PEDIATRIC Exam 2 Case Studies [[ [[ [[ [[
Revision Questions with Correct
[[ [[ [[ [[
Answers
[[
Which [[of [[the [[following [[would [[NOT [[indicate [[that [[the [[child [[with [[a [[cyanotic [[heart [[defect [[is [[at
[[risk [[for [[congestive [[heart [[failure?
A. [[Respiratory [[crackles
B. [[Decreased [[BP
C. [[Oxygen [[saturation [[increase
D. [[Hepatomegaly
E. [[Rapid [[weight [[gain [[- [[correct [[answer: [[C
The [[nurse [[is [[caring [[for [[a [[9 [[month [[old [[baby [[born [[with [[a [[CHD. [[Assessment [[reveals [[a [[HR [[of
[[160, [[capillary [[refill [[of [[4 [[seconds, [[crackles [[upon [[auscultation, [[and [[sweat [[on [[the [[scalp.
true [[or [[false [[- [[these [[are [[signs [[of [[hypoxemia [[- [[correct [[answer: [[true
A [[physician [[has [[prescribed [[oxygen [[as [[needed [[for [[an [[infant [[with [[CHF. [[In [[which [[situation [[is
[[the [[nurse [[most [[likely [[to [[plan [[to [[administer [[the [[oxygen [[to [[the [[infant?
A. [[During [[feeding
B. [[When [[the [[mother [[is [[holding [[the [[infant
C. [[When [[changing [[the [[infant's [[diaper
D. [[When [[the [[baby [[sleeps [[- [[correct [[answer: [[A. [[during [[feeding
,4. [[A [[child [[with [[a [[cyanotic [[heart [[defect [[is [[being [[discharged [[home [[to [[await [[surgical [[repair. [[In
[[the [[discharge [[teaching, [[the [[nurse [[instructs [[the [[parents:
A. [[To [[prevent [[the [[child [[from [[ever [[crying.
B. [[to [[observe [[for [[signs [[of [[increased [[intracranial [[pressure
C. [[In [[CPR
D. [[To [[identify [[growth [[and [[development [[milestones. [[- [[correct [[answer: [[C
5. [[A [[10 [[year [[old [[has [[undergone [[a [[cardiac [[catheterization. [[At [[the [[end [[of [[the [[procedure, [[the
[[nurse [[should [[first [[assess:
A. [[Pain
B. [[Pulses
C. [[Temperature
D. [[Intake [[and [[Output [[- [[correct [[answer: [[B
The [[nurse [[is [[caring [[for [[a [[school [[age [[boy [[with [[Kawasaki's [[disease. [[The [[student [[nurse [[asks
[[the [[nurse [[about [[the [[medications [[used [[to [[treat [[this [[disease. [[The [[nurse's [[response [[to [[the
[[student [[is:
A. [[Immunoglobulin [[G [[and [[aspirin
B. [[Immunoglobulin [[G [[and [[ACE [[inhibitors
C. [[Immunoglobulin [[E [[and [[heparin
D. [[Immunoglobulin [[E [[and [[ibuprofen [[- [[correct [[answer: [[A
A [[child [[with [[hemophilia [[is [[playing [[outside [[and [[injures [[his [[knee. [[The [[knee [[is [[swollen [[and
[[painful. [[Which [[of [[the [[following [[measures [[should [[be [[taken [[to [[stop [[the [[bleeding? [[(Select [[all
[[that [[apply)
, Immobilize [[the [[leg
Elevate [[the [[leg
Warm [[compresses [[to [[the [[site [[of [[injury
Passive [[ROM [[to [[the [[joint
Administer [[Factor [[VIII [[- [[correct [[answer: [[A, [[B, [[E
nursing [[interventions [[for [[Kawasaki’s [[disease [[- [[correct [[answer: [[comfort: [[fever [[control, [[keep
[[env [[quiet [[and [[dark, [[moisture [[to [[lips, [[mouth, [[and [[eyes, [[avoid [[touching [[child, [[high [[dose [[ASA
[[until [[fever [[is [[gone, [[low [[dose [[ASA [[until [[platelet [[count [[is [[normal [[and [[ECHO [[shows [[no
[[evidence [[of [[coronary [[artery [[changes [[
single [[dose [[of [[IVIG [[over [[10-12 [[hours [[-needs [[to [[be [[given [[within [[the [[first [[7-10 [[days [[
nutrition, [[fluids, [[IV [[and [[soft/liquid [[diet [[
safety: [[watch [[response [[to [[IVIG [[and [[coronary [[artery [[aneurysm [[
take [[temp [[for [[1 [[week [[following
what [[tests [[do [[you [[anticipate [[for [[someone [[with [[Kawasaki’s [[disease [[- [[correct [[answer:
[[frequent [[ECHOs [[to [[monitor [[for [[long [[term [[cardiac [[implications
what [[long [[term [[follow [[up [[and [[meds [[do [[you [[anticipate [[for [[someone [[with [[Kawasaki’s [[disease
[[- [[correct [[answer: [[Follow-up [[needed [[long-term [[with [[cardiologist [[if [[child [[develops [[coronary
[[abnormalities.
due [[to [[treatment [[for [[Kawasaki’s [[disease, [[what [[is [[a [[child [[at [[risk [[for [[- [[correct [[answer: [[watch
[[for [[low [[dose [[ASA [[toxicity [[- [[bleed [[as [[well [[as [[Reyes [[syndrome [[
ASA [[may [[be [[continued [[indefinitely [[in [[these [[children [[
Revision Questions with Correct
[[ [[ [[ [[
Answers
[[
Which [[of [[the [[following [[would [[NOT [[indicate [[that [[the [[child [[with [[a [[cyanotic [[heart [[defect [[is [[at
[[risk [[for [[congestive [[heart [[failure?
A. [[Respiratory [[crackles
B. [[Decreased [[BP
C. [[Oxygen [[saturation [[increase
D. [[Hepatomegaly
E. [[Rapid [[weight [[gain [[- [[correct [[answer: [[C
The [[nurse [[is [[caring [[for [[a [[9 [[month [[old [[baby [[born [[with [[a [[CHD. [[Assessment [[reveals [[a [[HR [[of
[[160, [[capillary [[refill [[of [[4 [[seconds, [[crackles [[upon [[auscultation, [[and [[sweat [[on [[the [[scalp.
true [[or [[false [[- [[these [[are [[signs [[of [[hypoxemia [[- [[correct [[answer: [[true
A [[physician [[has [[prescribed [[oxygen [[as [[needed [[for [[an [[infant [[with [[CHF. [[In [[which [[situation [[is
[[the [[nurse [[most [[likely [[to [[plan [[to [[administer [[the [[oxygen [[to [[the [[infant?
A. [[During [[feeding
B. [[When [[the [[mother [[is [[holding [[the [[infant
C. [[When [[changing [[the [[infant's [[diaper
D. [[When [[the [[baby [[sleeps [[- [[correct [[answer: [[A. [[during [[feeding
,4. [[A [[child [[with [[a [[cyanotic [[heart [[defect [[is [[being [[discharged [[home [[to [[await [[surgical [[repair. [[In
[[the [[discharge [[teaching, [[the [[nurse [[instructs [[the [[parents:
A. [[To [[prevent [[the [[child [[from [[ever [[crying.
B. [[to [[observe [[for [[signs [[of [[increased [[intracranial [[pressure
C. [[In [[CPR
D. [[To [[identify [[growth [[and [[development [[milestones. [[- [[correct [[answer: [[C
5. [[A [[10 [[year [[old [[has [[undergone [[a [[cardiac [[catheterization. [[At [[the [[end [[of [[the [[procedure, [[the
[[nurse [[should [[first [[assess:
A. [[Pain
B. [[Pulses
C. [[Temperature
D. [[Intake [[and [[Output [[- [[correct [[answer: [[B
The [[nurse [[is [[caring [[for [[a [[school [[age [[boy [[with [[Kawasaki's [[disease. [[The [[student [[nurse [[asks
[[the [[nurse [[about [[the [[medications [[used [[to [[treat [[this [[disease. [[The [[nurse's [[response [[to [[the
[[student [[is:
A. [[Immunoglobulin [[G [[and [[aspirin
B. [[Immunoglobulin [[G [[and [[ACE [[inhibitors
C. [[Immunoglobulin [[E [[and [[heparin
D. [[Immunoglobulin [[E [[and [[ibuprofen [[- [[correct [[answer: [[A
A [[child [[with [[hemophilia [[is [[playing [[outside [[and [[injures [[his [[knee. [[The [[knee [[is [[swollen [[and
[[painful. [[Which [[of [[the [[following [[measures [[should [[be [[taken [[to [[stop [[the [[bleeding? [[(Select [[all
[[that [[apply)
, Immobilize [[the [[leg
Elevate [[the [[leg
Warm [[compresses [[to [[the [[site [[of [[injury
Passive [[ROM [[to [[the [[joint
Administer [[Factor [[VIII [[- [[correct [[answer: [[A, [[B, [[E
nursing [[interventions [[for [[Kawasaki’s [[disease [[- [[correct [[answer: [[comfort: [[fever [[control, [[keep
[[env [[quiet [[and [[dark, [[moisture [[to [[lips, [[mouth, [[and [[eyes, [[avoid [[touching [[child, [[high [[dose [[ASA
[[until [[fever [[is [[gone, [[low [[dose [[ASA [[until [[platelet [[count [[is [[normal [[and [[ECHO [[shows [[no
[[evidence [[of [[coronary [[artery [[changes [[
single [[dose [[of [[IVIG [[over [[10-12 [[hours [[-needs [[to [[be [[given [[within [[the [[first [[7-10 [[days [[
nutrition, [[fluids, [[IV [[and [[soft/liquid [[diet [[
safety: [[watch [[response [[to [[IVIG [[and [[coronary [[artery [[aneurysm [[
take [[temp [[for [[1 [[week [[following
what [[tests [[do [[you [[anticipate [[for [[someone [[with [[Kawasaki’s [[disease [[- [[correct [[answer:
[[frequent [[ECHOs [[to [[monitor [[for [[long [[term [[cardiac [[implications
what [[long [[term [[follow [[up [[and [[meds [[do [[you [[anticipate [[for [[someone [[with [[Kawasaki’s [[disease
[[- [[correct [[answer: [[Follow-up [[needed [[long-term [[with [[cardiologist [[if [[child [[develops [[coronary
[[abnormalities.
due [[to [[treatment [[for [[Kawasaki’s [[disease, [[what [[is [[a [[child [[at [[risk [[for [[- [[correct [[answer: [[watch
[[for [[low [[dose [[ASA [[toxicity [[- [[bleed [[as [[well [[as [[Reyes [[syndrome [[
ASA [[may [[be [[continued [[indefinitely [[in [[these [[children [[
