NURS 4251 EXAM 2 Checkpoint Qs
The child develops idiopathic thrombocytopenic purpura (ITP) after a viral infection. The nurse identifies which action as most important? a. Caution the child and parent that easy bruising is likely. b. Show the child how to do a finger-stick test for glucose. c. Tell the child to report if sharp headache develops. d. Permit the parent to test the child's urine for protein.
a
The child has received iron chelation therapy by deferoxamine in the past. Which statement by the parent demonstrates understanding of the use and action of iron chelation therapy? a. "I know the drug acts to remove excess iron from my child." b. "I have to check my child's pulse before I turn on the pump." c. "The drug is used to increase the level of iron in bone cells." d. "The drug has few side effects, so I can't really give it wrong."
a
The child, who has sickle cell anemia, is being treated for sickle cell crisis. Which statement by the parent would best assure the nurse that the child is receiving adequate nursing care? a. "My child never used to understand why these crises occurred but now can describe the reason." b. "My child reports pain is less and is able to play." c. "The nurses who are caring for my child are such nice people." d. "My child is looking forward to getting home but really doesn't mind it here."
b
The child's parents are unsure about the use of immunotherapy, stating that some websites warn against the practice. Regarding risks, it is helpful to have them identify their specific concerns. What potential benefit could the nurse describe to the parent to increase comfort with the procedure? a. The child will recover more quickly from infections. b. The child will have increased protection against secondary infections. c. The child's level of helpful immunoglobulins will increase. d. The overall health of the child's immune system will improve.
c
The 17-year-old who had scoliosis surgery and then a COVID-19 infection on the second day of hospitalization is missing friends and is eager to return to school. When should the nurse inform the school nurse that it would be appropriate to return to school? a. Whenever the adolescent feels they are able to participate. b. Ten days after the first symptom appeared and fever-free for 24 hours c. As soon as the fever is within normal range and symptoms resolve d. Once the adolescent receives a vaccine
d The nurse would inform the school nurse that COVID-19 is contagious and the teen may return to school when fully vaccinated.
The child is prone to allergies. When planning care, what desired outcome should the nurse prioritize? a. Child states that symptoms do not interfere with being able to play with friends. b. Child is able to describe the cause of allergic response. c. Child states they no longer have allergies. d. Child states they enjoy taking medicine to prevent allergy symptoms.
a The nurse would deem treatment successful if the child is able to maintain age-appropriate activities despite having allergies. "Curing" allergies is not always a possibility.
When the child's parent was informed of the diagnosis of allergies, an evaluation for an immune system disorder was raised "because of the frequency of cold symptoms." When reviewing the blood work of a child with allergic rhinitis, what results are most helpful? Select all that apply. a. Specific immunoglobulin (Ig)E levels to cat, dog, tree, grass, and weed mix b. Serum Igs (IgG, IgA, and IgM) c. Complete blood count with differential d. Basic metabolic panel
a, c A complete blood count with differential is always the best starting point to evaluate a child with allergies. Allergic children generally have a higher number or proportion of eosinophils in the blood. Children with immunodeficiencies may have elevated neutrophil counts if they have an active bacterial infection. At baseline, a reduced lymphocyte count or percentage may be a "red flag" for an immunodeficiency. Allergic children generally have elevated IgE levels, both the overall serum IgE as well as allergen-specific IgE.
Food allergies are an important health concern for nurses working in childcare or preschool settings. Children eat meals and snacks in these settings, and the food they ingest may cause an allergic reaction that could be fatal if the child is not provided with the appropriate intervention. Early, appropriate administration of epinephrine for the treatment of the symptoms of anaphylaxis can significantly reduce the likelihood of anaphylaxis-related hospital admission. Delayed administration of epinephrine contributes to anaphylaxis-related fatalities. Epinephrine is significantly less likely to be injected in food-induced anaphylaxis than in venom-induced anaphylaxis. Reasons for failure to administer epinephrine include poor perception of the severity of symptoms or patient refusal (Simons et al., 2015). Based on the previous study and the fact that the child is allergic to peanuts, which statement by the child's parent should cause a nurse the most concern? a. "I pack my child's lunch every day so I'll know what is eaten." b. "My child doesn't need an EpiPen. They are very expensive, and it is not like a bee sting allergy. If my child goes to a party, I'll ask if peanuts will be served." c. "I know how to read food labels to limit my child's food to items that are safe."
b
A 15-year-old, who is overweight per their BMI, is being evaluated for hypertension. Four separate blood pressure readings were higher than 95% for gender, age, and height. There is a family history of hypertension. The parent is present and wants to know what they can do to lower their child's blood pressure. Which response by the nurse is best? a. Explain to the parent that high blood pressure is genetic and taking medications to treat the problem is helpful. b. Inform the parent that their child should decrease salt intake. c. Discuss with the adolescent and parent heart-healthy changes such as increasing physical activity level, increasing vegetable intake, and decreasing sodium intake. d. Develop an exercise plan and review it with the parent to implement with their child in the coming months.
c
A nurse is preparing to enter the room of the 17-year-old patient. Because the COVID-19 infection involves potential droplet transmission, what isolation precautions should the nurse use? The patient is wearing a mask when others enter the room. a. Goggles and nonsterile gloves b. Gown and nonsterile gloves c. N95 mask, gown, and nonsterile gloves d. No precautions needed since the patient is wearing a mask
c
A nurse on the care team is concerned as the nurse has symptoms consistent with a mumps (infectious parotitis) infection. Which symptom is most associated with mumps? a. A productive cough and a severe runny nose b. Pronounced swelling behind both ears c. Swelling above the jaw line in front of the ear, obscuring the jaw line d. Adenoid tonsils are reddened and swollen and hurt.
c
Any child can have an anaphylactic reaction to a food, drug, or insect sting, and the child is at risk because of an allergy history. If the child, who weighs 48 kg, had an anaphylactic reaction after a bee sting, what is the correct dose of epinephrine for a school nurse or staff member to give them? a. 0.03 mg b. 0.15 mg c. 0.3 mg d. 3.0 mg
c
A child is being seen in the primary care provider's office, and the nurse had been asked to assist with the physical examination. What safety intervention should the nurse use with the child who is known to have many allergies? a. Assess blood pressure using a new blood pressure cuff. b. Distract the child by showing a tropical fish tank. c. Spot-check the child's oxygen saturation using pulse oximetry. d. Use latex-free gloves to conduct the examination.
d
After cardiac surgery, infants and children have limitations to their activity and handling. When teaching parents how to help their child with daily activities, the nurse recognizes it is most important to emphasize which statement? a. Children are resilient and recover quickly after cardiac surgery. You do not need to do anything different when handling the child when they go home. b. Infants and children should remain in bed or on the couch at home and not be allowed to perform any activities other than go to the bathroom to prevent pain and injury until they have at least two follow-up visits with their cardiologist. c. Infants and children should be restricted from all physical activity for 6 months from the time of their surgery. They should not lift their arms over their head or be lifted under their arms for the same time. d. Infants and children should not be lifted under their arms for 6 weeks from the time of sternal closure. They should also not participate in physical activity or lift heavy items for this same time period.
d
Autoimmune acquired hemolytic anemia can occur in any child. The nurse identifies what usual cause of this disorder is important for team members to know? a. Allergy to the protein found in fish or shrimp b. A mutant gene similar to sickle cell anemia c. An elevated (increased) eosinophil cell count d. Antibody production against red blood cells
d
Children with HF are often prescribed digoxin. Knowing that this drug possesses a high risk of adverse effects if given incorrectly, the nurse provides educational materials to the parents. Which statement by the parent would alert the nurse that the parent requires additional education/instructions? a. "I know the drug is thought to help my child's heart pump better." b. "It's important I give the exact dose every time." c. "If I happen to miss a dose, I will not give double the dose at the next time." d. "Nausea and vomiting are expected side effects for the first few weeks of treatment."
d
The nurse is caring for a 2-year-old who has been admitted to the pediatric floor after the parents noted a fever of 103°F (39.4°C) for 2 days. The child had an ASD repaired approximately 4 weeks earlier and has since developed a pericardial effusion. The effusion was drained, and the fluid was purulent. The child is currently on IV antibiotics. The nurse enters the room and notes that the child is only breathing about 5 breaths per minute and the heart rate on the monitor is 40 beats per minute. What is the nurse's first action? a. Call for help and wait for direction when the arrest team arrives. b. Call for help as you run down the hall to get the defibrillator. c. Call the pediatric cardiologist to perform an echocardiogram and evaluate for reaccumulation of the pericardial fluid. d. Call for help and begin providing compressions per basic life support (BLS) protocol (CPR).
d
Surgical closure of a ventricular septal defect (VSD) is the most commonly performed procedure in cardiac surgery. Although considerably safe, complication can occur. Schipper et al. (2017) performed a retrospective study of all VSD closures at their single center to evaluate for risk factors for a complicated postoperative course. Of 243 patients who underwent a VSD surgical repair, there were no deaths, 0.8% required a pacemaker for heart block, and 2.1% required reoperation for hemodynamically significant residual VSD. Multivariate analysis identified a genetic syndrome, long bypass time, and low weight at operation as independent risk factors for a prolonged intensive care stay and prolonged ventilation times. None of these were associated with major adverse events. A 2-month-old with Down syndrome and a VSD arrives. The baby is in HF and has been having difficulty gaining weight, so surgery has been scheduled. Based on this study, what will you include in your preoperative discussions with the family? a. VSDs are very difficult to repair and children can have many complications after surgery. b. Because the baby also has Down syndrome and the weight is less than expected for age, the baby may need a few extra days on the ventilator or in the ICU but overall should do well. c. With the baby being less than 12 months old, there is a greater risk of complications after VSD surgery. d. A VSD repair is not done with cardiopulmonary bypass, so the risk of complications is significantly less than for other defects.
b
The 17-year-old patient's symptoms include a cough and shortness of breath. The patient is alert and oriented. Which action in the plan of care should the nurse prioritize? a. Elevate the side rails at all times. b. Monitor the patient's oxygen status by assessing work of breathing and oxygen saturation. c. Encourage deep breathing exercises every 2 hours. d. Obtain vital signs every 4 hours.
b
The sickle cell trait (hemoglobin AS) occurs in about 8% of Black people, and although typically benign, there is some concern that intense physical exercise could lead to cardiac deaths from occlusive crises. It has been reported that patients with sickle cell disease are more prone to kidney and renal failure as well as rhabdomyolysis during times of extreme exertion. There is still controversy as to whether testing of athletes for sickle cell should be mandatory. Although occurrences of death associated with sickle cell and exertion are rare, the National Collegiate Athletic Association (NCAA) has mandated testing for athletes (Buchanan et al., 2020). Based on the previous study, which would be the best exercise for an adolescent who has sickle cell disease, and the parent who has the sickle cell trait? a. Playing video games together b. Joining a swimming program at their local YMCA c. Watching sports together on television d. Organizing a touch (no contact) football game each weekend
b
A 12-year-old presents to the emergency department complaining of chest pain and a racing heart that started suddenly about 1 hour earlier. The child reports feeling a little tired and dizzy, but otherwise fine. The nurse notices during the assessment that the heart rate is 185 beats per minute, and the ECG demonstrates a very narrow complex with P waves that are not visible. The heart rate does not change with talking or resting. Blood pressure is 95/70 mm Hg, respiratory rate is 22 breaths per minute, and oxygen saturation is 98% on room air. Based on this assessment and data, the nurse recognizes the child is experiencing which of the following? a. Sinus tachycardia b. Supraventricular tachycardia c. Torsades de pointes d. Ventricular tachycardia
b The nurse notes that this heart rate is exceptionally high for a child of this age. This rate and rhythm meet all of the criteria for SVT: The rate is greater than 160 bpm, it is a narrow complex that does not change with activity level, and the P waves are not visible. Sinus tachycardia would most likely not have a rate this high, and the P waves would be visible. Torsades de pointes is a chaotic and pulseless rhythm, so the child would not have other vital signs that were life sustaining. Ventricular tachycardia in children is typically a very wide complex rhythm; it may or may not have associated vital signs that are near normal. This child has presented with classic symptoms, ECG, and onset pattern of SVT.
A child diagnosed with thalassemia major is scheduled for a bone marrow transplant, and the parent appears anxious about this upcoming procedure. The nurse recognizes which statement is most accurate and best exemplifies patient-centered care? a. "If you can hold the child still during the procedure, the pain will be less." b. "We will go to great lengths to make sure your child doesn't develop an infection." c. "Your child will need to lie still while the new bone marrow infuses into the bones." d. "Your child will not need any further bone marrow aspirations after this."
b The nurse reassuring child's parent that the consequent risks of infection will be addressed acknowledges potential risks while still providing reassurance. It would be inappropriate for the nurse to have the child's parent restrain the child during a painful procedure. It would also be inaccurate to reassure the parent that this is a one-time event.
Multiple studies reported the effectiveness of hand hygiene in the reduction of infection. As a result, the WHO and the CDC have endorsed the importance of hand hygiene to reduce infection (WHO, 2016a). Based on this study, the nurse determines which action is most effective to ensure that the 17-year-old consistently performs handwashing before meals? a. Continual reminders to wash hands as often as possible b. Discuss with the parent about the importance of modeling good hand hygiene practices. c. Explain to the patient the role that bacteria play in the transmission of illness. d. Stress that performing handwashing demonstrates maturity and responsibility.
b The nurse should stress handwashing and the role parents have in setting a good example with this practice. Parents' handwashing practices were noted to influence handwashing in their children. Frequent reminders, teaching children about bacteria, and characterizing hand hygiene as "grown up" were not specifically noted to be effective interventions.
The 17-year-old has a 4-year-old sibling at home with "mono," or infectious mononucleosis. In the event that the sibling requires hospitalization, assessment protocols should emphasize what action? a. Lymph nodes should be palpated before being percussed. b. The spleen should be evaluated by nontouching maneuvers using the scratch test. c. Lymph nodes should be assessed utilizing a Doppler. d. Petechiae should be lightly massaged.
b The nurse would assess for mono by evaluating the spleen by nontouching maneuvers using the scratch test. The spleen enlarges to destroy the affected cells, so the spleen could rupture easily on pressure. Petechiae should not be massaged; percussion and the use of a Doppler are unnecessary during assessment.
