PrepUs for Pediatrics Chapter 37

The nurse is planning care for an infant with a nursing diagnosis of decreased cardiac output related to a cardiac defect. What is the most appropriate outcome for this nursing diagnosis? The child will:

demonstrate stable vital signs, capillary refill less than 3 seconds, and a urine output of 1-2 mL/kg/hr.

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning?

"I mix ferrous sulfate with milk in a bottle."

The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation?

"The baby seems more comfortable over my shoulder."

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement by the parents indicates the need for additional teaching?

"We will place the liquid in the front of her gums, just below her teeth."

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply.

Administering oxygen Maintaining fluid intake Administering analgesics

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

Iliac crest

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura?

Ineffective tissue perfusion related to poor platelet formation

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?

Monitor the site dressing and vital signs.

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 nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura?

Risk for bleeding related to insufficient platelet formation

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

Serum potassium level

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

Some children with iron-deficiency anemia may be prescribed iron dextran by injection. This should be injected:

via Z-track technique.

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?

"Digoxin helps to improve the heart's ability to contract ."

The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which statement by the mother indicates a need for further teaching?

"I need to feed him every hour to make sure he eats enough."

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate?

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching?

"Our family is taking a fun hiking trip up in the mountains next week."

A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective?

"The sickle shape of red blood cells decreases oxygen to tissues."

A 9-year-old child is admitted to the hospital with a diagnosis of idiopathic thrombocytopenic purpura. When receiving shift handoff, which description is anticipated?

A petechial rash over body

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe? Select all that apply.

Acetaminophen Intravenous immunoglobulin Aspirin

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode?

Apply heat to the site of bleeding

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition?

Assessing for the presence of femoral pulses

The cardiac monitor of a child recovering from heart surgery alarms, and the nurse finds the child without a heartbeat. What should the nurse do first?

Begin cardiac compressions.

The nurse is caring for a child diagnosed with rheumatic fever. When addressing the child's pain, the nurse should perform which intervention(s)? Select all that apply.

Carefully handle the child's knees, ankles, elbows and wrists when moving the child. Administer salicylates after meals or with milk.

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding?

Compression

The nurse is concerned that a school-aged child has iron-deficiency anemia. What did the nurse assess in this client?

Craving for ice cubes

A child with hemophilia A has had repeated episodes of hemarthrosis. Which assessment finding is most important to consider?

Decreased range of motion

The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?

Digoxin

A 15-year-old client diagnosed with von Willebrand disease has reached menarche. Based on this fact, what information is most important for the nurse to convey to the client?

Expect menstrual bleeding to be heavy.

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care?

Giving ferrous sulfate with orange juice between meals

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client?

Handle the child gently when transferring to a stretcher.

The nurse has been asked to participate in a community health teaching session. Which interventions would the nurse include to help achieve the 2020 National Health Goals to reduce the incidence of anemias? Select all that apply.

Instruct pregnant women to take iron supplementation as prescribed. Explain the importance of healthy eating for adolescent participants. Review foods that are rich in iron that should be a part of school-age children's diets.

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered?

Intravenous immune globulin

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding?

Jerky movements of the face and upper extremities

The nurse sees a school-aged child in an ambulatory setting because of rheumatic fever. Which of the following would the nurse expect to find revealed by the health history?

Knee pain, abdominal rash, subcutaneous nodules

The nurse is evaluating the effectiveness of teaching provided to the parents of a school-age child prescribed liquid ferrous sulfate for iron-deficiency anemia. Which observations indicate that teaching has been effective? Select all that apply.

Parent places medication in orange juice. Child consumes fresh raw fruit and drinks water. Parent provides liquid-prepared medication to the child with a straw. Child goes to the bathroom to brush teeth immediately after taking the medication.

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

Peeling hands and feet and fever

During assessment of an infant diagnosed with tetralogy of Fallot, the nurse notes bluish colored lips and irritability. Which nursing action is priority?

Place in knee-chest position

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess?

Strawberry tongue

A nurse is caring for a child who is experiencing heart failure. Which assessment data was most likely seen when initially examined?

Tachycardia

A school-aged child is scheduled for a bone marrow aspiration to confirm the diagnosis of aplastic anemia. What should the nurse instruct the child about this procedure?

The child will have to lie on the stomach for the procedure.

A 13-year-old, diagnosed with beta-thalassemia major is seen in the pediatric clinic. The nurse completes an assessment and notes that the client is below the 10th percentile in height for age. What assumption can the nurse make based on this information?

This finding is a common manifestation of the client's diagnosis.

The nurse receives the shift report of multiple pediatric clients. Which pediatric client will the nurse see first?

a toddler with tetralogy of Fallot squatting quietly in the corner of the room

What evaluation best illustrates the effectiveness of furosemide therapy in a child diagnosed with congestive heart failure (CHF)? The child:

has clear breath sounds.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to

notify a health care provider if the child develops an upper respiratory infection.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

notify a health care provider if the child develops an upper respiratory infection.

A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate?

"Preterm infants are at risk for iron-deficiency anemia."

The nurse takes an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant?

100 beats per minute

Which nursing diagnosis would best apply to a child with rheumatic fever?

Activity intolerance related to inability of heart to sustain extra workload

An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits?

An enlarged spleen

A child has a history of sickle cell anemia, and is brought to the emergency department with reports of generalized pain for several hours. The nurse completes an assessment with the above results. The nurse suspects the child is experiencing a vaso-occlusive crisis. Which assessment finding best supports the nurse's suspicion

Dactylitis

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child?

Implement strategies to address the child's pain

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care care should be given priority?

Maintaining a fluid intravenous line

When assessing a child for a possible hematologic disorder, which would the nurse need to keep in mind as most important?

Multiple body sites can be affected.