Rasmussen - MCN - Exam 3/Final
Correct 100%
• crackles
• harsh cough
• elevated temperature
• thick secretions - ANSWER What is an expected assessment finding for bacterial
pneumonia?
▪ remain with the patient for the first 15 minutes of the infusion - ANSWER Safe practice
in administration of blood products
• "Strawberry" tongue
• edema of hands and feet
• conjunctivitis without exudate - ANSWER S/S: *Kawasaki disease (KD)*
• cool-mist humidity
• steamy shower - ANSWER Home Treatment: *Bronchiolitis*
• rheumatic fever
• glomerulonephritis (antibiotics decrease occurrence) - ANSWER Pharyngitis causes
increased risk of developing____________ ________?
▪ Monitor for s/s of bleeding (clearing throat)
▪ Give clear, cool liquid or ice chips
▪ No red, citrus/acidic, carbonated or milk products
▪ Clear fluids are best
▪ No straws, forks
▪ Position for drainage - ANSWER Nursing Care: *Post Tonsillectomy*
▪ inflammation of the pulmonary alveoli
▪ fever, cough, fine crackles
▪ viral - supportive care
▪ bacterial - antibiotics and supportive care - ANSWER S/S: *Pneumonia*
upright - ANSWER Epiglottitis position
echocardiogram - ANSWER Noninvasive diagnostic testing for the heart to see its
structure and function. Should be ordered first to evaluate a murmur.
**• Non-weight bearing**
• Activity limitations
• Cast education - ANSWER Patient Education: Legg-Calve-Perthes Disease
,Legg-Calve-Perthes Disease - ANSWER • This is an avascular necrosis (lack of blood
resulting in destruction) of the proximal femoral epiphysis
• Child normally look well but may have a limp, guarding of hip while moving it
• Less than 6 - NSAIDs and containment device to keep head of femur in place
• Older than 6 - reconstructive surgery followed by cast application - ANSWER
Treatment: *Legg-Calve-Perthes Disease*
▪ Machine like murmur heard at the *left sub clavicular margin*
▪ They may be asymptomatic or show signs of HF
▪ A widened pulse pressure and bounding pulses may be present - ANSWER
Symptoms: *Patent Ductus Arteriosus*
▪ Indomethacin, a prostaglandin inhibitor
▪ Closed during cardiac catherization or surgical management - ANSWER Treatment:
*Patent Ductus Arteriosus*
patent ductus arteriosus - ANSWER a failure of the fetal ductus arteriosus to close
within the first weeks of life
▪ BP higher in the upper extremities than in the lower extremities
▪ Signs of HF may occur in infants
▪ Bounding pulses in the arms and weak or absent femoral pulses and cool extremities
may be present
**be sure to assess the femoral and radial pulses simultaneously** - ANSWER S/S:
*Coarctation of the Aorta*
▪ balloon angioplasty
▪ surgical repair - ANSWER Treatment: *Coarctation of the Aorta*
coarctation of the aorta - ANSWER a localized narrowing near the insertion of the
ductus arteriosus
Place in a knee-chest position - ANSWER If your patient has Tetralogy of Fallot and
they become cyanotic and dyspneic, what is your intervention?
• REST
• HYDRATION
• PAIN CONTROL
• OXYGENATION - ANSWER Nursing Interventions: *Sickle Cell Anemia*
▪ mottling
▪ increased capillary refill time
▪ turgor
, ▪ dry mucous membranes
▪ tachycardia - ANSWER S/S: *Dehydration*
▪ oral rehydration - ANSWER Tx: *Mild to Moderate Dehydration*
Type II Diabetes - ANSWER This type of diabetes is associated with metabolic
disturbances that result in insulin resistance. Can be caused by PKU.
• polyuria
• polydipsia
• polyphagia
• weight loss
• headaches
• dehydration - ANSWER S/S: *Diabetes*
*Initial Signs:*
• Headache
• Irritability
• Restlessness
*Other Signs:*
**• Pulse and respiratory rate decrease**
• Blood pressure increases
**• LOC decreases**
• Increased Temperature
• Dilated pupils - ANSWER S/S: *Increased Intracranial Pressure (ICP)*
· draw up the short-acting insulin into the syringe first. - ANSWER How do you correctly
draw up insulin?
The rectal is avoided to prevent injury - ANSWER When a baby has acute lymphocytic
leukemia (ALL) why does the nurse take axillary, rather than rectal temperatures?
• private room
• limit crowd exposure
• hand hygiene
• daily bathing
• inspect mouth for bleeding or infections
• take daily temperature in the axillary (NOT rectum) - ANSWER Nursing Care: *Patient
with Neutropenia*
• Limitation on weight bearing
• Bed rest
• Immobilization
Correct 100%
• crackles
• harsh cough
• elevated temperature
• thick secretions - ANSWER What is an expected assessment finding for bacterial
pneumonia?
▪ remain with the patient for the first 15 minutes of the infusion - ANSWER Safe practice
in administration of blood products
• "Strawberry" tongue
• edema of hands and feet
• conjunctivitis without exudate - ANSWER S/S: *Kawasaki disease (KD)*
• cool-mist humidity
• steamy shower - ANSWER Home Treatment: *Bronchiolitis*
• rheumatic fever
• glomerulonephritis (antibiotics decrease occurrence) - ANSWER Pharyngitis causes
increased risk of developing____________ ________?
▪ Monitor for s/s of bleeding (clearing throat)
▪ Give clear, cool liquid or ice chips
▪ No red, citrus/acidic, carbonated or milk products
▪ Clear fluids are best
▪ No straws, forks
▪ Position for drainage - ANSWER Nursing Care: *Post Tonsillectomy*
▪ inflammation of the pulmonary alveoli
▪ fever, cough, fine crackles
▪ viral - supportive care
▪ bacterial - antibiotics and supportive care - ANSWER S/S: *Pneumonia*
upright - ANSWER Epiglottitis position
echocardiogram - ANSWER Noninvasive diagnostic testing for the heart to see its
structure and function. Should be ordered first to evaluate a murmur.
**• Non-weight bearing**
• Activity limitations
• Cast education - ANSWER Patient Education: Legg-Calve-Perthes Disease
,Legg-Calve-Perthes Disease - ANSWER • This is an avascular necrosis (lack of blood
resulting in destruction) of the proximal femoral epiphysis
• Child normally look well but may have a limp, guarding of hip while moving it
• Less than 6 - NSAIDs and containment device to keep head of femur in place
• Older than 6 - reconstructive surgery followed by cast application - ANSWER
Treatment: *Legg-Calve-Perthes Disease*
▪ Machine like murmur heard at the *left sub clavicular margin*
▪ They may be asymptomatic or show signs of HF
▪ A widened pulse pressure and bounding pulses may be present - ANSWER
Symptoms: *Patent Ductus Arteriosus*
▪ Indomethacin, a prostaglandin inhibitor
▪ Closed during cardiac catherization or surgical management - ANSWER Treatment:
*Patent Ductus Arteriosus*
patent ductus arteriosus - ANSWER a failure of the fetal ductus arteriosus to close
within the first weeks of life
▪ BP higher in the upper extremities than in the lower extremities
▪ Signs of HF may occur in infants
▪ Bounding pulses in the arms and weak or absent femoral pulses and cool extremities
may be present
**be sure to assess the femoral and radial pulses simultaneously** - ANSWER S/S:
*Coarctation of the Aorta*
▪ balloon angioplasty
▪ surgical repair - ANSWER Treatment: *Coarctation of the Aorta*
coarctation of the aorta - ANSWER a localized narrowing near the insertion of the
ductus arteriosus
Place in a knee-chest position - ANSWER If your patient has Tetralogy of Fallot and
they become cyanotic and dyspneic, what is your intervention?
• REST
• HYDRATION
• PAIN CONTROL
• OXYGENATION - ANSWER Nursing Interventions: *Sickle Cell Anemia*
▪ mottling
▪ increased capillary refill time
▪ turgor
, ▪ dry mucous membranes
▪ tachycardia - ANSWER S/S: *Dehydration*
▪ oral rehydration - ANSWER Tx: *Mild to Moderate Dehydration*
Type II Diabetes - ANSWER This type of diabetes is associated with metabolic
disturbances that result in insulin resistance. Can be caused by PKU.
• polyuria
• polydipsia
• polyphagia
• weight loss
• headaches
• dehydration - ANSWER S/S: *Diabetes*
*Initial Signs:*
• Headache
• Irritability
• Restlessness
*Other Signs:*
**• Pulse and respiratory rate decrease**
• Blood pressure increases
**• LOC decreases**
• Increased Temperature
• Dilated pupils - ANSWER S/S: *Increased Intracranial Pressure (ICP)*
· draw up the short-acting insulin into the syringe first. - ANSWER How do you correctly
draw up insulin?
The rectal is avoided to prevent injury - ANSWER When a baby has acute lymphocytic
leukemia (ALL) why does the nurse take axillary, rather than rectal temperatures?
• private room
• limit crowd exposure
• hand hygiene
• daily bathing
• inspect mouth for bleeding or infections
• take daily temperature in the axillary (NOT rectum) - ANSWER Nursing Care: *Patient
with Neutropenia*
• Limitation on weight bearing
• Bed rest
• Immobilization
