Peds Final (Exam 3)
The nurse is providing education to parents of a child with a blood pressure in the 90th
percentile. What would be included in the intervention strategies?
A. The nurse would review the child's 24-hour diet recall.
B. The child should not be allowed to participate in sports.
C. Blood pressures should be measured daily.
D. Beta blocker education should be given to the parents. - ANSANS: A
Rationale: With a child in the 90th percentile for blood pressure, diet and physical activity
should be the main focus. Blood pressures should be measured, but daily measurement is
not
necessary. Children are not routinely put on beta blockers, and the child should be allowed
to
participate in sports if monitored.
An infant with poor feeding is suspected of having a congenital heart defect. The parents are
asking why a chest x-ray is necessary in their infant. What is the best response from the
nurse?
A. It will determine if the heart is enlarged.
B. It will determine disturbances in heart conduction.
C. It will show if blood is being shunted.
D. This image will clarify the structures within the heart. - ANSANS: A
Rationale: Chest x-rays are performed to see if the heart is enlarged. This will determine if
the
heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG.
Visualizing where blood is being shunted is through the echocardiogram. The image used to
clarify the structures of the heart is the MRI.
The nurse is reviewing the health history and physical examination of a child diagnosed with
heart failure. What would the nurse expect to find? Select all that apply.
A. Tiring easily when eating
B. Shortness of breath when playing
C. Crackles on lung auscultation
D. Bradycardia
E. Hypertension - ANSANS: A, B, C
Rationale: Manifestations of heart failure include difficulty feeding or eating or becoming
tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles
and
wheezes on lung auscultation, tachycardia, and hypotension.
,The nurse is administering digoxin as ordered and the child vomits the dose. What should
the nurse do next?
A. Contact the physician.
B. Offer a snack and administer another dose.
C. Immediately administer another dose.
D. Administer next dose as ordered in 12 hours. - ANSANS: D
Rationale: Digoxin should be administered at regular intervals, every 12 hours, 1 hour before
or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose
and should wait until the next scheduled dose. It is not necessary to contact the physician.
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.
A. Intravenous immunoglobulin
B. Ibuprofen
C. Acetaminophen
D. Aspirin
E. Alprostadil - ANSANS: A, C, D
Rationale: In the acute phase, high-dose aspirin in four divided doses daily and a single
infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever.
Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is
receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent
in infants with ductal-dependent congenital heart defects.
When assessing a infant born at 32 weeks' gestation, which finding would lead the nurse to
suspect to suspect that the newborn has a patent ductus arteriosus (PDA)?
A. Weak, thready pulse
B. Decreased pulse rate
C. High diastolic arterial pressure
D. Continuous murmur on auscultation - ANSANS: D
Rationale: Presence of a continuous murmur on auscultation of the heart is indicative of
patent
ductus arteriosus (PDA) in preterm infants. Preterm infants are at an increased risk of
developing PDA. Other assessment findings that indicate PDA include bounding pulse,
increased pulse rate and low diastolic arterial pressure.
A nurse is assessing the history of a 7-year-old boy who is suspected of having a
cardiovascular disorder. Which of the following findings would tend to indicate a
cardiovascular disorder in this child? Select all that apply.
A. Fatigues easily after a short walk home from school
B. A tendency to squat
C. Periorbital edema
D. A lack of perspiration
,E. Frequent voiding
F. Bouts of hyperactivity - ANSANS: A, B, C
Rationale: A mark of older children with heart disease is that they notice easy fatigue. They
often voluntarily squat, as this position traps blood in the lower extremities because of the
sharp bend at the knee and hip, allowing the child to oxygenate the blood remaining in the
upper body more fully and easily. Ask about perspiration as children with left-to-right cardiac
shunts may perspire excessively because of sympathetic nerve stimulation. They are able to
effectively produce urine only when cardiac function is adequate to perfuse kidneys. To
assess
kidney output, evaluate how often the child voids. Infrequent voiding could indicate lack of
perfusion of the kidneys, and thus decreased heart function. Edema from retained fluid that
cannot be voided is a late sign of heart disease in children. If it does occur, periorbital edema
(swelling around the eyes) generally occurs first. Bouts of hyperactivity are not associated
with cardiovascular disorders.
The nurse is providing care to a child with a congenital heart defect. Which of the following
would lead the nurse to suspect that the child is developing heart failure? Select all that
apply.
A. Tachycardia
B. Sacral edema
C. Bradypnea
D. Inability to sweat
E. Splenomegaly - ANSANS: A, B
Rationale: Signs of heart failure include tachycardia, dependent edema such as in the sacral
area, tachypnea, and hepatomegaly. In addition, diaphoresis, fatigue and exercise
intolerance
may be noted.
The nurse is providing teaching to the parents of a child whose blood pressure is in the 90th
percentile. Which of the following would the nurse expect to include? Select all that apply
A. Family lifestyle modification
B. Sodium restriction
C. Aerobic exercise
D. Stress reduction
E. Antihypertensive therapy. - ANSANS: A, B, C, D
Rationale: With a child in the 90th percentile for blood pressure, lifestyle modification
including diet and exercise are the main focus. These include salt restriction, aerobic
exercise,
and stress reduction. Antihypertensives are used if the child has symptomatic hypertension.
Which assessment findings should the nurse expect to see in the infant diagnosed with
pulmonary stenosis and heart failure? Select all that apply.
, A. Crackles (rales)
B. Cyanosis
C. Left ventricular hypertrophy
D. Murmur
E. Right ventricular hypertrophy - ANSANS: B, D, E
Rationale: Patients with pulmonary stenosis have a narrowing in their pulmonary arteries,
causing a decrease in blood flow to the lungs, which can cause cyanosis and the inability of
the right ventricle to empty, leading to right ventricular hypertrophy. Crackles (rales) and left
ventricular hypertrophy are signs of left-sided heart failure, which this patient does not have.
A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series
of laboratory tests have been ordered. Which findings are consistent with this disease?
Select all that apply.
A. Reduced hemoglobin levels
B. Reduced white blood cell count
C. Elevated erythrocyte sedimentation rate (ESR)
D. Negative C reactive protein levels
E. Reduced platelet levels - ANSANS: A, C
Rationale: Kawasaki disease is an acute systemic vasculitis occurring mostly in children 6
months to 5 years of age. It is the leading cause of acquired heart disease among children.
The
CBC count may reveal mild to moderate anemia, an elevated white blood cell count during
the acute phase, and significant thrombocytosis (elevated platelet count [500,000 to 1
million]) in the later phase. The erythrocyte sedimentation rate (ESR) and the C-reactive
protein (CRP) level are elevated.
The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive
heart failure. Which clinical manifestation observed during the physical assessment would be
consistent with this diagnosis?
A. Jerking movements of the arms and legs
B. Scissoring of the legs with toes pointed down
C. Failure to gain weight
D. Spooning of the finger nails - ANSANS: C
Rationale: In infants and older children, one of the first signs of CHF is tachycardia. Other
signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue,
restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or
tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and
enlargement
of the liver and heart may be present. Jerking movements indicate seizure activity.
Scissoring
of the legs is seen in cerebral palsy, and spooning of the finger nails is seen in iron
deficiency
anemia.
The nurse is providing education to parents of a child with a blood pressure in the 90th
percentile. What would be included in the intervention strategies?
A. The nurse would review the child's 24-hour diet recall.
B. The child should not be allowed to participate in sports.
C. Blood pressures should be measured daily.
D. Beta blocker education should be given to the parents. - ANSANS: A
Rationale: With a child in the 90th percentile for blood pressure, diet and physical activity
should be the main focus. Blood pressures should be measured, but daily measurement is
not
necessary. Children are not routinely put on beta blockers, and the child should be allowed
to
participate in sports if monitored.
An infant with poor feeding is suspected of having a congenital heart defect. The parents are
asking why a chest x-ray is necessary in their infant. What is the best response from the
nurse?
A. It will determine if the heart is enlarged.
B. It will determine disturbances in heart conduction.
C. It will show if blood is being shunted.
D. This image will clarify the structures within the heart. - ANSANS: A
Rationale: Chest x-rays are performed to see if the heart is enlarged. This will determine if
the
heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG.
Visualizing where blood is being shunted is through the echocardiogram. The image used to
clarify the structures of the heart is the MRI.
The nurse is reviewing the health history and physical examination of a child diagnosed with
heart failure. What would the nurse expect to find? Select all that apply.
A. Tiring easily when eating
B. Shortness of breath when playing
C. Crackles on lung auscultation
D. Bradycardia
E. Hypertension - ANSANS: A, B, C
Rationale: Manifestations of heart failure include difficulty feeding or eating or becoming
tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles
and
wheezes on lung auscultation, tachycardia, and hypotension.
,The nurse is administering digoxin as ordered and the child vomits the dose. What should
the nurse do next?
A. Contact the physician.
B. Offer a snack and administer another dose.
C. Immediately administer another dose.
D. Administer next dose as ordered in 12 hours. - ANSANS: D
Rationale: Digoxin should be administered at regular intervals, every 12 hours, 1 hour before
or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose
and should wait until the next scheduled dose. It is not necessary to contact the physician.
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.
A. Intravenous immunoglobulin
B. Ibuprofen
C. Acetaminophen
D. Aspirin
E. Alprostadil - ANSANS: A, C, D
Rationale: In the acute phase, high-dose aspirin in four divided doses daily and a single
infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever.
Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is
receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent
in infants with ductal-dependent congenital heart defects.
When assessing a infant born at 32 weeks' gestation, which finding would lead the nurse to
suspect to suspect that the newborn has a patent ductus arteriosus (PDA)?
A. Weak, thready pulse
B. Decreased pulse rate
C. High diastolic arterial pressure
D. Continuous murmur on auscultation - ANSANS: D
Rationale: Presence of a continuous murmur on auscultation of the heart is indicative of
patent
ductus arteriosus (PDA) in preterm infants. Preterm infants are at an increased risk of
developing PDA. Other assessment findings that indicate PDA include bounding pulse,
increased pulse rate and low diastolic arterial pressure.
A nurse is assessing the history of a 7-year-old boy who is suspected of having a
cardiovascular disorder. Which of the following findings would tend to indicate a
cardiovascular disorder in this child? Select all that apply.
A. Fatigues easily after a short walk home from school
B. A tendency to squat
C. Periorbital edema
D. A lack of perspiration
,E. Frequent voiding
F. Bouts of hyperactivity - ANSANS: A, B, C
Rationale: A mark of older children with heart disease is that they notice easy fatigue. They
often voluntarily squat, as this position traps blood in the lower extremities because of the
sharp bend at the knee and hip, allowing the child to oxygenate the blood remaining in the
upper body more fully and easily. Ask about perspiration as children with left-to-right cardiac
shunts may perspire excessively because of sympathetic nerve stimulation. They are able to
effectively produce urine only when cardiac function is adequate to perfuse kidneys. To
assess
kidney output, evaluate how often the child voids. Infrequent voiding could indicate lack of
perfusion of the kidneys, and thus decreased heart function. Edema from retained fluid that
cannot be voided is a late sign of heart disease in children. If it does occur, periorbital edema
(swelling around the eyes) generally occurs first. Bouts of hyperactivity are not associated
with cardiovascular disorders.
The nurse is providing care to a child with a congenital heart defect. Which of the following
would lead the nurse to suspect that the child is developing heart failure? Select all that
apply.
A. Tachycardia
B. Sacral edema
C. Bradypnea
D. Inability to sweat
E. Splenomegaly - ANSANS: A, B
Rationale: Signs of heart failure include tachycardia, dependent edema such as in the sacral
area, tachypnea, and hepatomegaly. In addition, diaphoresis, fatigue and exercise
intolerance
may be noted.
The nurse is providing teaching to the parents of a child whose blood pressure is in the 90th
percentile. Which of the following would the nurse expect to include? Select all that apply
A. Family lifestyle modification
B. Sodium restriction
C. Aerobic exercise
D. Stress reduction
E. Antihypertensive therapy. - ANSANS: A, B, C, D
Rationale: With a child in the 90th percentile for blood pressure, lifestyle modification
including diet and exercise are the main focus. These include salt restriction, aerobic
exercise,
and stress reduction. Antihypertensives are used if the child has symptomatic hypertension.
Which assessment findings should the nurse expect to see in the infant diagnosed with
pulmonary stenosis and heart failure? Select all that apply.
, A. Crackles (rales)
B. Cyanosis
C. Left ventricular hypertrophy
D. Murmur
E. Right ventricular hypertrophy - ANSANS: B, D, E
Rationale: Patients with pulmonary stenosis have a narrowing in their pulmonary arteries,
causing a decrease in blood flow to the lungs, which can cause cyanosis and the inability of
the right ventricle to empty, leading to right ventricular hypertrophy. Crackles (rales) and left
ventricular hypertrophy are signs of left-sided heart failure, which this patient does not have.
A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series
of laboratory tests have been ordered. Which findings are consistent with this disease?
Select all that apply.
A. Reduced hemoglobin levels
B. Reduced white blood cell count
C. Elevated erythrocyte sedimentation rate (ESR)
D. Negative C reactive protein levels
E. Reduced platelet levels - ANSANS: A, C
Rationale: Kawasaki disease is an acute systemic vasculitis occurring mostly in children 6
months to 5 years of age. It is the leading cause of acquired heart disease among children.
The
CBC count may reveal mild to moderate anemia, an elevated white blood cell count during
the acute phase, and significant thrombocytosis (elevated platelet count [500,000 to 1
million]) in the later phase. The erythrocyte sedimentation rate (ESR) and the C-reactive
protein (CRP) level are elevated.
The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive
heart failure. Which clinical manifestation observed during the physical assessment would be
consistent with this diagnosis?
A. Jerking movements of the arms and legs
B. Scissoring of the legs with toes pointed down
C. Failure to gain weight
D. Spooning of the finger nails - ANSANS: C
Rationale: In infants and older children, one of the first signs of CHF is tachycardia. Other
signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue,
restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or
tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and
enlargement
of the liver and heart may be present. Jerking movements indicate seizure activity.
Scissoring
of the legs is seen in cerebral palsy, and spooning of the finger nails is seen in iron
deficiency
anemia.
