Saunders Peds - Test 2

The mother of a child with cystic fibrosis (CF) asks the clinic nurse about the disease. What should the nurse tell the mother about CF? 1.Transmitted as an autosomal dominant trait 2.A chronic multisystem disorder affecting the exocrine glands 3.A disease that causes the formation of multiple cysts in the lungs 4.A disease that causes dilation of the passageways of many organs

2.A chronic multisystem disorder affecting the exocrine glands

A child with sickle cell anemia who is in vaso-occlusive crisis is admitted to the hospital. Which primary health care provider prescription would assist in reversing the vaso-occlusive crisis? 1.Monitor pulse oximetry. 2.Begin intravenous fluids. 3.Administer oxygen by face mask. 4.Monitor vital signs and respiratory status.

2.Begin intravenous fluids.

A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? 1.Warm, dry skin 2.Decreased wheezing 3.Pulse rate of 90 beats/minute 4.Respirations of 18 breaths/minute

2.Decreased wheezing

The pediatric nursing instructor asks a nursing student to prioritize care for a child diagnosed with sickle cell disease. Which student response correctly identifies the priority of care? 1.Fatigue 2.Hypoxia 3.Delayed growth 4.Avascular necrosis

2.Hypoxia

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriatenursing action? 1.Initiate strict enteric precautions. 2.Move the infant to a room with another child with RSV. 3.Leave the infant in the present room because RSV is not contagious. 4.Inform the staff that they must wear a mask, gloves, and a gown when caring for the child.

2.Move the infant to a room with another child with RSV.

The nurse is monitoring an infant with heart failure. Which sign alerts the nurse to suspect fluid accumulation and the need to call the primary health care provider? 1.Bradypnea 2.Diaphoresis 3.Decreased blood pressure 4.A weight gain of 1 lb (0.5 kg) in 1 day

4.A weight gain of 1 lb (0.5 kg) in 1 day

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF? 1. Pallor 2.Cough 3.Tachycardia 4.Slow and shallow breathing

tachycardia

The nurse is preparing a plan of care for a child with sickle cell crisis who will be admitted to the nursing unit. The nurse should include which intervention as a priority in the plan of care for the child? 1.Initiate an intravenous (IV) line for the administration of fluids. 2.Consult with the psychiatric department regarding genetic counseling. 3.Call the blood bank and request preparation of a unit of packed red blood cells. 4.Call the respiratory department to prepare for intubation and mechanical ventilation.

1.Initiate an intravenous (IV) line for the administration of fluids.

A mother arrives at the hospital emergency department with her child, in whom a diagnosis of epiglottitis is documented. Which prescription, if written by the primary health care provider, should the nurse question? 1.Obtain a throat culture. 2.Obtain axillary temperatures. 3.Administer humidified oxygen. 4.Administer acetaminophen for fever.

1.Obtain a throat culture.

The nurse is preparing to perform an assessment on a child being admitted to the hospital with a diagnosis of sickle cell crisis, vaso-occlusive crisis. Which findings should the nurse expect to note on assessment of the child? Select all that apply. 1.Pallor 2.Fever 3.Joint swelling 4.Blurred vision 5.Abdominal pain

1.Pallor 2.Fever 3.Joint swelling 5.Abdominal pain

The nurse is creating a plan of care for a child admitted with a diagnosis of Kawasaki disease. In developing the initial plan of care, the nurse should include monitoring the child for signs of which condition? 1.Bleeding 2.Heart failure 3.Failure to thrive 4.Decreased tolerance to stimulation

2.Heart failure Rationale: Nursing care initially centers on observing for signs of heart failure. The nurse monitors for increased respiratory rate, increased heart rate, dyspnea, crackles, and abdominal distension. The remaining options are not conditions directly associated with this disorder.

The clinic nurse reviews the record of a child just seen by a primary health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? 1.Pallor 2.Hyperactivity 3.Exercise intolerance 4.Gastrointestinal disturbances

3.Exercise intolerance

The emergency department nurse is caring for a child with suspected epiglottitis and has ensured that the child has a patent airway. Which action is the next priority in the care of this child? 1.Prepare the child for tracheotomy. 2.Prepare to administer epinephrine. 3.Prepare the child for a chest radiograph. 4.Assist the primary health care provider with intubation.

3.Prepare the child for a chest radiograph.

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF? 1.Pallor 2.Cough 3.Tachycardia 4.Slow and shallow breathing

3.Tachycardia

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? Select all that apply. 1.Place the infant in a private room. 2.Ensure that the infant's head is in a flexed position. 3.Wear a mask at all times when in contact with the infant. 4.Place the infant in a tent that delivers warm humidified air. 5.Position the infant on the side, with the head lower than the chest. 6.Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

1.Place the infant in a private room. 3.Wear a mask at all times when in contact with the infant. 6.Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

A child is admitted to the pediatric unit with a diagnosis of acute stage Kawasaki disease. Which assessment findings by the nurse are characteristic of this disorder? Select all that apply. 1.Red throat 2.Cracking lips 3.Conjunctival hyperemia 4.Desquamation of the skin 5.Enlargement of the cervical lymph nodes

1.Red throat 3.Conjunctival hyperemia 5.Enlargement of the cervical lymph nodes Rationale: Kawasaki disease is known as mucocutaneous lymph node syndrome and is an acute systemic inflammatory disease. Assessment findings in the acute stage include fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. Desquamation of the skin, cracking lips, joint pain, cardiac manifestations, and thrombocytosis are characteristics of the subacute stage.

A child with a diagnosis of sickle cell disease is being admitted for the treatment of vaso-occlusive crisis. The nurse prepares for the admission anticipating which prescription for the child? 1.NPO status 2.Intravenous fluids 3.Meperidine for pain 4.Intubation to administer oxygen

2.Intravenous fluids

The nurse is caring for a child with a diagnosis of a right-to-left cardiac shunt. On review of the child's record, the nurse should expect to note documentation of which most common assessment finding? 1.Severe bradycardia 2.Asymptomatic after feeding 3.Bluish discoloration of the skin 4.Higher than normal body weight

3.Bluish discoloration of the skin

The nurse is caring for an infant with congenital heart disease. Which, if noted in the infant, should alert the nurse to the early development of heart failure? 1.Paleness of the skin 2.Strong sucking reflex 3.Diaphoresis during feeding 4.Slow and shallow breathing

3.Diaphoresis during feeding

A child with croup is being discharged from the hospital. The nurse provides instructions to the mother and advises the mother to bring the child to the emergency department if which occurs? 1.The child is irritable. 2.The child appears tired. 3.The child develops stridor. 4.The child takes fluids poorly.

3.The child develops stridor. Rationale: The mother should be instructed to bring the child to the emergency department if the child develops stridor at rest, cyanosis, severe agitation or fatigue, or moderate to severe retractions or is unable to take oral fluids.

During a clinical conference, a nursing student is discussing care for a child with a diagnosis of cystic fibrosis (CF). Which comment by a student indicates the need for further review of information about CF? 1.CF causes mucus that is formed to be abnormally thick. 2.It is a condition transmitted as an autosomal recessive trait. 3.This disease causes dilation of the passageways of many organs. 4.It is a chronic multisystem disorder affecting the exocrine glands.

3.This disease causes dilation of the passageways of many organs.

The nurse has provided instructions to the mother of a child with cystic fibrosis about appropriate dietary measures. Which statement by the mother indicates an understanding of these dietary measures? 1."The diet needs to be low in fat." 2."The diet needs to be low in protein." 3."The diet needs to be low in calories." 4."The diet needs to be high in calories."

4."The diet needs to be high in calories."

The nurse is caring for a hospitalized infant with a diagnosis of bronchiolitis. In which position should the nurse place the infant? 1.Supine, side-lying position with the arms elevated 2.Prone with the head of the bed elevated 15 degrees 3.Trendelenburg's, at a 60-degree angle with pelvis higher than head 4.Head and chest at a 30-degree angle with the neck slightly extended

4.Head and chest at a 30-degree angle with the neck slightly extended

A child in whom sickle cell anemia is suspected is seen in a clinic, and laboratory studies are performed. The nurse checks the laboratory results, knowing that which value would be increased in this disease? 1.Platelet count 2.Hematocrit level 3.Hemoglobin level 4.Reticulocyte count

4.Reticulocyte count Rationale: Sickle cell anemia is a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell. Insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. A diagnosis is established on the basis of a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin level and hematocrit, a decreased platelet count, an increased reticulocyte count, and the presence of nucleated red blood cells. Reticulocyte counts are increased in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

Breathing exercises and postural drainage are prescribed for a hospitalized child with cystic fibrosis. What instruction should the nurse include in the client's teaching plan? 1.Schedule the procedures so they are 4 hours apart. 2.Perform the breathing exercises and then the postural drainage. 3.Perform the postural drainage first and then the breathing exercises. 4.Perform postural drainage in the morning and breathing exercises in the evening.

Perform the postural drainage first and then the breathing exercises. Rationale: Breathing exercises are recommended for a majority of children with cystic fibrosis (CF), even those with minimal pulmonary involvement. The exercises usually are performed twice daily, and they are preceded by postural drainage. The postural drainage will mobilize secretions, and the breathing exercises will then assist with expectoration. Exercises to assist in assuming correct postures and in maximizing thoracic mobility, such as swinging the arms and bending and twisting the trunk, are included. The ultimate aim of these exercises is to establish a good habitual breathing pattern.

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? Select all that apply. 1.Place the infant in a private room. 2.Ensure that the infant's head is in a flexed position. 3.Wear a mask, gown, and gloves when in contact with the infant. 4.Place the infant in a tent that delivers warm humidified air. 5.Position the infant on the side, with the head lower than the chest. 6.Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

Place the infant in a private room. Wear a mask, gown, and gloves when in contact with the infant. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

The nurse is caring for an infant client with tetralogy of Fallot who is experiencing a hypercyanotic spell. Place the actions the nurse should take in order of priority. All options must be used. .Place the infant in a knee-chest position. Administer 100% oxygen. Administer morphine sulfate as prescribed. Administer fluids intravenously. Document the occurrence, actions taken, and the infant's response.

1. Place the infant in a knee-chest position. 2. Administer 100% oxygen. 3. Administer morphine sulfate as prescribed. 4. Administer fluids intravenously. 5. Document the occurrence, actions taken, and the infant's response.

The nurse is providing instructions to the mother of a child with croup regarding treatment measures if an acute spasmodic episode occurs. Which statement made by the mother indicates a need for further teaching? 1."I should place a steam vaporizer in my child's room." 2."I will take my child out into the cool, humid night air." 3."I could place a cool-mist humidifier in my child's room." 4."I will have my child inhale the steam from warm running water."

1."I should place a steam vaporizer in my child's room." Rationale: Steam from running water in a closed bathroom will assist in keeping secretions thin so that they can be easily expectorated. Steam from a vaporizer however can present a danger of scald burns because of the more direct effect than that provided from steam from running water. A cool mist from a bedside humidifier may be effective in reducing mucosal edema. Cool-mist humidifiers are recommended over steam vaporizers. Taking the child out into the cool, humid night air may also relieve mucosal swelling.

A pediatric client with ventricular septal defect repair is placed on a maintenance dosage of digoxin. The dosage is 8 mcg/kg. The child's weight is 7.2 kg. The pediatrician prescribes digoxin to be given twice daily. The nurse prepares how many mcg of digoxin to administer at each dose?

1.12.6 mcg 2.21.4 mcg 3.28.8 mcg 4.32.2 mcg

A child with a diagnosis of tetralogy of Fallot exhibits an increased depth and rate of respirations. On further assessment, the nurse notes increased hypoxemia. The nurse interprets these findings as indicating which situation? 1.Anxiety 2.A temper tantrum 3.A hypercyanotic episode 4.The need for immediate primary health care provider notification

3.A hypercyanotic episode Rationale: Children with tetralogy of Fallot or similar physiology may experience hypercyanotic episodes, or tet spells. These episodes are characterized by increased respiratory rate and depth and increased hypoxia. Immediate primary health care provider (PHCP) notification is not required unless other appropriate nursing interventions are unsuccessful. Anxiety and a temper tantrum are unrelated to tetralogy of Fallot.

A mother calls the primary health care provider's office requesting an appointment for her 8-year-old child. She states he has asthma and is telling her he had trouble breathing last night and does not want to go to school. In triaging this child, which is the most important question to initially ask the mother? 1."Is your child crying and irritable?" 2."Does your child have a productive cough?" 3."Did he have a temperature last night of greater than 100º F (37.8º C)?" 4."Is your child telling you at this time he is having trouble breathing?"

4."Is your child telling you at this time he is having trouble breathing?

The nurse has provided instructions to the mother of a child with sickle cell disease regarding measures that will prevent a sickle cell crisis. Which client statement indicates an understanding of these measures? 1."My child needs to avoid any exercise." 2."My child needs to avoid increasing any fluid intake." 3."My child needs to avoid going outdoors in warm weather." 4."My child needs to avoid situations that may lead to an infection."

4."My child needs to avoid situations that may lead to an infection."

The clinic nurse reviews the record of a child just seen by the pediatrician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? 1.Pallor 2.Hyperactivity 3.Activity intolerance 4.Gastrointestinal disturbances

Activity intolerance

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1.Cracked lips 2.Normal appearance 3.Conjunctival hyperemia 4.Desquamation of the skin

Conjunctival hyperemia

A nursing student is assigned to care for a child with sickle cell disease (SCD). The nursing instructor asks the student to describe the causative factors related to this disease. Which statement by the student indicates a need for further research? 1.SCD is an autosomal recessive disease. 2.Children with the HbS (sickle cell hemoglobin) trait are not symptomatic. 3.If each parent carries the trait, the child will carry the trait, and the probability of the child having the disease is 75%. 4.If one parent has the HbS trait and the other parent is normal, there is a 50% chance that each offspring will inherit the trait.

If each parent carries the trait, the child will carry the trait, and the probability of the child having the disease is 75%.

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriatenursing action? 1.Initiate strict enteric precautions. 2.Move the infant to a private room. 3.Leave the infant in the present room, because RSV is not contagious. 4.Inform the staff that using standard precautions is all that is necessary when caring for the child.

Move the infant to a private room.