Questions Wk3 Ch 32, 33,

The nurse is assigned to care for a child admitted to the hospital with a diagnosis of suspedcted bacterial endocarditis. The nurse prepares the child for which diagnostic test that will confirm the diagnosis?

Answer: Blood cultures. Strategy: Bacterial endocarditis, Rationale: When endocarditis is suspected, a definitive diagnosis is achieved through blood cultures.

The nurse is reviewing the primary health care provider's prescriptions for a child with rheumatic fever who is suspected of having a viral infection. The nurse notes that acetylsalicylic acid is prescribed for the child. Which nursing action is appropriate?

Answer: Consult with the registered nurse to verify the prescription. Strategy: Knowledge that acetylsalicylic acid should not be administered to a child with a viral infection. Rationale: Anti inflammatory agents, including acetylsalicylic acid, may be prescribed for the child with rheumatic fever. Acetylsalcylic acid should not be given to a child who has chickenpox or other viral infections. The nurse would not administer any other medication without phcp prescription.

The nurse is assisting in developing a plan of care for a child admitted with a diagnosis of Kawasaki disease. In developing the initial plan of care, the nurse suggests that the child should be monitored for which signs?

Answer: Heart failure (HF). Strategy: initial, and kawasaki disease is a cause of a acquired heart disease in children. Rationale: Nursing care for a kawasaki disease initially centers on observing for signs of HF. The nurse monitors for increased respiratory rate, increased heart rate, dyspnea, lung congestion, and abdominal distention.

A nursing student is assigned to care for an infant with a diagnosis of heart failure (HF). The student develops a plan of care for the child that is focused on monitoring for fluid overload. The student plans to best assess the urine output of the infant by taking which action?

Answer: Weighing the diapers. Strategy: Monitoring IO for infants. Rationale: The best method to assess urine output in an infant is to weigh the diapers.

The nurse is caring for an infant with congenital heart disease. Which signs, if noted in the infant, should alert the nurse to the early development of heart failure (HF)?

Answer: Diaphoresis during feeding Strategy: Diaphoresis = Sweating. Related to heart bc of fluid overload. Rationale: Early symptoms of HF include: *Tachypnea(rapid breathing). *Poor feeding, *diaphoresis during feeding, (sweating).

The nurse is collecting data on a child with a diagnosis of rheumatic fever. Which question should the nurse initially ask the mother of the child?

Answer: Has the child complained of a sore throat within the past few months? Strategy: Rationale:

The nurse is assigned to care for an infant with tetralogy of Fallot. The mother of the infant calls the nurse to the room because the infant suddenly seems to be having difficulty breathing. The nurse enters the room and notes that the infant is experiencing a hypercyanotic episode. Which action should the nurse take?

Answer: Place the infant in a knee-chest position. Strategy:a hypercyanotic episode. for an infant with tetralogy of Fallot. Rationale: If a hypercyanotic episode occurs, the infant is placed in a knee-chest position.The nurse would contact the registered nurse, who would then contact the primary health care provider. *knee-chest position increases pulmonary blood flow by increasing systemic vascular resistance. Also improves systemic arterial oxygen saturation. *hypoxia- when a region of body is deprived of enough oxygen.