NURS 366 EXAM #2 QUESTIONS AND
VERIFIED ANSWERS
Kawasaki Disease (KD) ANSW✅✅= acute systemic vasculitis w/o a known cause
> Characterized by multisystem involvement and inflammation of small-medium sized arteries (self-
limited, 20% of kids develop coronary artery dilation or aneurysms w/o treatment)
> Diagnostic criteria: fever for at least 5 days + 4 of the following symptoms
1. Eyes - bilat conjunctival infection w/o discharge
2. Lips/mouth - erythema, cracked lips, strawberry tongue
3. Hands/feet - edema, erythema, periungual desquamation (peeling)
4. Skin - polymorphous rash
5. Cervical lymphadenopathy - lymph node > 1.5 cm
Kawasaki Disease (KD) phases & Tx ANSW✅✅> Phases:
- Acute phase: 1-2 weeks, high fever > 5 days, hand erythema/edema, polymorphous rash, bilat no
drainage conjunctivitis, strawberry tongue, cervical lymphadenopathy, extremely irritable
- Subacute phase: 30 days, last until all signs gone, resolution of fever, desquamation, increased
platelets, coronary aneurysms develop (high risk), irritable
- Convalescent phase: all clinical signs gone, lab values NOT normalized, phase complete when all
blood values normal (6-8 weeks), child regains normal energy/attitude
> Treatment: reduce inflammation, prevent thrombus formation
> AHA guidelines:
- High dose IVIG (single dose 2g/kg)
- High dose ASA (80-100mg/kg/day) until no fever
- Low dose ASA (3-5 mg/kg/day) for 6-8 weeks
- Discontinue ASA if normal after 8 weeks
Outline a plan of care for an infant or child with congestive heart failure ANSW✅✅> Oxygen
therapy
> Rest - turning off alarms in room, dimming lights, not interrupting sleep, cluster care
> Sodium/fluid restriction - dependent on side of heart effected
> Drug therapy - inotropes, afterload reduction
,> Small/frequent feedings (increase caloric intake)
> Correction of underlying congenital heart disease or precipitation cause
Design a plan of care for a post -operative child who received a cardiac diagnostic procedure
ANSW✅✅> Keep child lying flat as ordered
> Monitor pulses distal to the site (get a baseline so you can compare)
> Monitor temp and color of effected extremities/area
> Take VS every 15 mins, especially HR and BP
> Monitor the dressing for bleeding or hematoma
> Ensure adequate hydration & monitor I&Os
> Monitor BG levels
3 phases of peri-operative nursing ANSW✅✅Preoperative, intraoperative, postoperative
Nursing responsibilities for preoperative ANSW✅✅> Assessment: name, DOB, MRN, allergies,
history & physical (h&p), history of present illness (HPI), vitals trends, nutritional status, anesthesia
hx, current infections, meds used, use of contraindicated meds, current labs, physiological status,
psychological status
> Patient concerns: fear, anxiety, finances, anger, depression
> Nurse interventions: address/explore concerns, allow dialogue, provide accurate info (brief, direct,
simple), empathy, religious preferences/support
> Routine testing: CBC (WBC, Hgb/Hct/RBC, Plt), blood type, BMP/CMP (metabolic panel for
hydration), PT/PTT/INR (clotting), fasting BG, BUN/creatine (kidney), ALT/Bilirubin (liver),
Albumin/total protein (nutrient status), urinalysis, chest x-ray (respiratory status/heart), ECG
(cardiac rhythm/issues)
> Teaching: incentive spirometer, diaphragmatic breathing, coughing, splinting, turning, foot/leg
exercises, early mobility/ambulation
> Consent: Physicians are responsible for obtaining consent, nurses can check/answer questions
- Informed consent components: adequate disclosure of all info, understanding/comprehension of
above, voluntary consent
Nursing responsibilities for intraoperative ANSW✅✅> Certified RN first assist (CRNFA): assists w
retracing, hemostasis, suturing, anything surgeon asks
> Anesthetist: Specialized DNP responsible for anesthesia
, > Circulating nurse: advocate/teacher/role model/leader, safety maintenance (sterile field,
sponge/instrument/needle counts, patient positioning, equipment/medication safety, chemically
preps patient for procedure), monitors physical/psychological status, communicate with family
> Surgical tech: reviews procedure, preps OR, scrubs/gloves/gowns all team members,
preps/organizes instruments, helps drape patient, passes instruments to doc, counts
sponges/needles/instruments, monitors for sterility, tracks irrigations, calculates EBL, helps position
patient
> Support staff: transports staff to preop area, transport labs, retrieve blood prn, cleans equipment
(before, during, after), helps positioning patient, sets up specialized equipment, cleans room after
Nursing responsibilities for postoperative ANSW✅✅> Frequent assessments: vitals, RR depth, skin
color, LOC, bleeding, ABCs
> Maintain patent airway & ensure breathing: give O2, prevent hypoxia/hypocapnia, frequent RR
assessments
> Maintain cardiovascular stability: assess mental status, vitals, cardiac rhythm, skin temp/color,
urine output (watch for shock, hypo/hyper-tension, hemorrhage, dysrhythmias)
> Pain and anxiety relief
> Assess/manage surgical site: bleeding, type, integrity, drains
> Assess GI function: N/V, bowel sounds
> Urine output: urinary retention
> Ambulate ASAP: reduces post op complications (atelectasis, pneumonia, GI issues, DVTs, pressure
ulcers, reduces pain)
Know and be able to discuss the national patient safety goals ANSW✅✅> Identify patients
correctly
> Prevent surgical mistakes
> Improve communication
> Safe medication administration
> Alarm safety
> Reduce risk of health care-associated infections
> Fall prevention
> Pressure ulcer prevention (PUP)
VERIFIED ANSWERS
Kawasaki Disease (KD) ANSW✅✅= acute systemic vasculitis w/o a known cause
> Characterized by multisystem involvement and inflammation of small-medium sized arteries (self-
limited, 20% of kids develop coronary artery dilation or aneurysms w/o treatment)
> Diagnostic criteria: fever for at least 5 days + 4 of the following symptoms
1. Eyes - bilat conjunctival infection w/o discharge
2. Lips/mouth - erythema, cracked lips, strawberry tongue
3. Hands/feet - edema, erythema, periungual desquamation (peeling)
4. Skin - polymorphous rash
5. Cervical lymphadenopathy - lymph node > 1.5 cm
Kawasaki Disease (KD) phases & Tx ANSW✅✅> Phases:
- Acute phase: 1-2 weeks, high fever > 5 days, hand erythema/edema, polymorphous rash, bilat no
drainage conjunctivitis, strawberry tongue, cervical lymphadenopathy, extremely irritable
- Subacute phase: 30 days, last until all signs gone, resolution of fever, desquamation, increased
platelets, coronary aneurysms develop (high risk), irritable
- Convalescent phase: all clinical signs gone, lab values NOT normalized, phase complete when all
blood values normal (6-8 weeks), child regains normal energy/attitude
> Treatment: reduce inflammation, prevent thrombus formation
> AHA guidelines:
- High dose IVIG (single dose 2g/kg)
- High dose ASA (80-100mg/kg/day) until no fever
- Low dose ASA (3-5 mg/kg/day) for 6-8 weeks
- Discontinue ASA if normal after 8 weeks
Outline a plan of care for an infant or child with congestive heart failure ANSW✅✅> Oxygen
therapy
> Rest - turning off alarms in room, dimming lights, not interrupting sleep, cluster care
> Sodium/fluid restriction - dependent on side of heart effected
> Drug therapy - inotropes, afterload reduction
,> Small/frequent feedings (increase caloric intake)
> Correction of underlying congenital heart disease or precipitation cause
Design a plan of care for a post -operative child who received a cardiac diagnostic procedure
ANSW✅✅> Keep child lying flat as ordered
> Monitor pulses distal to the site (get a baseline so you can compare)
> Monitor temp and color of effected extremities/area
> Take VS every 15 mins, especially HR and BP
> Monitor the dressing for bleeding or hematoma
> Ensure adequate hydration & monitor I&Os
> Monitor BG levels
3 phases of peri-operative nursing ANSW✅✅Preoperative, intraoperative, postoperative
Nursing responsibilities for preoperative ANSW✅✅> Assessment: name, DOB, MRN, allergies,
history & physical (h&p), history of present illness (HPI), vitals trends, nutritional status, anesthesia
hx, current infections, meds used, use of contraindicated meds, current labs, physiological status,
psychological status
> Patient concerns: fear, anxiety, finances, anger, depression
> Nurse interventions: address/explore concerns, allow dialogue, provide accurate info (brief, direct,
simple), empathy, religious preferences/support
> Routine testing: CBC (WBC, Hgb/Hct/RBC, Plt), blood type, BMP/CMP (metabolic panel for
hydration), PT/PTT/INR (clotting), fasting BG, BUN/creatine (kidney), ALT/Bilirubin (liver),
Albumin/total protein (nutrient status), urinalysis, chest x-ray (respiratory status/heart), ECG
(cardiac rhythm/issues)
> Teaching: incentive spirometer, diaphragmatic breathing, coughing, splinting, turning, foot/leg
exercises, early mobility/ambulation
> Consent: Physicians are responsible for obtaining consent, nurses can check/answer questions
- Informed consent components: adequate disclosure of all info, understanding/comprehension of
above, voluntary consent
Nursing responsibilities for intraoperative ANSW✅✅> Certified RN first assist (CRNFA): assists w
retracing, hemostasis, suturing, anything surgeon asks
> Anesthetist: Specialized DNP responsible for anesthesia
, > Circulating nurse: advocate/teacher/role model/leader, safety maintenance (sterile field,
sponge/instrument/needle counts, patient positioning, equipment/medication safety, chemically
preps patient for procedure), monitors physical/psychological status, communicate with family
> Surgical tech: reviews procedure, preps OR, scrubs/gloves/gowns all team members,
preps/organizes instruments, helps drape patient, passes instruments to doc, counts
sponges/needles/instruments, monitors for sterility, tracks irrigations, calculates EBL, helps position
patient
> Support staff: transports staff to preop area, transport labs, retrieve blood prn, cleans equipment
(before, during, after), helps positioning patient, sets up specialized equipment, cleans room after
Nursing responsibilities for postoperative ANSW✅✅> Frequent assessments: vitals, RR depth, skin
color, LOC, bleeding, ABCs
> Maintain patent airway & ensure breathing: give O2, prevent hypoxia/hypocapnia, frequent RR
assessments
> Maintain cardiovascular stability: assess mental status, vitals, cardiac rhythm, skin temp/color,
urine output (watch for shock, hypo/hyper-tension, hemorrhage, dysrhythmias)
> Pain and anxiety relief
> Assess/manage surgical site: bleeding, type, integrity, drains
> Assess GI function: N/V, bowel sounds
> Urine output: urinary retention
> Ambulate ASAP: reduces post op complications (atelectasis, pneumonia, GI issues, DVTs, pressure
ulcers, reduces pain)
Know and be able to discuss the national patient safety goals ANSW✅✅> Identify patients
correctly
> Prevent surgical mistakes
> Improve communication
> Safe medication administration
> Alarm safety
> Reduce risk of health care-associated infections
> Fall prevention
> Pressure ulcer prevention (PUP)
