Exam 4
The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:
acute glomerulonephritis.
To prevent infective endocarditis in the child with an artificial heart valve, the nurse teaches parents to:
administer prophylactic antibiotics before dental work
What function does the ductus arteriosus perform?
allows blood from the right side of the heart to flow to the aorta and back out into the body without going through the lungs
What degree of scoliosis requires surgery?
greater than 45
What is often the first indication of a heart defect?
heart murmur
The nurse is checking a newborn for the presence of Ortolani maneuver and Barlow sign. For which health problem are these assessments used?
hip dysplagia
What needs to be monitored as a possible complication related to a meningocele?
hydrocephalus, so careful monitoring of head circumference and watch for S/S of increased ICP
The nurse is caring for a child admitted with juvenile idiopathic arthritis (JIA). Which clinical manifestation would likely have been noted in the child with this diagnosis?
inflammation of the joints
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 IV access
What are examples of acquired cardiovascular disorders?
kawasaki disease, acute rheumatic fever, cardiomyopathy, infective endocarditis, hyperlipidemia, hypertension
The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess?
leukocyte count
What causes decorticate posturing?
loss of cerebral cortex function
What causes decerebrate posturing?
loss of mid brain function
The nurse is assessing a child with suspected rheumatic fever. What assessment findings are consistent with the disease process? Select all that apply.
macular rash on trunk, tender swollen joints, involuntary limb movements
What medication is given during preterm labor for neuroprotection?
mag sulfate
If an atrial septal defect is left untreated what might occur?
may lead to pulmonary hypertension, CHF, atrial arrhythmias, and increased risk of stroke
With mild obstructions, the child may appear with what signs/symptoms?
mild leg cramping, cooler feet than hands, and stronger pulses and higher BP in the upper extremities compared to the lower extremities.
The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is:
obtaining a clean catch voided urine
What treatment is contraindicated in a patient that has increased pulmonary blood flow?
oxygen - causes vessels to dilate which causes a greater problem
A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?
peeling hand and feet - fever
The nurse is triaging clients as they come in to an urgent care facility. Which assessment finding is clinically significant for early nephrotic syndrome?
periorbital edema
What are signs/symptoms of rheumatic fever?
pharyngitis, erythema rash on trunk, inflammatory nodules in the heart-blood vessels-brain- and joints
What are S/S of myasthenia gravis in infants?
poor muscle tone, poor suck, weak respiratory effort
It would be best to place an infant with a meningomyelocele in which position prior to surgery?
prone (on stomach)
Which environmental consideration is most helpful to promoting comfort when the neonate is withdrawing from alcohol and drugs?
provide a dark, quite environment
What does increased pulmonary blood flow place the child at risk for?
pulmonary infection due to constant wet lungs, pulmonary hypertension, CHF
Nursing students are reviewing information about cardiopulmonary arrest in children. They demonstrate an understanding of the information when they identify which of the following as the most common cause of cardiac arrest?
respiratory failure
A 6-year-old child has undergone a renal transplant and is receiving cyclosporine. The nurse instructs the parents to be especially alert for which complication?
signs of infection
What are signs/symptoms of kawasaki?
strawberry tongue, palmar erythema, polymorphous rash, lymphadenopathy
The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as:
sunsetting
When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?
tachycardia
What is included in post op care for hypospadias repair?
•Assessing the urinary drainage from the urethral stent •Pain management •Do not allow for any type of stress along the surgical site •Medicate for bladder spasms •Double diapering to protect the stent and keeps the site clean
What does mag sulfate do?
•It stabilizes blood pressure and normalizes cerebral blood flow •It stabilizes neuronal membranes and blocks excitatory neurotransmitters •Minimizes inflammation
What effect does narrowing of the aorta have on the body?
▪B/P increased in heart and upper body and decreased in the lower body ▪Strong, bounding pulses and higher BP in upper body ▪Weak or absent pulses and lower BP in lower body
What is done to diagnose tetralogy of fallot?
-notice a failure to respond to O2 -echocardiogram -cardiac cath -appears as a "boot" on xray
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 most accurate regarding the diagnosis of rheumatic fever?
"Children who have this diagnosis may have had strep throat."
A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group?
"The kidneys help control blood pressure, so our child's blood pressure needs to be checked often."
A nurse is caring for an infant newly diagnosed with spina bifida occulta. The infant's parent is crying stating, "My child will have physical disabilities." Which statement by the nurse is appropriate?
"This is the mildest form and there may be no deficits seen."
When does permanent closure of the ductus arteriosus occur?
10-21 days after birth
What are signs/symptoms of cardiovascular disorders?
-cyanosis -irregular HR -edema -clubbing of fingers -fever -retractions -abdominal distention
What are signs/symptoms of obstructed systemic blood flow?
-diminished pulses -poor color -delayed cap refill -decreased UO -CHF -pulmonary edema
What is included in pre heart cath nursing care?
-informed consent -premedicate, if ordered -weigh child -NPO -assess for allergies
What is included in the care for an infant with bladder exstrophy?
-keep in supine -keep bladder moist, wrapped in gauze, and covered in a sterile plastic bag -sponge baths -apply skin barriers
A child and mother come into the orthopedic clinic. The mother is concerned about her child who has recently been diagnosed with scoliosis. The mother asks about surgical treatment and if it will be necessary. The nurse bases her response on knowledge that surgery is implicated for curvatures greater than:
40 degrees
What is a normal MAP
60-100mm Hg
What is a meningocele?
A birth defect where the child's spinal column or meninges are protruding from the child back within a sac
Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage?
Apply a sterile dressing moistened in a warm, sterile saline solution.
The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications?
Assess the popliteal region carefully for skin breakdown.
What will the nurse include in the feeding plan for a breastfed infant with congenital heart disease?
Breastfeed with small, frequent feeds.
What medication may be given to preterm infants to help close a PDA?
IV ibuprofen or indomethacin
What is the treatment for kawasaki disease?
IV immunoglobulin and aspirin
A 6-year-old girl is diagnosed with aortic stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother?
Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing SUBMIT ANSWER
A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers?
NSAIDs
What is spina bifida?
Neural tube defects often called the "hidden or closed spina bifida" (occulta) in which there is a malformation of one or more vertebrae
A nursing instructor is leading a group discussion on congenital hydrocephalus. The instructor determines the session is successful after the students correctly choose which factor that determines the noncommunicating type?
Obstruction that keeps CSF from passing between the ventricles and the spinal cord
What are the 4 related defects characteristic of tetralogy of fallot?
PRO-V P- pulmonic stenosis R- right ventricular hypertrophy O- overriding aorta V- ventricular septal defect
The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?
Place the child in a knee-to-chest position
A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta?
Pulses weaker in lower extremities compared to upper extremities
What is the most common sign of pulmonic stenosis?
a heart murmur
What is an atrial spetal defect?
a hole in the septum which causes oxygenated blood to pass from the left atrium, through the opening in the septum, and into the right atrium, causing the two to mix. Over time, this "extra" blood volume stresses the heart and causes the right atrium, ventricle and pulmonary arteries to dilate
In the infant diagnosed with spina bifida with myelomeningocele, the infant will likely have:
a partial to complete paralysis in the lower extremities
What results from a sudden increased constriction of the outflow tract to the lungs?
a tetrology spell
What is cerebral palsy?
abnormal development or damage to the motor area of the brain
What is the treatment for hydrocephalus?
diamox (diuretic) and surgically placed shunt
What effect does pulmonic stenosis have on the heart?
due to the increased workload of the right ventricle it compensates by becoming thickened (hypertrophy)
What is the most common cause of UTIs?
e coli
What bacterias cause meningitis?
e coli and group b streep
How can a tetralogy spell be treated?
in infants; comforting and flexing the knees forward and upward in older infants/toddlers; may squat to increase systemic vascular resistance
What effects does tachypnea and tachycardia have on the body?
increases caloric need, poor cellular nutrition, and often the child cannot get enough calories to support the high metabolic rate (failure to thrive)
What does nursing care focus on for bladder exstrophy?
preventing infection and protecting the abdominal skin round the exstrophied area
Which type of fracture might indicate child abuse?
spiral fracture
A newborn has been diagnosed with congenital heart disease. Which congenital heart diseases is associated with cyanosis?
tetralogy of fallot
What is done to compensate for lost oxygen with a decreased pulmonary blood flow?
the kidneys produce erythropoietin to stimulate the bone marrow to produce more red blood cells
Why are infants kidneys at risk for injury?
they are large in relation to abdomen, less protected by ribs, and have much less padding covering them
If an infant with tetralogy of fallots O2 sats are critically low what will be done for them?
they will be given a prostaglandin infusion to keep the PDA open
What is the presentation of coarctation of the aorta?
▪Leg pain with activity ▪Epistaxis ▪Dizziness ▪Fainting ▪Headaches ▪Murmur may be noted at base of the heart
What is included in the focus of care for a child with a CV disorder?
-obtain a thorough health history -improve oxygenation and circulation -promote adequate nutrition -assist the child and family -provide postoperative nursing care -preventing infection
What is included in post op care following a heart cath?
-strict bed rest -pressure dressing and observe site for bleeding -monitor VS frequently -monitor pulses, color, and skin temp distal to site
What are the steps for relieving a hypercyanotic spell?
-use a calm, comforting approach -place infant in knee-to-chest position -provide O2 -administer morphine -IV fluids -administer propranolol
If the newborn is following a normal development process, the child will most likely void when which amount of urine is in the bladder?
15mL
What are signs/symptoms of mixed defects?
cyanosis, poor weight gain, pulmonary congestion, and CHF
What does indomethacin do?
stimulates the muscles inside the PDA to tighten and close the connection
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
An infant with congenital heart disease is not growing and developing adequately. The nurse will institute what feeding strategy?
Raise the caloric density of the feeding beyond 20 calories per ounce
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
What is the treatment for bacterial meningitis?
antibiotics, corticosteroids, and mannitol to decrease ICP
What are S/S of meningitis?
arched back, neck hyperextended, and nuchal rigidity
Which heart defects cause an increased pulmonary blood flow?
atrial septal defect and patent ductus arteriosus
What type of disease is rheumatic fever and what is it a reaction to?
autoimmune disease - reaction to group A infection
What is the emergency treatment for pulmonic stenosis?
balloon dilation of the valve or surgery
Why are preterm infants more susceptible to patent ductus arteriosus?
because they might have persistent respiratory distress syndrome and hypoxia that allows the ductus to remain open after birth
What is the tx for osteomyelitits?
bed rest, IV abx followed by 3-4 weeks of oral abx
The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis?
blood pressure 136/84
What is osteogenesis imperfecta?
brittle bone disease - leading to recurrent fractures
What are the 2 signs of meningitis?
brudzinski and kernig
What is the primary diagnostic test used in infants and children to identify cardiovascular disorders?
cardiac cath
What effect does increased pulmonary blood flow have on the heart?
causes right ventricular hypertrophy
To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority?
cerebral edema
What does the corrective repair of tetralogy of fallot involve?
closure of the ventricular septal defect with a synthetic Dacron patch so that the blood can flow normally from the left ventricle to the aorta
What medications are used in the management of muscular dystrophy?
corticosteroids, calcium supplements, vitamin D, beta blockers, ace inhib, antidepressants
What are clinical manifestations of decreased pulmonary blood flow?
cyanosis, failure to thrive, and polycythemia
A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting?
feeding problems
What medication is taken to prevent defects of the neural tube?
folic acid
What is the progression of muscular dystrophy?
generalized weakness, late learning to walk, walks on balls of feet w/ waddling gait, eventually movement of extremities requires support
Which heart defect causes a decreased pulmonary blood flow?
tetralogy of fallot
What is indicated if an infants blood saturations remain low up to 211 days following birth?
the ductus arteriosus closure may be delayed or prevented
A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:
significant bending without breaking
