation c) Strengthen the heart's contractility d) Eliminate excess fluids
Eliminate excess fluids
The nurse is assessing an infant for peripheral edema. Based on the nurse's knowledge, the nurse would expect edema to occur in which area first? a) Face b) Lower extremities c) Upper extremities d) Presacral region
Face
After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with which of the following? a) Factor IX b) Platelets c) Plasmin d) Factor VIII
Factor VIII
The nurse is collecting data on a 5 year old child admitted with the diagnosis of congestive heart failure. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Failure to gain weight b) Jerking movements of the arms and legs c) Scissoring of the legs with toes pointed down d) Clubbing of the fingers
Failure to gain weight
The most serious concern for the child diagnosed with Kawasaki disease is the effect on which of the following body organs? a) Brain b) Kidneys c) Heart d) Lungs
Heart
A symptom often seen in the child diagnosed with hemophilia is that the child has bleeding into the joints. This symptom is referred to as which of the following? a) Hemarthrosis b) Nuchal rigidity c) Purpuric rash d) Encephalopathy
Hemarthrosis
The nurse is caring for a child diagnosed with hemophilia. The child is crying and complaining of pain. Of the following nursing actions, which action would be appropriate for the nurse to do to relieve the child's pain? The nurse should a) Distract the child with an age-appropriate activity b) Give aspirin as ordered c) Immobilize the affected extremity d) Have the child do range-of-motion exercises
Immobilize the affected extremity
The nurse is caring for a child with rheumatic fever who has polyarthritis. Which of the following lab results would the nurse most anticipate with this child's diagnosis and symptoms? a) Decreased leukocyte count b) Increased clotting time c) Decreased white blood cell count (WBC) d) Increased erythrocyte sedimentation rate (ESR)
Increased erythrocyte sedimentation rate (ESR)
The child with Thalassemia may be given which of the following classifications of medications to prevent one of the complications frequently seen with the treatment of this disorder. a) Vitamin supplements b) Iron-chelating drugs c) Factor VIII preparations d) Potassium supplements
Iron-chelating drugs
After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which of the following as an assessment finding? a) Osler nodes b) Jerky movements of the face and upper extremities c) Janeway lesions d) Black lines
Jerky movements of the face and upper extremities
The nurse is collecting data on a child who is noted to be lethargic and have inflammation of both eyes and a strawberry-colored tongue. These clinical manifestations suggest the child would likely have which of the following disorders? a) Rheumatic fever b) Kawasaki disease c) Iron deficiency anemia d) Congestive heart failure
Kawasaki disease
When caring for a child with Kawasaki Disease, the nurse would know which of the following? a) Steroid creams are used for the hand peeling. b) Management includes administration of aspirin and IVIG. c) Joint pain is a permanent problem. d) Antibiotics should be administered exactly every 8 hours by IV.
Management includes administration of aspirin and IVIG.
A nurse is administering digoxin to a 3-year-old. Which of the following would be a reason to hold the dose of digoxin? a) Nausea and vomiting b) Ataxia c) Fever and tinnitus d) Hypertension
Nausea and vomiting
A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? a) Low blood pressure and decreased heart rate b) Peeling hands and feet and fever c) Irritability and dry mucous membranes d) Decreased heart rate and impalpable pulse
Peeling hands and feet and fever
Which of the following would be most important to implement for an infant who develops heart failure? a) Restricting milk intake daily b) Keeping her supine and playing quiet games c) Placing her in a semi-Fowler's position d) Planning ways to reduce salt intake
Placing her in a semi-Fowler's position
A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor? a) Serum sodium level b) Serum potassium level c) Erythrocyte sedimentation rate d) Oxygen saturation level
Serum potassium level
The parents of a child with a bleeding disorder ask the nurse about appropriate activities and sports that they should encourage the child to participate in. Which of the following would be the safest for the nurse to suggest? a) Rugby b) Gymnastics c) Soccer d) Swimming
Swimming
A nurse is caring for a child who is experiencing heart failure. Which of the following assessment data was most likely seen when initially examined? a) Bradycardia b) Polyuria c) Splenomegaly d) Tachycardia
Tachycardia
The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which of the following disorders? a) Kawasaki disease b) Thalassemia c) Hemophilia d) Sickle cell disease
Thalassemia
When administering corticosteroids to the child with rheumatic fever, which of the following should the nurse recognize as an important aspect of giving this classification of medications for this diagnosis? a) The drug should be taken using a metered-dose inhaler b) The drug will be given for the rest of the child's life. c) The drug should be stopped gradually by giving decreasing dosages. d) The drug should be taken for a full course, usually 10 days.
The drug should be stopped gradually by giving decreasing dosages.
The nurse is discussing the stages of Kawasaki disease with a group of peers. The nurse states that the child is at the greatest risk for having an aneurysm during which of the following? a) The acute stage b) The subacute stage c) The convalescent stage d) The chronic stage
The subacute stage
The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy the process of digitalization is done for which of the following reasons? a) To decrease the pain to a tolerable level b) To increase the heart rate c) To establish a maintenance dose of the drug d) To build the blood levels to a therapeutic level
To build the blood levels to a therapeutic level
Acute rheumatic fever primarily affects which heart valve? a) mitral b) aortic c) tricuspid d) pulmonary
mitral
Thalassemia major ( Cooley's anemia) is treated primarily with: a) bed rest until the sedimentation rate is normal b) oxygen therapy c) a diet high in iron d) multiple blood transfusions
multiple blood transfusions
The nurse is teaching an inservice 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 most accurate regarding the diagnosis of rheumatic fever? a) "Children who have this diagnosis may have had strep throat." b) "Being up to date on immunizations is the best way to prevent this disorder." c) "This disorder is caused by genetic factors." d) "The onset and progression of this disorder is rapid."
"Children who have this diagnosis may have had strep throat."
The nurse is teaching the parents of a 4-year-old girl with thalassemia about sound nutritional choices. The nurse asks the mother about good snack choices to send to preschool. Which response by the mother would indicate a need for further teaching? a) "She likes string cheese and saltine crackers." b) "She can bring graham crackers and peanut butter." c) "Yogurt and granola is a good choice." d) "I can send apple slices with yogurt dip."
"She can bring graham crackers and peanut butter."
The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which of the following statements by the mother would warrant further investigation? a) "The baby usually drinks all of her bottle." b) "The baby seems more comfortable over my shoulder." c) "I don't notice any rapid breathing patterns." d) "My baby does not make any grunting noises."
"The baby seems more comfortable over my shoulder."
The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was: a) 140 beats per minute b) 100 beats per minute c) 80 beats per minute d) 120 beats per minute
80 beats per minute
A school nurse is caring for a child with a severe sore throat and fever. Which of the following would be the best recommendation by the nurse to the parent? a) Have the child drink fluids that contain electrolytes. b) Have the child be seen by the primary care provider. c) Give acetaminophen for the fever and pain, and have the child rest. d) Have the child go to the emergency room.
Have the child be seen by the primary care provider.
You see a school-aged child in an ambulatory setting because of rheumatic fever. Which of the following would you expect to find revealed by the health history? a) Loss of weight, abdominal pain, chest pain b) An elevated temperature, back pain, loss of hair c) Fatigue, slow pulse, frequent urination d) Knee pain, abdominal rash, subcutaneous nodules
Knee pain, abdominal rash, subcutaneous nodules
For the child with Kawasaki disease who is treated with immunoglobulin it is most important to delay the administration of which of the following immunizations for 3 to 6 months following the treatment? a) MMR (measles, mumps, rubella) b) Inactivated poliovirus c) Hepatitis B d) DTaP (diphtheria, tetanus, acellular pertussis)
MMR (measles, mumps, rubella)