PEDS Chapter 23, ATI 20 (Exam 3) Q & A.docx

  The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose; 4 ml of the drug is to be drawn up. Based on the nurse's knowledge of this medication and safe pediatric dosages, the most appropriate action by the nurse is a. do not draw-up dose; suspect dosage error. b. mix dose with juice to disguise its taste. c. check heart rate; administer dose by placing it to the back and side of mouth. d. check heart rate; administer dose by letting infant suck it through a nipple. -Correct Answers: a. do not draw-up dose; suspect dosage error. Digoxin is often prescribed in micrograms. Rarely is more than 1 ml administered to an infant. As a potentially dangerous drug, digoxin has precise administration guidelines. Some institutions require that digoxin dosages be checked with another professional before administration. The nurse has drawn up too much medication and should not give it to the child. Administration procedures as described are correct, but too much medication is prepared, so it should not be given to the child. What procedure uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? a. Echocardiography b. Electrocardiography c. Cardiac catheterization d. Electrophysiology -Correct Answers: a. Echocardiography Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, a diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is an electrical tracing of the depolarization of myocardial cells. Cardiac catheterization is an invasive procedure where a catheter is threaded into the heart, a contrast medium is injected, and the heart and its vessels are visualized. Electrophysiology is an invasive procedure where catheters with electrodes record the impulses of the heart directly from the conduction system. After a patient returns from cardiac catheterization, the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). The most appropriate nursing intervention is to a. elevate the affected extremity. b. document the findings and continue to monitor. c. notify the health care provider of the finding. d. apply warm compresses to the insertion site. -Correct Answers: b. document the findings and continue to monitor. The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. It should gradually increase in strength. The extremity is kept straight and immobile, but elevation is not necessary. Because a weaker pulse is an expected finding, the nurse should document it and continue to monitor it. There is no need to notify the physician. The insertion site is kept dry. Warm compresses would increase the risk of bleeding from the insertion site. Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse's knowledge of congenital heart defects, this system in clinical practice is a. helpful, because it explains the hemodynamics involved. b. helpful, because children with cyanotic defects are easily identified. c. problematic, because cyanosis is rarely present in children. d. problematic, because children with acyanotic heart defects may develop cyanosis. -Correct Answers: d. problematic, because children with acyanotic heart defects may develop cyanosis. This classification is problematic. Children with traditionally named acyanotic defects may become cyanotic, and children with traditionally classified cyanotic defects may be pink at times. The classification does not reflect the blood flow within the heart. Cardiac defects are best described by using the actual pathophysiologic process and mechanism. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Cyanosis is present when children have defects where there is mixing of oxygenated blood with unoxygenated blood. Surgical repair for patent ductus arteriosus (PDA) is done to prevent the complication of a. pulmonary infection. b. right-to-left shunt of blood. c. decreased workload on left side of heart. d. increased pulmonary vascular congestion. -Correct Answers: d. increased pulmonary vascular congestion. A PDA allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary vascular congestion can occur. The increased pulmonary vascular congestion is the primary complication; pulmonary infection may occur, but it is not the priority complication. A PDA involves a left-to-right shunt of blood. The decreased workload on the left side of the heart is not a priority complication of a PDA. A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is a. the low Fowler position. b. the prone position. c. the supine position. d. the squatting position. -Correct Answers: d. the squatting position. The squatting or knee-chest position increases the return of blood flow to the heart for oxygenation in a child with a defect that consists of decreased pulmonary blood flow. The low Fowler, prone or supine position does not offer any physiologic advantage to the child related to cardiac compensation. What is considered a mixed cardiac defect? a. Pulmonic stenosis b. Atrial septal defect c. Patent ductus arteriosus d. Transposition of the great arteries -Correct Answers: d. Transposition of the great arteries Transposition of the great arteries allows the mixing of both oxygenated and unoxygenated blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect and patent ductus arteriosus are classified as defects with increased pulmonary blood flow. What is an early sign of congestive heart failure that the nurse should recognize? a. Tachypnea b. Bradycardia c. Inability to sweat d. Increased urinary output -Correct Answers: a. Tachypnea Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic if experiencing congestive heart failure. There will usually be decreased urinary output in a child experiencing congestive heart failure. The nurse should explain to the parents that their child is receiving furosemide (Lasix) for severe congestive heart failure because of its effects as a. a diuretic. b. a beta-blocker. c. a form of digitalis. d. an ACE inhibitor. -Correct Answers: a. a diuretic. Furosemide is a loop diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated with congestive heart failure. Nursing care of the infant and child with congestive heart failure includes a. force fluids appropriate to age. b. monitor respirations during active periods. c. organize activities to allow for uninterrupted sleep. d. give larger feedings less often to conserve energy. -Correct Answers: c. organize activities to allow for uninterrupted sleep. The child needs to be well rested before feeding. The child's needs should be met to minimize crying. The nurse must organize care to decrease energy expenditure. The child in congestive heart failure has an excess of fluid, so forcing fluids is contraindicated. Monitoring of vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings; small, frequent feedings should be given to the child in congestive heart failure. What should nurses stress when counseling parents regarding the home care of the child with a cardiac defect before corrective surgery? a. The importance of reducing caloric intake to decrease cardiac demands b. The importance of relaxing discipline and limit setting to prevent crying c. The need to be extremely concerned about cyanotic spells d. The desirability of promoting normalcy within the limits of the child's condition -Correct Answers: d. The desirability of promoting normalcy within the limits of the childs condition The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake after cardiac surgery. The child needs discipline and appropriate limit setting, as would be done with any other child his or her age. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern. What is an important nursing responsibility when a dysrhythmia is suspected? a. Order an immediate electrocardiogram. b. Count the radial pulse every 1 minute for five times. c. Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate. d. Have someone else take the radial pulse simultaneously with the apical pulse. -Correct Answers: c. Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate. This is the nurse's first action. If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate. This may be indicated after conferring with the practitioner. The radial pulse rate needs to be compared with the apical pulse rate. It does not need to be counted for 1 minute five times. Only one nurse is needed to carry out this action. The primary therapy for secondary hypertension in children is a. weight reduction. b. low-salt diet. c. increased exercise and fitness. d. treatment of underlying cause. -Correct Answers: d. treatment of underlying cause. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved. Weight reduction and a low-salt diet are usually effective in managing essential hypertension. Increased exercise and fitness are usually effective in managing essential hypertension. What should the nurse recognize as an early clinical sign of compensated shock in a child? a. Confusion b. Sleepiness c. Hypotension d. Apprehensiveness -Correct Answers: d. Apprehensiveness Apprehensiveness is indicative of compensated shock. Confusion is indicative of uncompensated shock. Sleepiness is not an indication of shock. Hypotension is a symptom of irreversible shock. A cardiac assessment is required to determine if a child's physical symptoms are related to possible heart disease. The nurse is proceeding to auscultation techniques. When observing the nursing student perform this assessment, which action would indicate that additional training was required? a. Documentation of heart sounds in reference to anatomical location. b. Determination that there is no evidence of carotid bruits. c. Calculation of heart rate. d. Ascertaining whether there is evidence of splenic enlargement. -Correct Answers: d. Ascertaining whether there is evidence of splenic enlargement. Evidence of splenic enlargement requires palpation as an assessment technique. All of the other options are in-line with auscultation techniques. A physician suspects that a child may have congenital cardiac disease. Which noninvasive diagnostic procedure would help to confirm the possibility of heart disease? a. EKG b. Echocardiogram c. Chest x-ray d. Pulse oximetry -Correct Answers: b. Echocardiogram An echocardiogram is the most common test used to identify either a cardiac anomaly or evidence of heart disease. EKG provides evidence of electrical system conduction. Pulse oximetry provides information relative to perfusion. And a chest x-ray focuses on lungs and airway exchange, it may not be sensitive and specific to determine cardiac pathology. The goals of therapeutic management for congestive heart failure is to a. increase afterload and perfusion to tissues. b. decrease preload and increase afterload. c. decrease preload, afterload and increase contractility. d. decrease contractility and increase preload and afterload. -Correct Answers: c. decrease preload, afterload and increase contractility. Treatment goals for congestive heart failure are aimed at decreasing preload (volume), afterload (resistance) and increasing contractility (improving efficiency). If a child is being treated with ACE inhibitors as part of the therapeutic regimen for heart failure, which observation is noted would alert the nurse to a potential interaction? a. Diuretic therapy with Aldactone b. Child complains of being slightly dizzy at times c. Maintaining normal urine output d. Blood pressure monitoring at lower end of normal range -Correct Answers: a. Diuretic therapy with Aldactone The use of ACE inhibitors in combination with Aldactone, which is a potassium sparing inhibitor can lead to potential hyperkalemia. As such this type of diuretic therapy should not be used. ACE inhibitors typically are not associated with dizziness but continued monitoring for this presentation should be included. Normal urine output is a favorable sign. ACE inhibitors can cause hypotension so continued monitoring would be needed at this point. An adolescent is being treated for new-onset hypertension with medication. Firs line therapy previously tried was with dietary management but the decision has now been made to start oral medications. Which complaint if provided by the patient would indicate a potential concern? a. Patient states that he is no longer losing weight after being on the medication for one week's time. b. Patient states he is maintaining his oral intake of 8 glasses of water a day. c. He is taking the medication in the evening rather than taking the medication in the morning as prescribed as he thinks that he feels better and has less side effects. d. He reports that he occasionally feels "lightheaded" when getting out of a chair during the course of the school day in some of his classes. -Correct Answers: d. He reports that he occasionally feels "lightheaded" when getting out of a chair during the course of the school day in some of his classes. Safety aspects should be considered with use of anti-hypertensives and the possibility of orthostatic hypotension. As such the patient should be assessed for this event and prospective safety management should be instituted. Anti-hypertensive therapy is typically not associated with weight loss. Maintaining fluid hydration and the fact that the medication dosing is taken in the evening rather than the daytime to minimize size effects is showing individualization to patient's needs. A diagnosis of rheumatic fever is being ruled out for a child. Which lab test(s) is/are the most reliable? (Select all that apply.) a. Throat culture b. C-reactive protein (CRP) c. Antistreptolysin-O titer (ASO) titer d. Elevated white blood count (WBC) e. Erythrocyte sedimentation rate (ESR) -Correct Answers: c. Antistreptolysin-O titer (ASO) titer The most reliable and best standardized lab for antistreptococcal antibodies is an Antistreptolysin-O (ASO) titer. A throat culture indicates a current streptococcal infection. C-reactive protein (CRP) lab test indicates inflammation. An elevated white blood count (WBC) may indicate a possible infection but does not indicate a causative agent. An erythrocyte sedimentation rate (ESR) indicates inflammation. A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? (select all that apply) a. weak femoral pulses b. cool skin of lower extremities c. severe cyanosis d. clubbing of the fingers e. heart failure -Correct Answers: a. weak femoral pulses b. cool skin of lower extremities e. heart failure A nurse is assessing an infant who has heart failure. Which of the following findings should the nurse expect? (select all that apply) a. bradycardia b. cool extremities c. peripheral edema d. increased urinary output e. nasal flaring -Correct Answers: b. cool extremities c. peripheral edema e. nasal flaring A nurse is providing teaching to the mother of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include? a. do not offer your baby fluids after giving the medication. b. digoxin increases your baby's heart rate c. give the correct dose of medication at regularly scheduled times d. if your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount. -Correct Answers: c. give the correct dose of medication at regularly scheduled times A nurse is caring for a 2 yr old child who has a heart defect and is scheduled for cardiac catheterization. Which of the following actions should the nurse take? a. Place on NPO status for 12 hr prior to the procedure b. Check for iodine or shellfish allergies prior to the procedure c. Elevate the affected extremity following the procedure d. Limit fluid intake following the procedure -Correct Answers: b. Check for iodine or shellfish allergies prior to the procedure A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following findings should the nurse expect? select all that apply a. erythema marginatum (rash) b. continuous joint pain of the digits. c. tender, subcutaneous nodules d. decreased erythrocyte sedimentation rate e. elevated C-reactive protein -Correct Answers: a. erythema marginatum (rash) e. elevated C-reactive protein You are working with a new graduate on the pediatric unit and your patient is returning from the cardiac catheterization lab. You feel the graduate understands the important nursing interventions when she says which of the following? (select all that apply) a. check pulses especially below the catheterization site, for equality and symmetry b. check vital signs, which may be taken as frequently as every 30 to 45 mins, with special emphasis on the heart rate, which is counted for 1 full minute for evidece of dysrhythmias or bradycardia. c. special attention needs to be given to the BP, especially for hypertension, which may indicate hemorrhage or bleeding from the catheterization site d. check the dressing for evidence of bleeding or hematoma formation in the femoral or antecubital area. e. allow the child to ambulate because this will prevent skin breakdown from lying so long in one place. -Correct Answers: a. check pulses especially below the catheterization site, for equality and symmetry d. check the dressing for evidence of bleeding or hematoma formation in the femoral or antecubital area. You are working with a family with a child who has a congenital heart defect. Future surgery is planned, and you are teaching the parent how to reduce cardiac demands. The parent needs more teaching when she says which of the following? a. I will wake my child for feeding every 2hrs so he can get enough calories to gain weight b. When I give digoxin, I will listen to the pulse for 1 full minute c. I should protect my child from people who have respiratory infections d. I will count the number of wet diapers to be sure my child is not getting too much or too little fluid. -Correct Answers: a. I will wake my child for feeding every 2hrs so he can get enough calories to gain weight Which heart defect and hemodynamic change pairing is correct? a. Aortic stenosis and obstruction to blood flow out of the heart b. Ventricular septal defect (VSD) and decreased pulmonary blood flow c. Tricuspid atresia and increased pulmonary blood flow d. Atrioventricular (AV) canal and mixed blood flow, in which saturated and desaturated blood mix within the heart or great arteries -Correct Answers: a. Aortic stenosis and obstruction to blood flow out of the heart You are discharging a 5 week old infant with a congenital heart defect who will be going home on digoxin. Which of the following answers by the father indicate the need for more teaching? (select all that apply) a. I know I give the drug carefully by slowly directing it to the side and back of the mouth b. I give the medication every 12 hrs, and I can place it in a bit of formula so that I know the baby will take it c. If I miss a dose, I dont give an extra dose, but I give the next dose as ordered. d. If the baby vomits, I should give a second dose e. If more than two doses have been missed, I should call the doctor -Correct Answers: b. I give the medication every 12 hrs, and I can place it in a bit of formula so that I know the baby will take it d. If the baby vomits, I should give a second dose You are working in the pediatric clinic, and a child presents with symptoms that are suspicious of the acute phase of Kawasaki disease. Which of the following symptoms are included? (select all that apply) a. Periungual desquamation (peeling that begins under the fingertips and toes) of the hands and feet is present b. The bulbar conjunctivae of the eyes become reddened, with clearing around the iris c. A temporary arthritis is evident, which may affect the larger weight-bearing joints. d. Inflammation of the pharynx and the oral mucosa develops, with red, cracked lips and the characteristic "strawberry tongue" e. Loud pansystolic murmur along with ECG changes are present -Correct Answers: b. The bulbar conjunctivae of the eyes become reddened, with clearing around the iris d. Inflammation of the pharynx and the oral mucosa develops, with red, cracked lips and the characteristic "strawberry tongue"