PEDS214

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TomWruble
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236247
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PEDS214
Updated:
2013-10-09 08:53:13
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chapters 23 thru 26
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respiratory, cardiac, hematologic/immunologic and gastrointestonal
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  1. What symptoms support the diagnosis of moderate persistent asthma in a child over 5 years of age?

    A) Symptoms two to four times a week
    B) Daily symptoms
    C) Symptoms less than two times a week
    D) Frequent nighttime symptoms
    B) Daily symptoms

    Severe Persistent:
    - continuous throughout day
    - PEF < 60%
    - extremely limited
    Moderate Persistent:
    - daily symptoms
    - PEF 60-80 % for 5 and over
    - some limitation
    Mild Persistent:
    - > 2 times / week but <= 1 per day
    - PEF >=80 %
    - minor limitation
    Intermittent:
    - <= 2 days / week
    - PEF >= 80%
    - no limitation
    (this multiple choice question has been scrambled)
  2. The nurse should anticipate that the first treatment for epiglottitis will be

    A) intubation.
    B) intravenous antibiotics.
    C) cough suppressant.
    D) placement in a croup tent.
    A) intubation.

    The primary management goal of epiglottitis is to stabilize the airway; this can be done by intubation or tracheostomy.

    Intravenous antibiotics are usually administered after the child's airway is stabilized.

    Starting an intravenous line causes pain, which can further compromise the child's airway.

    A cough is not a common symptom of epiglottitis; the child should not be asked to swallow any medication until his airway is stabilized.

    The child should be allowed to remain in the position that provides the most comfort and security, usually a sitting position held by the parents.

    Humidity is not an intervention in the treatment of acute epiglottitis.
    (this multiple choice question has been scrambled)
  3. What is the most prevalent etiologic agent causing bronchiolitis in young infants?
    Respiratory syncytial virus (RSV) is responsible for at least 50% of children admitted for bronchiolitis.
  4. How is the diagnosis of RSV established?
    For respiratory syncytial virus the enzyme-linked immunosorbent assay (ELISA) of nasal secretions. Either the rapid immunofluorescent antibody (IFA) or the ELISA technique for RSV detection can be used. These techniques are rapid and have sensitivities and specificities of about 90%.
  5. Repeated episodes of bronchiolitis not associated with RSV in young children require follow-up testing for which disorders?
    Asthma and cystic fibrosis.

    Because of the nature of asthma and cystic fibrosis, the airways are more reactive and/or mucus production is increased, causing a perfect medium for bacterial growth. Children with asthma and cystic fibrosis are more likely to display repeated symptoms of bronchiolitis before the diagnosis of a chronic disorder.
  6. What type of isolation measures are indicated for health personnel treating pt with RSV (respiratory syncytial virus)?
    Good hand-washing; gown and glove to prevent cross contamination.

    RSV is highly virulent, and health care personnel should take precautions to avoid spreading the virus to uninfected hospital personnel, visitors, and patients in the hospital.
  7. Discuss the guidelines for use of ribavirin aerosol therapy.
    For hospitalized children with bronchiolitis (caused by RSV): Use for infants at high risk because of other abnormalities, especially chronic lung disorders and immunodeficiency; infants less than 6 months old; and severely ill infants.

    Special precautions such as mask and goggles are required for caregivers; no pregnant personnel should be involved because of teratogenicity (birth defects).

    Because of the potential toxic effects of the drug to health care workers and the unclear evidence of the drug’s benefit, the American Academy of Pediatrics recommends the preceding criteria for use of ribavirin.

    It can also be used for persistent hepatitis C infection.
  8. What genotype would Mr. and Mrs. Bradley need to be if their son, David, is diagnosed with CF?
    Each would need to carry the recessive gene for CF.

    CF is inherited as an autosomal recessive gene; the child must inherit the defective gene from both parents
  9. If Mr. and Mrs. Bradley ask about fertility therapy contributing to their son’s illness (CF), the most appropriate response is
    Fertility therapy has no relationship with CF, which is an inborn error of metabolism affecting the exocrine glands.

    The CF gene has been discovered on the long arm of chromosome 7 and is a genetic mutation not attributed to external factors
  10. What SaO2 values can be expected via pulse oximetry for a patient with CO poisoning?
    It will be normal because a pulse ox device only measure oxygenated and deoxygenated hemoglobin. It does not measure dysfunctional hemoglobin such as COHb, where CO has a 230 times greater affinity for hemoglobin compared to O2.
  11. Discuss the effects of increased viscosity of mucous gland secretions from CF on the following:

    A) Bronchi
    B) Small intestine
    C) Pancreatic ducts
    D) Bile ducts
    • A) Chronic pneumonia and emphysema
    • B) Meconium ileus
    • C) Malabsorption syndrome
    • D) Portal hypertension
  12. Lisa’s father calls the clinic and tells the nurse that Lisa, who has CF, “seems very sick.” Lisa's father describes her symptoms as “breathing very fast, fast heart rate, short of breath, pale, and color is bluish. The nurse recognizes these symptoms as

    A) possible pneumothorax.
    B) possible bronchospasms.
    C) terminal stage of the disease.
    D) normal progression of the disease
    A) possible pneumothorax.

    A) Pneumothorax, air in the pleural space, is often caused by rupture of subpleural blebs through the visceral pleura and usually causes nonspecific symptoms, which include tachypnea, tachycardia, dyspnea, pallor, and cyanosis.
    B) Symptoms of bronchospasm usually include dyspnea, wheezing, and pallor. Bronchospasm is not a common threat to the child with CF.
    C) Although pneumothorax occurs in patients with more advanced CF, these symptoms do not indicate a terminal stage of the disease.
    D) It is estimated that only 5% to 8% of all CF patients will eventually have a pneumothorax; therefore, this is not a necessary progression of the disease.
    (this multiple choice question has been scrambled)
  13. When discussing nutrition with Lisa and her family, the nurse recommends continued supplementation of vitamins A, D, E, and K. This is important because

    A) uptake of fat-soluble vitamins is decreased in CF.
    B) pancreatic enzymes are administered with meals.
    C) children with CF cannot receive a well-balanced diet.
    D) excretion of water-soluble vitamins is increased in CF.
    A) uptake of fat-soluble vitamins is decreased in CF.

    - The administration of pancreatic enzymes with meals and snacks is the principle treatment for pancreatic insufficiency and not related to the need for vitamin supplementation.
    - Children with CF require a well-balanced, high-protein, high-calorie diet.
    - The uptake of fat-soluble vitamins is decreased because of pancreatic insufficiency.
    - Vitamins A, D, E, and K are fat-soluble vitamins
    (this multiple choice question has been scrambled)
  14. Jennifer Drew, a 20-year-old junior in college, is seen in the college clinic with complaints of a sore throat, muscle soreness, and general malaise for the past 3 days. Jennifer’s temperature is 38.3° C (101° F). The health care provider makes a tentative diagnosis of infectious mononucleosis. On assessment, the nurse should expect to find

    A) a white-coated tongue.
    B) abdominal distention.
    C) a pruritic rash on the chest and extremities.
    D) cervical lymphadenopathy.
    D) cervical lymphadenopathy.

    A) A macular eruption prominent over the trunk is found in only a few cases.
    B) The tonsils, rather than the tongue, may be covered with a diphtheria-like membrane.
    C) The characteristic symptoms of the disease include malaise, sore throat, and fever with generalized lymphadenopathy and splenomegaly that may persist for several months.
    D) Some children have abdominal pain; abdominal distention is not common.
    (this multiple choice question has been scrambled)
  15. Ms. Drew is admitted to the hospital to prevent the spread of mononucleosis. Which precaution should be implemented?

    A) Enteric isolation
    B) Good hand-washing techniques only
    C) Respiratory isolation
    D) Strict isolation
    B) Good hand-washing techniques only

    The mechanism of spread has not been proved, although it is believed to be transmitted by direct intimate contact with oral secretions. Therefore, respiratory, enteric, and strict isolation would not be necessary.
    (this multiple choice question has been scrambled)
  16. Which would you expect the health care provider to order for the diagnosis of mononucleosis?

    A) Anemia and thrombocytopenia
    B) Bacterial blood culture
    C) A Mono spot urine test
    D) Heterophil agglutination test
    D) Heterophil agglutination test

    A) Blood is usually obtained for the spot test (Monospot) by finger puncture.
    B) The heterophil antibody test determines the extent to which the patient’s serum will agglutinate sheep red blood cells and is the most effective diagnostic test during the earlier stages of illness and in older children.
    C) The causative agent is the Epstein-Barr virus, which would not be detected by a bacterial blood culture.
    D) Anemia and thrombocytopenia are considered complications of the illness, rather than laboratory values used in diagnosing mononucleosis.
    (this multiple choice question has been scrambled)
  17. Ms. Drew is ready for discharge (after being treated for mononucleosis) and inquires about her activity level. The most appropriate response is

    A) only sedentary activities are permitted.
    B) strict bed rest is necessary to prevent a relapse.
    C) activity restrictions are not necessary, but crowds should be avoided.
    D) additional rest periods are necessary, and very strenuous activities should be avoided.
    D) additional rest periods are necessary, and very strenuous activities should be avoided.

    A) Bed rest is encouraged for fatigue but is not imposed for any specified time.
    B) Patients with mononucleosis should regulate their activities to their own tolerance unless complications, such as splenomegaly, are present.
    C) Additional rest periods are encouraged because of fatigue caused by the illness. Very strenuous activities are avoided to prevent secondary complications and fatigue.
    D) Crowds should be avoided to prevent a secondary infection, especially during the acute phase of the illness. Very strenuous activities, however, should also be avoided to prevent complications and fatigue.
    (this multiple choice question has been scrambled)
  18. Tommy is 5 years old and is hospitalized for a tonsillectomy and adenoidectomy. In talking with Tommy, you would expect him to complain of

    A) generalized weakness.
    B) chills.
    C) difficulty breathing.
    D) enuresis
    C) difficulty breathing.

    A) The manifestations of tonsillitis are chiefly caused by inflammation and do not typically include generalized weakness.
    B) As the palatine tonsils enlarge from edema, they may meet in the midline, obstructing the passage of air or food.
    C) Difficulty swallowing or breathing, a result of inflammation of the palatine tonsils, is the most common symptom of tonsillitis; chills are not a usual complaint.
    D) The manifestations of tonsillitis are chiefly caused by inflammation of the palatine tonsils, which does not influence the child's ability to void.
    (this multiple choice question has been scrambled)
  19. Tommy is 5 years old and is hospitalized for a tonsillectomy and adenoidectomy. Which should alert the nurse to the possibility of postoperative hemorrhage?

    A) Fever of 39.4° C (103° F)
    B) Expectoration of reddish brown saliva
    C) Slow heart rate
    D) Frequent swallowing
    D) Frequent swallowing

    A) Increased bleeding would result in an increased pulse, not a slow heart rate.
    B) Hemorrhage of operative site would result in bright red expectorant, rather than reddish brown, because of the presence of fresh blood.
    C) The most obvious sign of bleeding is the child's continuous swallowing of the trickling blood. This is often noted while the child is sleeping.
    D) An elevated temperature is more commonly a sign of infection, rather than hemorrhage
    (this multiple choice question has been scrambled)
  20. Tommy is 5 years old and is hospitalized for a tonsillectomy and adenoidectomy. In completing a nursing care plan for Tommy, which intervention(s) is/are most appropriate? (Select all that apply.)

    A) Application of an ice collar
    B) Administration of acetaminophen (Tylenol) elixir
    C) Offering cool liquids as tolerated
    D) Suctioning of the posterior pharynx
    A, B, C

    • A) An ice collar may provide relief of pain from the soreness in the throat following surgery (although many children find it bothersome and prefer not to have it).
    • B) Most children experience moderate pain after a tonsillectomy and should receive pain medication for at least the first 24 hours.
    • C) When the child is alert with no signs of hemorrhage, cool water and crushed ice are given, progressing to clear liquids as tolerated (avoiding fluids with a red or brown color to distinguish fresh or old blood in emesis from the ingested liquid).
    • D) Suction equipment should be available in the event that a hemorrhage occurs. However, the posterior pharynx should not be suctioned due to the potential trauma to the operative site.
  21. Acute infection of the respiratory tract is the most common cause of illness in infancy and childhood. Most upper respiratory tract infections in otherwise healthy children are caused by AAA.
    viruses
  22. Influenza is spread from one individual to another by direct contact (large-droplet infection) or by articles recently contaminated by nasopharyngeal secretions. Treatment includes symptomatic management of AAA, as well as ensuring BBB.
    • A) fever, cough, and dry throat
    • B) adequate hydration
  23. AAA and BBB may be used for treatment of influenza but must be initiated within CCC hours of appearance of symptoms.
    • A) Zanamivir
    • B) oseltamivir
    • C) 48
  24. Infectious mononucleosis is an acute, self-limiting infectious disease that is common among young people under 25 years of age. The disease is characterized by an increase in the mononuclear elements of the blood and by symptoms of an infectious process. The characteristics of the disease are malaise, sore throat, and AAA and BBB that may persist for several months. The CCC is the principal cause of infectious mononucleosis. It is believed to be transmitted by direct contact with oral secretions, via blood transfusion, or by transplantation.
    • A) fever with generalized lymphadenopathy
    • B) splenomegaly
    • C) herpes-like Epstein-Barr virus
  25. Treatment for infectious mononucleosis.
    No specific treatment exists for infectious mononucleosis.
  26. Many cases of AAA otitis media are preceded by a BBB respiratory tract infection.
    • A) bacterial
    • B) viral
  27. Treatment for acute otitis media (AOM) is one of the most common reasons for antibiotic use in the ambulatory setting. Concerns about drug-resistant Streptococcus pneumoniae and other drug resistances have led infectious disease authorities to recommend careful and judicious use of antibiotics for treatment of this illness. Current literature indicates that waiting up to AAA for spontaneous resolution is safe and appropriate management of AOM in healthy infants over BBB and children.
    • A) 72 hours
    • B) 6 months
  28. Croup is a general term applied to a symptom complex characterized by hoarseness, a cough described as AAA, varying degrees of BBB, and varying degrees of CCC resulting from swelling or obstruction in the region of the larynx. The primary goals in the care of children with croup are DDD and EEE.
    • A) “barking” or “brassy” (croupy)
    • B) inspiratory stridor
    • C) respiratory distress
    • D) observation for signs of respiratory distress E) relief of laryngeal obstruction
  29. Acute epiglottitis, or acute supraglottitis, is a serious obstructive inflammatory process that occurs predominantly in children AAA of age, but can occur from infancy to adulthood. Three clinical observations that are predictive of epiglottitis are BBB, CCC, and DDD. Emergency airway equipment and trained health care providers should always be readily available for treatment of the child with acute epiglottitis.
    • A) 2 to 5 years
    • B) absence of spontaneous cough
    • C) presence of drooling
    • D) agitation
  30. Bronchiolitis is an acute viral infection with maximum effect at the bronchiolar level. Most cases of bronchiolitis are caused by AAA, which is the most frequent cause of hospitalization in children less than 1 year old. AAA is treated symptomatically with BBB, CCC, DDD, and EEE. An intervention is FFF.
    • A) RSV (respiratory syncytial virus)
    • B) cool humidified oxygen
    • C) adequate fluid intake
    • D) airway maintenance
    • E) medications
    • F) teaching parents how to suction the infant’s nose and mouth to remove excess mucus
  31. The two primary reasons for hospitalization with RSV are AAA and BBB.
    • A) inability to maintain adequate oxygen saturation without supplemental oxygen
    • B) inadequate hydration
  32. The only product available in the United States for AAA of RSV is BBB, a monoclonal antibody, which is CCC.
    • A) prevention
    • B) palivizumab
    • C) given monthly in an intramuscular injection to preterm infants and those with medical conditions that place them at greater risk for mortality as a result of RSV

    ribavirin can be used to treat severe RSV infection, but not w/o controversy and risk to providers.
  33. AAA, an infection of the mucosa of the upper trachea, is a distinct entity with features of both croup and epiglottitis. The disease is more common in children younger than 3 years and may be a serious cause of airway obstruction—severe enough to cause respiratory arrest. The condition requires vigorous management with antipyretics and antibiotics.
    A) Bacterial tracheitis
  34. Pneumonias are classified according to site (AAA, BBB, or CCC) or by etiologic agent (DDD, EEE, or FFF), or are associated with GGG.
    • A) lobar
    • B) bronchial
    • C) interstitial
    • D) viral
    • E) bacterial
    • F) mycoplasmal
    • G) aspiration of foreign material
  35. Treatment of viral pneumonia is AAA, whereas bacterial pneumonia requires BBB, and CCC.
    • A) primarily symptomatic
    • B) aggressive management with antibiotics
    • C) supplemental oxygen
  36. Pertussis, or whooping cough, is an acute respiratory tract infection caused by AAA that occurs primarily in children less than BBB who have CCC.
    • A) Bordetella pertussis
    • B) 4 years old
    • C) not been immunized
  37. Infants less than 6 months of age may not have the typical whooping cough of Pertussis; in this age group, AAA. Older children often manifest the disease with a persistent cough but BBB.
    • A) apnea is a common presenting manifestation
    • B) without the characteristic whoop
  38. Adolescents who have completed a primary vaccine series with DTaP should receive a booster of Tdap at age AAA years to protect from pertussis.
    A) 11 to 12
  39. The source of TB infection in children is usually AAA or BBB.
    • A) an infected member of the household
    • B) any frequent visitor to the household, such as a sitter or domestic worker
  40. Clinical manifestations of pulmonary TB in children are AAA.
    A) extremely variable
  41. Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) occur in children and have been associated with clinical conditions and injuries such as sepsis, trauma, viral pneumonia, fat emboli, drug overdose, reperfusion injury after lung transplantation, smoke inhalation, and near-drowning. Both conditions are characterized by respiratory distress and hypoxemia that occur within AAA of a serious injury or surgery in a person with previously normal lungs. Acute pulmonary inflammation with alveolar capillary membrane destruction results in significant hypoxemia; mechanical ventilation is often required.
    A) 72 hours
  42. General therapeutic management of asthma includes AAA, BBB, CCC, DDD and sometimes EEE.
    • A) assessment of asthma severity
    • B) allergen control
    • C) drug therapy
    • D) symptom management
    • E) hyposensitization
  43. Effects of CF on the gastrointestinal system include AAA, BBB, and CCC.
    • A) vitamin and nutrient malabsorption
    • B) growth failure
    • C) cystic fibrosis-related diabetes (CFRD)
  44. Management of pulmonary problems caused by cystic fibrosis is directed toward AAA, BBB, bad CCC.
    • A) prevention and treatment of pulmonary infection by improving ventilation
    • B) removing mucopurulent secretions
    • C) administering antimicrobial agents
  45. The principal treatment for pancreatic insufficiency with CF is AAA. Water-miscible forms of vitamins BBB are given, along with multi vitamins. Children with CF require a well-balanced, high-protein, high-caloric diet, with CCC.
    • A) replacement of pancreatic enzymes, which are administered with meals and snacks to ensure that digestive enzymes are mixed with food in the duodenum
    • B) A, D, E, and K
    • C) unrestricted fat (because of the impaired intestinal absorption)
  46. The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect?
    A) Suffocation
    B) Infantile apnea
    C) Child abuse
    D) Sudden infant death syndrome (SIDS)
    D) Sudden infant death syndrome (SIDS)

    Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death.
    (this multiple choice question has been scrambled)
  47. The most appropriate time to perform bronchial postural drainage is

    A) thirty minutes after meals and at bedtime
    B) immediately on arising and at bedtime.
    C) immediately before all aerosol therapy.
    D) before meals and at bedtime.
    D) before meals and at bedtime.

    The most effective time for bronchial drainage is before meals and before bedtime to prevent the interaction of excessive amounts of mucus and food intake, thereby increasing the risk of vomiting. Bronchial drainage is more effective after other respiratory therapies such as bronchodilator or nebulizer treatments. These treatments open the airways, facilitating the movement of mucus with the positioning of bronchial drainage. Bronchial drainage should be done three or four times each day to be effective. When bronchial drainage is completed after meals, it may cause the child to vomit.
    (this multiple choice question has been scrambled)
  48. A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it

    A) soothes inflamed mucous membrane.
    B) improves oxygenation.
    C) promotes ventilation.
    D) liquefies secretions.
    A) soothes inflamed mucous membrane.

    Humidified inspired air soothes the membranes inflamed by the infection and dry air. The size of the droplets in humidified air is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation.
    (this multiple choice question has been scrambled)
  49. It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent

    A) acute rheumatic fever.
    B) diabetes insipidus.
    C) nephrotic syndrome.
    D) otitis media.
    A) acute rheumatic fever.

    Children with group A β-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome.
    (this multiple choice question has been scrambled)
  50. The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child’s temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend

    A) trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement.
    B) bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.
    C) controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight.
    D) trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.
    D) trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.

    Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will assist in opening up the child's airways. The child does not have a temperature and, therefore, does not need management with acetaminophen. Cough suppressants are not indicated by symptom, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.
    (this multiple choice question has been scrambled)
  51. Palivizumab is a monoclonal antibody specifically used in the prevention of AAA. Monthly administration is expected to prevent infection with AAA.
    A) RSV (respiratory syncytial virus)

    ribavirin can be used to treat severe RSV infection, but not w/o controversy and risk to providers.
  52. AAA is a monoclonal antibody specifically used in the prevention of RSV. Monthly administration is expected to prevent infection with RSV.
    A) Palivizumab

    ribavirin can be used to treat severe RSV infection, but not w/o controversy and risk to providers.
  53. Children with cystic fibrosis have thick AAA gland secretions
    A) exocrine
  54. The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of

    A) carbon dioxide retention.
    B) increased viscosity of sputum.
    C) bronchodilation.
    D) pneumothorax.
    D) pneumothorax.

    signs of increasing respiratory distress: tachypnea, tachycardia, dyspnea, pallor, and cyanosis
    (this multiple choice question has been scrambled)
  55. A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.)

    A) Vital signs
    B) Throat culture
    C) Medical history
    D) Assessment of breath sounds
    E) Emergency airway equipment readily available
    All but B.

    Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted.
  56. Infants are subject to fluid depletion because of their AAA, BBB, and CCC.
    • A) greater body surface area relative to body mass
    • B) high rate of metabolism
    • C) immature kidney function
  57. The primary treatment of diarrhea is the use of?
    oral rehydrating solutions (ORS), e.g. pedialyte
  58. AAA (also known as congenital aganglionic megacolon) is a mechanical obstruction caused by inadequate motility of part of the intestine. AAA disease requires BBB.
    • A) Hirschsprung disease
    • B) surgical removal of aganglionic segments of bowel
  59. AAA and BBB are congenital abdominal wall defects in which the bowel is exterior to the abdominal cavity; BBB protrudes through the umbilical cord and bowel is covered by viscera, whereas AAA protrudes to the right of the umbilical cord and the bowel is not covered by viscera.
    • A) Gastroschisis
    • B) omphalocele
  60. AAA is one of the most common causes of intestinal obstruction during infancy and is characterized by abdominal pain and blood in stools. The condition occurs when BBB, pulling the mesentery with it. Treatment is either nonsurgical hydrostatic reduction or surgical reduction.
    • A) Intussusception
    • B) one segment of the bowel telescopes into another segment
  61. AAA is characterized by an intolerance to gluten. It is thought to be either an inborn error of metabolism or an immunologic response. Symptoms of AAA appear when solid foods such as beans and pasta are introduced in the child’s diet between the ages of 1 and 5 years. Treatment of AAA consists primarily of dietary management.
    A) Celiac disease
  62. Gastroesophageal reflux (GER) is defined as the transfer of gastric contents into the esophagus. This phenomenon is physiologic, occurring throughout the day, most frequently after meals and at night; therefore it is important to differentiate GER from gastroesophageal reflux disease (GERD). AAA represents symptoms or tissue damage that result from BBB.
    • A) GERD
    • B) GER
  63. Inflammatory bowel disease refers to ulcerative colitis (UC) and Crohn disease(CD). Chronic diarrhea is the most common feature. In addition to GI symptoms, both CD and UC are characterized by extraintestinal and systemic inflammatory responses. The inflammation found with UC is limited to ...
    the colon and rectum, with the distal colon and rectum the most severely affected
  64. Crohn's disease, which has a AAA, is a type of inflammatory bowel disease that may affect ,
    • A) genetic association
    • B) any part of the gastrointestinal tract from mouth to anus
  65. One might wonder if peptic ulcers would be diagnosed as Crohn's disease (which can affect any part of the gastrointestinal tract from mouth to anus) if it were not for the presence of AAA.
    A) Helicobacter pylori
  66. Viral hepatitis is caused by six types of virus: hepatitis virus...
    A, B, C, D, E, and G
  67. Hepatitis A virus is spread by the AAA, whereas hepatitis B and C viruses are transmitted primarily by BBB.
    • A) fecal-oral route
    • B) the parenteral route
  68. Surgical correction of the AAA usually occurs within the first few months of life, and postoperative care centers on protection of the suture line. BBB surgical closure is typically performed at CCC before DDD.
    • A) CL (cleft lip)
    • B) CP (cleft palate)
    • C) 9 to 15 months
    • D) the child develops compensatory speech patterns

    Note, though CL is usually repaired in the "first few months of life", surgical repair of cleft lip can be done during the first week of life when the infant is free of any oral, respiratory, or systemic infection.

    Note 2: In case studies it says: "Usually between 12 and 18 months of age" for CP repair to "take advantage of palatal changes that occur with normal growth."
  69. Congenital esophageal atresia (EA) and BBB are rare malformations that represent AAA and a failure of the trachea and esophagus to separate into distinct structures.
    • A) a failure of the esophagus to develop as a continuous passage
    • B) tracheoesophageal fistula (TEF)
  70. The following grouping of birth defects can occur together more often than simply by chance:
    • VACTERL association:
    • V - Vertebral anomalies
    • A - Anal atresia
    • C - Cardiovascular anomalies
    • TE - Tracheoesophageal fistula
    • R - Renal (Kidney) and/or radial anomalies
    • L - Limb defects
  71. T/F: Oral rehydration solutions can be given in addition to breastfeeding to replace ongoing losses.
    True
  72. T/F: Mother asks about giving the children antidiarrheal medications. Based on the nurse’s knowledge of these medications, the appropriate response is that they are recommended for children over age 6 months.
    False: Antidiarrheal agents are not indicated in acute infectious diarrhea in infants and young children because of the toxicity and adverse effects that may occur, such as worsening of the diarrhea because of slowing of motility and ileus or a decrease in diarrhea, with continuing fluid losses and dehydration.
  73. T/F: The mother asks about giving Brian, age 4 years, food after he is rehydrated. Which is the most appropriate recommendation?

    Give clear liquids for the next 24 hours.
    False: Early reintroduction of a regular diet is an important aspect of treatment of acute diarrhea in children to prevent malnutrition.
  74. Maria is a 10-year-old girl who is brought to the emergency department by her parents because of generalized abdominal pain. She has had slight diarrhea for the past few hours. Her temperature is 37.5° C (99.5° F). Bowel sounds are present. The diagnosis is a possible appendicitis. Several diagnostic tests are ordered. The most appropriate nursing intervention in the preoperative period is:

    A) Perform deep abdominal palpation to assess level of pain.
    B) Apply moist heat to abdomen to relieve pain.
    C) Ensure that diagnostic tests are administered as soon as possible to prevent delay in treatment.
    D) Administer an enema to ensure total bowel evacuation preoperatively.
    C) Ensure that diagnostic tests are administered as soon as possible to prevent delay in treatment.

    The pain related to appendicitis is severe and should be treated by allowing the child to maintain a comfortable position, using a pillow to splint the abdomen, and administering analgesics.

    Laxatives or enemas should not be administered preoperatively. Such measures stimulate bowel motility and increase the risk of perforation.

    Deep abdominal palpation is not necessary to elicit pain and causes excessive trauma to the child with appendicitis.

    Successful treatment of appendicitis is based on prompt recognition of the disorder; the primary nursing objective is to assist in establishing a diagnosis.
    (this multiple choice question has been scrambled)
  75. Which clinical manifestations should lead the nurse to suspect that Maria’s appendix has ruptured?

    A) Fever
    B) Localized pain
    C) Increasing anorexia
    D) Sudden relief from pain
    D) Sudden relief from pain

    A low-grade fever is present in appendicitis; only when the fever becomes greater than 39° C (102.2° F) is a perforation suspected.

    Localized pain is present in appendicitis and is briefly relieved when the appendix becomes ruptured.

    Anorexia is present in appendicitis and is not a symptom of peritonitis caused by a ruptured appendix.

    The sudden relief of pain occurs after rupture of the appendix. This symptom is brief, followed by an increase in pain that is diffuse and accompanied by rigid guarding of the abdomen because of peritonitis.
    (this multiple choice question has been scrambled)
  76. Maria has an appendectomy. The nurse anticipates that she will remain on low intermittent gastric decompression until

    A) nausea subsides.
    B) pain decreases.
    C) bowel motility returns.
    D) infection resolves.
    C) bowel motility returns.

    Pain resulting from an appendectomy is treated by around-the-clock analgesics, not low intermittent gastric decompression. Therefore, a decrease in pain is not related to the goal of gastric decompression.

    Gastric decompression is an intervention that helps prevent nausea; however, nausea will recur if the suction is stopped before gastric motility returns.

    Gastric decompression is not an intervention related to the prevention or treatment of infection. Therefore, a resolved infection is not an indication that the goal of gastric decompression has been achieved.

    Gastric decompression evacuates excess stomach contents, which prevents abdominal distention, nausea, and vomiting until bowel motility returns.
    (this multiple choice question has been scrambled)
  77. Protection of the suture line for cleft lip repair is provided by what means?
    Nursing care during the postoperative period is directed toward protecting the operative site. The Logan bow, a lip protective device that prevents trauma to the suture lines, is taped securely to the cheeks. Arm restraints are applied immediately after surgery to prevent the infant from rubbing the suture line.
  78. An early clinical sign of dehydration is usually

    A) hypotension.
    B) capillary refill time over 3 seconds.
    C) tachycardia.
    D) increased urinary output.
    C) tachycardia.

    Hypotension is a late sign of dehydration that occurs when fluid losses exceed the body’s ability to sustain blood volume and blood pressure.

    Urinary output is decreased as a compensatory mechanism causes decreased blood flow through the kidneys; this is not an early sign of dehydration.

    Capillary refill time over 3 seconds indicates a seriously compromised circulatory system and is an indication of severe dehydration.

    The earliest detectable sign of dehydration is usually tachycardia, the body’s attempt to increase cardiac output because of the low blood volume.
    (this multiple choice question has been scrambled)
  79. Which type of dehydration is Nancy experiencing (from bacterial induced diarrhea)?

    A) Hypotonic
    B) Hypertonic
    C) Isotonic
    B) Hypertonic

    Hypertonic dehydration results from excess water loss, like when a child experiences diarrhea.
    (this multiple choice question has been scrambled)
  80. Some of the most dreaded potential outcomes of hypertonic dehydration are related to

    A) neurologic disturbances.
    B) parenteral therapy complications.
    C) hypovolemic shock.
    D) impaired kidney function.
    A) neurologic disturbances.

    Shock is more likely to occur in hypotonic or isotonic dehydration rather than hypertonic dehydration.

    Cerebral changes in hypertonic dehydration are serious and may result in permanent damage and are therefore the most dreaded potential outcomes.

    Renal compensation is impaired by reduced blood flow through the kidneys, which occurs in any form of dehydration.

    Parenteral therapy complications, such as too rapid initial fluid replacement, can result in cerebral edema in hypertonic dehydration. This, therefore, can be the cause of the dreaded outcome rather than the outcome itself.
    (this multiple choice question has been scrambled)
  81. Nancy’s dehydration increases and she is hospitalized with parenteral fluid therapy. Which replacement is not added until kidney function is reestablished?

    A) Potassium
    B) Sodium chloride
    C) Sodium bicarbonate
    D) Magnesium
    A) Potassium

    Magnesium is usually decreased with prolonged vomiting or diarrhea and therefore the risk of excess magnesium is low.

    Sodium chloride 0.9% is the initial replacement fluid of choice in the management of dehydration.

    Sodium bicarbonate can be added to replacement fluid because acidosis is usually associated with dehydration.

    Potassium is not administered until kidney functions are appropriate because of the risk of hyperkalemia, which causes cardiac arrhythmias, respiratory failure, mental confusion, and numbness of extremities.
    (this multiple choice question has been scrambled)
  82. Identify four clinical indicators of mild dehydration
    • Weight loss— infants = 5%
    • Weight loss— children = 3%-4%
    • Pulse = Normal
    • Blood pressure = Normal
    • Behavior = Normal
    • Thirst = Slight
    • Mucous membranes = Normal
    • Tears = Present
    • Anterior fontanel = Normal
    • External jugular vein = Visible when supine
    • Skin (less useful in children >2 years) = Capillary refill >2 seconds
    • Urine specific gravity = >1.020
  83. Adam, a usually healthy 2-month-old infant, was brought to the pediatricians office by his mother for excessive vomiting for 2 days. On examination, you note that he is irritable and has not gained any weight since his last checkup. His mother states that he "throws up after every feeding." What should the nurse assess first?

    A) Mucous membranes
    B) Bowel sounds
    C) Breath sounds
    D) Vital signs
    A) Mucous membranes

    Assessing mucous membranes will help determine whether Adam is dehydrated. Discussing his urinary output with his mother, assessing skin turgor, or assessing fontanels can also help determine hydration status.

    Bowel sounds should be assessed, but the patients hydration status is of higher importance.

    The illness and symptoms are not related to Adams respiratory status, so assessing breath sounds would not be your first action.

    Assessing Adams vital signs can help determine whether he is severely dehydrated. However, low blood pressure and increased heart rate are late signs of dehydration.
    (this multiple choice question has been scrambled)
  84. Adam, a usually healthy 2-month-old infant, was brought to the pediatricians office by his mother for excessive vomiting for 2 days. On examination, you note that he is irritable and has not gained any weight since his last checkup. His mother states that he "throws up after every feeding." What are three probable diagnoses for Adams condition?
    Pyloric stenosis— characterized by recurrent projectile vomiting after feeds. It is predominantly seen in male infants.

    Gastroesophageal reflux (GERD)—characterized by recurrent regurgitation that begins in the first few weeks of life and peaks at about 4 months of age.

    Increased intracranial pressure —irritability and vomiting are hallmark signs of increased intracranial pressure caused by trauma, such as falling or being dropped.
  85. In discussing treatment of GERD, which is the most appropriate, immediate intervention to discuss with Adams mother? (Select all that apply.)

    A) Thicken feedings with rice cereal.
    B) Do not feed more frequently than every 3 hours.
    C) Avoid placing the child supine after feedings.
    D) Use medications to control Adams symptoms.
    A, B, and C

    Thickening feedings and using a cross-cut nipple are indicated to decrease GERD symptoms.

    Feedings should be spaced at least every 3 hours so proper digestion can occur between feedings. This lessens the possibility of regurgitation.

    The infant should be held or positioned as upright as possible or on his side after feedings to prevent aspiration.

    Pharmacologic intervention should be used only after more conservative therapy has failed. These medications will be used to suppress acid production and improve gastric motility.
  86. Sandy, a 15-year-old girl, is brought to the health care providers office with complaints of anorexia, malaise, fever, and right upper quadrant pain. Sandy’s sclera is slightly jaundiced. A diagnosis of hepatitis is suspected. What information would be important to gather in taking the history of this patient?
    Any family member known to have hepatitis; any evidence of unsafe sanitation practices, including drinking contaminated water; eating certain foods like clams or oysters (could be from polluted waters); ingestion of hepatotoxic drugs, such as salicylates, sulfonamides, chemotherapy, acetaminophen; use of illicit intravenous drugs or sexual contact with a person who uses these drugs.
  87. Hepatitis, an acute or chronic inflammation of the liver, is caused by hepatitis viruses in 90% of the cases. Match the following characteristics of hepatitis to the three most common types of hepatitis (which are?).

    ____ Incubation period of 45 to 160 days
    ____ Principal mode of transmission is by infected fecal material.
    ____ Incubation period averages 6 to 7 weeks.
    ____ Can be transmitted perinatally
    ____ Commonly occurs with symptoms of nausea and vomiting
    ____ Incubation period of 15 to 50 days ____ Rash commonly present
    ____ Does not cause chronic infection
    ____ Children often have diarrhea.
    ____ Commonly associated with children and adolescents involved with IV drug use
    • B____ Incubation period of 45 to 160 days
    • A____ Principal mode of transmission is by infected fecal material
    • C____ Incubation period averages 6 to 7 weeks
    • B____ Can be transmitted perinatally
    • A____ Commonly occurs with symptoms of nausea and vomiting
    • A____ Incubation period of 15 to 50 days
    • B____ Rash commonly present
    • A____ Does not cause chronic infection
    • A____ Children often have diarrhea
    • B____ Commonly associated with children and adolescents involved with IV drug use
  88. Hepatitis by category:
    • A____ Incubation period of 15 to 50 days; avg 25-30
    • B____ Incubation period of 30 to 180 days; avg 50
    • C____ Incubation period averages 14 to 180 days; avg 42-49 days

    • A____ Principal mode of transmission is by infected fecal material
    • B____ Can be transmitted perinatally
    • C____ Can be transmitted perinatally
    • A____ Commonly occurs with symptoms of nausea and vomiting
    • B____ Rash commonly present
    • A____ Does not cause chronic infection
    • B____ Commonly associated with children and adolescents involved with IV drug use
  89. What clinical manifestations would the nurse expect to find in a newborn who has developed necrotizing enterocolitis (NEC)?

    A) Gastric residual and melena
    B) The passage of ribbon-like stools
    C) Hyperthermia
    D) Projectile vomiting
    A) Gastric residual and melena

    The most prominent signs of NEC are abdominal distention, gastric residuals, and blood in the stools (melena). NEC resembles septicemia; the newborn may "not look well," in addition to having nonspecific signs such as lethargy, poor feeding, hypotension, hypothermia, bile-stained vomitus, and oliguria.

    The newborn with NEC is more likely to be seen with hypothermia, not hyperthermia.

    The passage of ribbon-like stools is seen in newborns and infants born with Hirschsprung disease.

    Projectile vomiting is seen in newborns and infants with pyloric stenosis
    (this multiple choice question has been scrambled)
  90. The care of a newborn with a cleft lip and palate before surgical repair includes

    A) little to no sucking.
    B) gastrostomy feedings.
    C) providing nonnutritive and nutritive sucking.
    D) positioning infant in near-horizontal for feeding.
    C) providing nonnutritive and nutritive sucking.

    Infants need nutritive and nonnutritive sucking.

    Nutritive and nonnutritive sucking is important to the infant.

    Gastrostomy feedings are not usually required or indicated.

    The appropriate positioning for the infant is the upright position.
    (this multiple choice question has been scrambled)
  91. T/F: Activated charcoal is a course of treatment for a 4-year-old child who has ingested a toxic dose of iron.
    False: Activated charcoal does not bind iron and, therefore, is not a course of treatment for this child.

    The child should be transported to the hospital immediately for assessment and possible gastric lavage.

    The period of concern for complications of iron toxicity is from 30 minutes to 6 hours.
  92. Which statement best describes Hirschsprung disease?

    A) There is a passage of excessive amounts of meconium in the neonate.
    B) It results in excessive peristaltic movements within the gastrointestinal tract.
    C) It results in frequent evacuation of solids, liquids, and gas.
    D) The colon has an aganglionic segment.
    D) The colon has an aganglionic segment.
    (this multiple choice question has been scrambled)
  93. T/F: Hirschsprung disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine as a result of the lack of ganglionic cells; therefore, it is referred to as aganglionic megacolon.
    True
  94. T/F: The infant or child with Hirschsprung disease will be seen with constipation or the passage of ribbon-like stools.
    True
  95. A child has a nasogastric (NG) tube after surgery for acute appendicitis. What is the purpose of the NG tube?

    A) Prevent the spread of infection
    B) Prevent abdominal distention
    C) Maintain an accurate record of output
    D) Maintain electrolyte balance
    B) Prevent abdominal distention

    The NG tube is used to maintain gastric decompression until intestinal activity returns.

    The NG tube may adversely affect electrolyte balance by removing stomach secretions.NG drainage is one part of the child's output.

    The nurse would need to incorporate the NG drainage with other output.

    There is no relationship between the NG tube and prevention of the spread of infection.
    (this multiple choice question has been scrambled)
  96. Dietary management of a child with inflammatory bowel disease (IBD) should include

    A) low calorie.
    B) vitamin supplements.
    C) low protein.
    D) high fiber.
    B) vitamin supplements.

    As well as iron and folic acid supplementation
    (this multiple choice question has been scrambled)
  97. T/F: A high-fiber diet is recommended for IBD. Even small amounts of bran have been associated with an improvement of the child's condition.
    False
  98. Management of the child with a peptic ulcer often includes

    A) coping with stress and adjusting to chronic illness.
    B) proton pump inhibitors.
    C) milk at frequent intervals.
    D) antacids 1 and 3 hours before meals and at bedtime.
    B) proton pump inhibitors.

    Proton pump inhibitors block the production of acid. They are well tolerated and have infrequent side effects.

    Milk is not beneficial in the management of peptic ulcer disease.

    Proton pump inhibitors are more effective than antacids.

    Coping with stress is beneficial, but peptic ulcer disease is treatable.
    (this multiple choice question has been scrambled)
  99. T/F: Hepatitis A is a contagious disease, transmitted through the fecal-oral route. The nurse should teach infection control measures to family members.
    True
  100. What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia?

    A) The prognosis for full recovery is excellent.
    B) Liver transplantation may be needed eventually.
    C) Death usually occurs by 6 months of age.
    D) Children with surgical correction live normal lives.
    B) Liver transplantation may be needed eventually.

    Approximately 80% to 90% of children with biliary atresia will require liver transplantation.

    If the condition is untreated, death will usually occur by 2 years of age. Long-term survival is possible with surgical intervention.

    Liver transplantation is usually required for long-term survival.

    Even with surgical intervention, most children progress to liver failure and require transplantation.
    (this multiple choice question has been scrambled)
  101. T/F: Excessive salivation and drooling are indicative of tracheoesophageal fistulas. With a fistula, the child has difficulty managing the secretions, resulting in an excessive amount of frothy saliva in the mouth. This may cause choking, coughing, and cyanosis.
    True
  102. The nurse is caring for a child with probable intussusception. The child had diarrhea before admission, but while waiting for administration of air pressure to reduce the intussusception, the child passed a normal brown stool. What is the most appropriate nursing action?

    A) Notify the physician.
    B) Measure the abdominal girth.
    C) Take vital signs, including blood pressure.
    D) Auscultate for bowel sounds.
    A) Notify the physician.

    Passage of a normal stool indicates that the intussusception has resolved. Notification of the physician is essential to determine whether a change in the treatment plan is indicated.

    Measurement of the abdominal girth may be indicated, but notifying the physician is the priority.

    Auscultating for bowel sounds may be indicted, but notifying the physician is the priority.

    Taking the vital signs, including the blood pressure, may be indicated, but notifying the physician is the priority.
    (this multiple choice question has been scrambled)
  103. T/F: Celiac disease is characterized by intolerance of gluten, the protein found in wheat, barley, rye, and oats. A low-gluten diet is indicated for life. The diet of a child with celiac disease should be high in calories and protein and low in fat, in addition to the low-gluten requirement.
    True
  104. When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration (15% weight loss) are

    A) irritability, moderate thirst, normal eyes and fontanels.
    B) normal pulse and blood pressure, intense thirst.
    C) tachycardia, parched mucous membranes, sunken eyes and fontanels.
    D) tachycardia, decreased tears, 5% weight loss.
    C) tachycardia, parched mucous membranes, sunken eyes and fontanels.

    Symptoms of severe dehydration include tachycardia, parched mucous membranes, and sunken eyes and fontanels.

    In severe dehydration, there is a 15% weight loss in infants, not 5%, although the infant will exhibit tachycardia and decreased tears.

    Tachycardia, orthostatic hypotension and shock, and intense thirst would be expected in an infant with severe dehydration.

    The infant would be extremely irritable, with sunken eyes and fontanels, if severely dehydrated.
    (this multiple choice question has been scrambled)
  105. A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child's mother calls the clinic nurse because the child is also occasionally vomiting. What should the nurse recommend?

    A) Continue to give ORS frequently in small amounts.
    B) Institute a nothing by mouth (NPO) status for the child for 8 hours, and resume ORS if vomiting has subsided.
    C) Alternate giving ORS and carbonated drinks.
    D) Bring the child to the hospital for intravenous fluids.
    A) Continue to give ORS frequently in small amounts.

    Vomiting is not a contraindication to the use of ORS unless it is severe. The mother should continue to give the ORS in small amounts and at frequent intervals.

    For a school-age child with mild dehydration, rehydration can be safely done at home with oral solutions.

    Carbonated drinks should not be used. They may have a high carbohydrate content and contain caffeine, which is a diuretic and could exacerbate fluid loss and dehydration.

    NPO status is not indicated. Small, frequent intake of ORS is recommended.
    (this multiple choice question has been scrambled)
  106. The clinical consequences of congenital heart defects, the most common form of cardiac disease in children, fall into two broad categories: AAA and BBB.
    • A) heart failure (HF)
    • B) hypoxemia
  107. Several prenatal factors may predispose children to congenital heart disease. These include AAA, BBB, CCC, and DDD.
    • A) maternal rubella during pregnancy
    • B) maternal alcoholism
    • C) maternal age older than 40 years
    • D) maternal type 1 diabetes
  108. AAA is an extensive inflammation of small vessels and capillaries that may progress to involve the coronary arteries, causing aneurysm formation. The administration of BBB is an important aspect of treatment.
    • A) Kawasaki disease
    • B) gamma globulin
  109. Toxic shock syndrome is a relatively rare condition caused by the toxins produced by the AAA. Nursing management of the patient with toxic shock syndrome focuses on prevention primarily through education concerning safe tampon use.
    A) Staphylococcus bacteria

    • Safe tampon use:
    • 1 - Not at all. Barring that:
    • 2 - Good hand washing
    • 3 - Careful insertion for no vaginal abrasion
    • 4 - Do not use "super-absorbent" kind
    • 5 - Use sanitary pads whenever possible, e.g. at home, at night, etc.
    • 6 - Never leave tampon in body for more than 4-6 hours
  110. What is BE?
    Bacterial Endocarditis
  111. At his 2-month checkup, Reese is found to have patent ductus arteriosus (PDA).
    The ductus arteriosus is a fetal structure. Blood enters the pulmonary artery from the right ventricle and is diverted from the nonfunctioning lungs to the systemic circulation through the ductus, which is fine for a fetus, but not for infants where it causes a left-to-right shunt.
  112. How does the ductus arteriosus usually close?
    At birth, closure occurs within hours from exposure of smooth muscle to increased oxygen tension and the changed blood-flow dynamics.

    The most important factor controlling ductal closure is the increased oxygen concentration of the blood as a result of clamping the umbilical cord.
  113. What is HF (heart failure)?
    It is the inability of the heart to pump blood into systemic circulation at normal filling pressures to meet body metabolic demands.
  114. What are the consequences of PDA?
    patent ductus arteriosus - pulmonary to aorta as fetus, should turn to ligament as child

    Depending on the size of the ducts, blood is recirculated through the lungs from the aorta and returned to the left atrium and ventricle. There is increased workload on the left side of the heart and increased pulmonary vascular congestion and possibly resistance. Finally, right ventricular pressure increases and hypertrophy can occur.

    PDA is an acyanotic congenital heart defect that causes increased pulmonary blood flow. The resulting increased workload on the left side of the heart caused by increased blood volume, and increased workload on the right side of the heart caused by increased pulmonary resistance, results in ventricular hypertrophy and heart failure.
  115. How is the murmur of PDA described?
    It is usually described as a machinery-type murmur, often diagnostic for PDA.

    patent ductus arteriosus - pulmonary to aorta as fetus, should turn to ligament as child
  116. 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) notify the healthcare provider of the finding.
    B) elevate the affected extremity.
    C) apply warm compresses to the insertion site.
    D) document the findings and continue to monitor.
    D) 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.
    (this multiple choice question has been scrambled)
  117. 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) problematic, because cyanosis is rarely present in children.
    C) helpful, because children with cyanotic defects are easily identified.
    D) problematic, because children with acyanotic heart defects may develop cyanosis.
    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.
    (this multiple choice question has been scrambled)
  118. What is considered a mixed cardiac defect?

    A) Atrial septal defect
    B) Patent ductus arteriosus
    C) Pulmonic stenosis
    D) Transposition of the great arteries
    D) Transposition of the great arteries

    "Mixed" as in mixing of ocy and deoxy blood!

    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 is classified as a defect with increased pulmonary blood flow.

    Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow.
    (this multiple choice question has been scrambled)
  119. What is an early sign of congestive heart failure that the nurse should recognize?

    A) Inability to sweat
    B) Bradycardia
    C) Tachypnea
    D) Increased urinary output
    C) 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.
    (this multiple choice question has been scrambled)
  120. Nursing care of the infant and child with congestive heart failure includes

    A) force fluids appropriate to age.
    B) give larger feedings less often to conserve energy.
    C) organize activities to allow for uninterrupted sleep.
    D) monitor respirations during active periods.
    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.
    (this multiple choice question has been scrambled)
  121. What is an important nursing responsibility when a dysrhythmia is suspected?

    A) Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate.
    B) Count the radial pulse every 1 minute for five times.
    C) Have someone else take the radial pulse simultaneously with the apical pulse.
    D) Order an immediate electrocardiogram.
    A) 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.
    (this multiple choice question has been scrambled)
  122. The primary therapy for secondary hypertension in children is

    A) treatment of underlying cause.
    B) low-salt diet.
    C) weight reduction.
    D) increased exercise and fitness.
    A) 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 is usually effective in managing essential hypertension.

    A low-salt diet is usually effective in managing essential hypertension.

    Increased exercise and fitness are usually effective in managing essential hypertension.
    (this multiple choice question has been scrambled)
  123. What should the nurse recognize as an early clinical sign of compensated shock in a child?

    A) Confusion
    B) Hypotension
    C) Sleepiness
    D) Apprehensiveness
    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.
    (this multiple choice question has been scrambled)
  124. 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) Elevated white blood count (WBC)
    B) Erythrocyte sedimentation rate (ESR)
    C) Antistreptolysin-O titer (ASO) titer
    D) Throat culture
    E) C-reactive protein (CRP)
    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.
    (this multiple choice question has been scrambled)
  125. The main nursing goal in prevention of nutritional anemia is parent education regarding correct feeding practices. Use only breast milk or iron-fortified formula (containing AAA for full-term infants and BBB for preterm infants of iron) for the first CCC months.
    • A) 7 to 12 mg/L
    • B) 15 mg/L
    • C) 12
  126. In sickle cell anemia and thalassemia, erythrocyte life spans are decreased because of a AAA defect, whereas in spherocytosis erythrocyte life span is decreased due to a defective BBB.
    • A) hemoglobin
    • B) red cell membrane
  127. Hereditaryspherocytosis (HS), acommon hemolytic disorder, is caused by a defect in AAA.
    A) the proteins that form the RBC membrane
  128. Aplastic anemia refers to a bone marrow failure condition in which AAA. Causes of acquired aplastic anemia include irradiation, drugs, industrial and household chemicals, infections, and infiltration and replacement of myeloid elements; however, the majority of cases are BBB.
    • A) the formed elements of the blood are simultaneously depressed
    • B) idiopathic
  129. AAA is the process that stops bleeding when a blood vessel is injured. Vascular and plasma clotting factors and platelets are required. A complex system of clotting, anticlotting, and clot breakdown mechanisms exists in equilibrium to ensure clot formation only in the presence of blood vessel injury and to limit the clotting process to the site of vessel wall injury. Dysfunction in these systems leads to bleeding or abnormal clotting.
    A) Hemostasis
  130. Although the coagulation process is complex, clotting depends on three factors:
    • 1) vascular influence
    • 2) platelet role
    • 3) clotting factors
  131. Hemophilia "X?" involves a deficiency of factor VIII (antihemophilic factor). Factor VIII is produced by the liver and is necessary for the formation of thromboplastin in phase I of blood coagulation. The less factor VIII found in the blood, the more severe the disease.
    A
  132. The term AAA refers to a group of bleeding disorders resulting from congenital deficiency of specific coagulation proteins. Although the symptomatology is similar regardless of which clotting factor is deficient, the identification of specific factor deficiencies has allowed definitive treatment with replacement agents.
    A) hemophilia

    Cuurently there is only one factor that can be treated: factor VIII for hemophilia A, produced through genetic engineering (recombinant form) or derived from pooled plasma, which are reconstituted with sterile water immediately before use.
  133. von Willebrand disease (vWD) is a hereditary bleeding disorder characterized by a deficiency of or defect in a protein called von Willebrand factor (vWF). The vWF protein contributes to the adherence of platelets to damaged endothelium and serves as a carrier protein for factor VIII. The results are...
    prolonged bleeding time because platelets fail to adhere to the walls of the ruptured vessel to form a platelet plug.

    The most characteristic clinical feature of vWD is an increased tendency toward bleeding from mucous membranes. The most common symptom is frequent nosebleeds, followedby gingival bleeding, easy bruising, and excessive menstrual bleeding (menorrhagia) in females. Unlike hemophilia, vWD affects both males and females because its inheritance shows an autosomal dominant pattern.
  134. Idiopathic thrombocytopenic purpura (ITP) is an acquired hemorrhagic disorder characterized by (1) excessive destruction of platelets (thrombocytopenia); (2) purpura (discoloration caused by petechiae beneath the skin); and (3) normal bone marrow with a usual increase in large, young platelets.

    Treatment? Management?
    Treatment - ·         Treatment for acute presentation is symptomatic and has included prednisone, IV immune globulin (IVIG), and anti-D antibody. These are not curative therapies. Some experts suggest that no therapy is necessary for asymptomatic patients because the recovery time of platelet counts is the same with or without treatment.

    Management - ·         includes teaching on the possible side effects of therapy and limitation in activities while the child’s platelet count is lower than 100,000/mm3. Children with ITP should not participate in any contact sports, bike riding, skateboarding, in-line skating, gymnastics, climbing, or running.
  135. Disseminated intravascular coagulation (DIC), also known as AAA, is a secondary disorder of coagulation that complicates a number of pathologic processes (e.g., hypoxia, acidosis, shock, and endothelial damage [burns]) and many severe systemic disease states (e.g., congenital heart disease, necrotizing enterocolitis, gram-negative bacterial sepsis, rickettsial infections, and some severe viral infections). The hallmarks of this disorder are bleeding and clotting, which occur simultaneously. Direct treatment is toward control of the underlying or initiating cause, which in most instances stops the coagulation problem. Administration of platelets and fresh frozen plasma may be needed to replace lost plasma components, especially in the child whose underlying disease remains uncontrolled.
    A) consumption coagulopathy
  136. Neutropenia is a reduction in the number of circulating neutrophils and is usually defined as an absolute neutrophil count (ANC) of less than AAA in infants 2 weeks to 1 year of age or less than BBB in children older than 1 year of age. Therapy to increase the ANC is rarely required. Children who have recurrent or severe infections, however, may benefit from the administration of granulocyte colony-stimulating factor.
    • A) 1000/mm3
    • B) 1500/mm3
  137. The most serious are those conditions that completely depress immunity, such as AAA However, the disorders that generate the most anxiety, within both the family and the community at large, are human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS).
    A) severe combined immunodeficiency disease (SCID).
  138. Todd is a 3-year-old child who has acute lymphoblastic leukemia. He is being seen in the oncology clinic for chemotherapy. Todd asks the nurse, "What is wrong with my blood?" Based on the nurse's knowledge of leukemia and developmental stages, the most appropriate response is

    A) "You have more red blood cells."
    B) "You have more platelets."
    C) "You have more older-mature white blood cells."
    D) "You have more young-immature white blood cells."
    D) "You have more young-immature white blood cells."

    Bone-marrow dysfunction causes a proliferation of immature cells, which depress bone marrow production of the formed elements of the blood by competing for and depriving the normal cells of the essential nutrients for metabolism; thus all elements are less and the ones that are produced are immature.
    (this multiple choice question has been scrambled)
  139. Todd is a 3-year-old child who has acute lymphoblastic leukemia. Todd has some oral ulcers (stomatitis). His parents ask about oral hygiene. The nurse should suggest

    A) use frequent mouthwashes with hydrogen proxide.
    B) use frequent mouthwashes with normal saline.
    C) cleanse teeth with lemon glycerin swabs.
    D) avoid brushing teeth until ulcers heal.
    B) use frequent mouthwashes with normal saline.

    Oral care is important in the cancer patient to prevent infection; brushing the teeth with a toothbrush is discouraged only when the child has a low platelet count.

    Frequent saline mouthwashes promote healing of oral ulcers.

    Mouthwashes with hydrogen peroxide are avoided because this delays healing by breaking down protein.

    The use of lemon glycerin swabs is discouraged because this irritates eroded tissue and can decay teeth.
    (this multiple choice question has been scrambled)
  140. Dillon, an 8-year-old boy, arrives in the emergency department with a nosebleed and purpura on his arms and chest. Dillon’s parents tell you that Dillon has been feeling well except for a recent upper respiratory tract infection. The suspected diagnosis is idiopathic thrombocytopenic purpura (ITP). The most common viral infections associated with acute ITP are:
    The most common viral infections that precede ITP are upper respiratory tract infection, measles, rubella, mumps, chickenpox, or human parvovirus.
  141. Dillon, an 8-year-old boy, arrives in the emergency department with a nosebleed and purpura on his arms and chest. Dillon’s parents tell you that Dillon has been feeling well except for a recent upper respiratory tract infection. The suspected diagnosis is idiopathic thrombocytopenic purpura (ITP). True or False: Anti-D antibody would be the treatment of choice to stop Dillon’s nosebleed.
    False - After an infusion of anti-D antibody, the platelet count does not increase for 48 hours. It is not the appropriate choice of treatment for patients who are actively bleeding. Intravenous γ-globulin or prednisone would be the more appropriate choice.
  142. Dillon, an 8-year-old boy, arrives in the emergency department with a nosebleed and purpura on his arms and chest. Dillon’s parents tell you that Dillon has been feeling well except for a recent upper respiratory tract infection. The suspected diagnosis is idiopathic thrombocytopenic purpura (ITP). Nursing intervention(s) to help stop Dillon’s nosebleed is/are: (Select all that apply.)

    A) Keep child calm and quiet.
    B) Apply continuous pressure to nose with thumb and forefinger for at least 10 minutes.
    C) Have child lie down with head tilted up.
    D) Insert cotton into each nostril and apply ice to bridge of the nose.
    A, B, and D

    NOT C: The child should sit up and lean forward to keep from swallowing the blood.
  143. Dillon, an 8-year-old boy, arrives in the emergency department with a nosebleed and purpura on his arms and chest. Dillon’s parents tell you that Dillon has been feeling well except for a recent upper respiratory tract infection. The suspected diagnosis is idiopathic thrombocytopenic purpura (ITP). What precautions should be included in the discharge teaching plan?
    No contact sports, bike riding, skateboarding, gymnastics, or climbing until the platelet count recovers.

    Avoid use of aspirin and ibuprofen. These can interfere with platelet function. Acetaminophen is the appropriate medication to use for pain.

    Obtain medical attention if the child has any head or abdominal trauma.
  144. Dillon, an 8-year-old boy, arrives in the emergency department with a nosebleed and purpura on his arms and chest. Dillon’s parents tell you that Dillon has been feeling well except for a recent upper respiratory tract infection. The suspected diagnosis is idiopathic thrombocytopenic purpura (ITP).
    Idiopathic thrombocytopenic purpura can become a chronic condition. What is the best therapy for long-term remission of chronic ITP?

    A) Splenectomy when the child is age 5 or greater
    B) Daily dose of prednisone
    C) Monthly infusions of IV γ-globulin
    D) No therapy is needed.
    A) Splenectomy when the child is age 5 or greater

    Infusions of intravenous immunoglobulin can be effective when patients are symptomatic. This has not been shown to induce a remission of the disorder.

    Chronic use of prednisone is not a treatment of choice and is associated with many side effects.

    Splenectomy is the only treatment associated with long-term remission for 60% to 90% of children. It is advisable to wait until the child is at least 5 years of age because of increased risk of bacterial infection. The child should receive penicillin prophylaxis following splenectomy.

    Eighty percent of patients with ITP are between the ages of 2 and 10 years. This is a difficult age group to limit activities. Those with platelets at <20,000/mm3 are at risk for symptomatic bleeding; therefore, therapy to modify or lessen symptoms is recommended.
    (this multiple choice question has been scrambled)
  145. Carlos is a 10-month-old infant who is brought to the clinic. His mother states he has been irritable and his skin looks pale to her. The suspected diagnosis is iron deficiency anemia. an inadequate supply of iron. Discuss what information would be important to obtain in asking Carlos’s mom about his diet.
    A diet that lacks iron-fortified formula and cereals can lead to anemia. An excessive intake of cow’s milk can also lead to an inadequate supply of iron and decreased intake of solid foods, and it can cause blood loss in the gastrointestinal tract because of an allergy to the milk protein.
  146. Carlos is a 10-month-old infant who is brought to the clinic. His mother states he has been irritable and his skin looks pale to her. The suspected diagnosis is iron deficiency anemia. True or False: Carlos is an overweight infant so he could not be anemic because of nutritional causes.
    False: Although many infants with iron deficiency anemia are underweight, it can also occur in those who are overweight. These babies are often known as "milk babies." They are often fed a diet composed mostly of cow’s milk with little solid foods and have an increased amount of fecal blood loss. These chubby infants are often pale, have poor muscle development, and may be prone to infections.
  147. Carlos is a 10-month-old infant who is brought to the clinic. His mother states he has been irritable and his skin looks pale to her. The suspected diagnosis is iron deficiency anemia. diagnosed with iron deficiency anemia and is to take an oral iron supplement, ferrous sulfate (Fer-Iron). What nursing instructions would you give his mother?
    Iron absorbs better in an acidic environment. Iron supplements should be administered between meals and given with a citrus fruit or juice.

    Oral iron will turn stools a tarry green or black color. Parents should be aware this is a normal and expected change.

    Liquid iron may cause a temporary stain on teeth. If possible, administer medication through a syringe or medicine dropper placed toward back of the mouth. Brushing the infant’s teeth after administration reduces the discoloration.

    Store the medication safely away from the reach of children in the home. Iron ingested in large quantities is toxic and may be fatal.
  148. Carlos is a 10-month-old infant who is brought to the clinic. His mother states he has been irritable and his skin looks pale to her. The suspected diagnosis is iron deficiency anemia. can be caused by more than nutritional deficiencies of iron. Discuss other causes of iron deficiency anemia.
    Impaired absorption of iron can result from presence of iron inhibitors, malabsorptive disorders, or chronic diarrhea. Blood loss can occur with acute or chronic hemorrhage or parasitic infection. Excessive demands for iron required for growth may be present in premature babies, adolescents, or pregnant girls.
  149. Carlos is a 10-month-old infant who is brought to the clinic. His mother states he has been irritable and his skin looks pale to her. The suspected diagnosis is iron deficiency anemia. True or False: Physical effects of anemia are very obvious; therefore, counseling families on medication and diet changes is easy and effective.
    Physical effects of anemia are often subtle, and parents may not consider their child ill. Stressing the expected physical and behavioral improvements may encourage parents to adhere to the treatment plan.
  150. Katherine is a 16-year-old African-American admitted with vasoocclusive sickle cell crisis. Katherine complains of weakness and fatigue. On assessment, the nurse finds that Katherine has a fever of 38° C (100° F) with a right-upper-quadrant abdominal pain on palpation. In addition to the above, the nurse’s assessment would most likely reveal

    A) large areas of bruising and ecchymosis.

    B) painful joints.
    C) enlarged abdomen and signs of shock.
    D) extremely low hemoglobin (6 mg/dl)
    B) painful joints.

    Sickle cells obstruct the blood vessels, causing occlusion and ischemia and resulting in mild to severe bone and joint pain.

    The acute abdominal pain is due to visceral hypoxia or gallstones, which do not usually result in abdominal distention or signs of shock.

    The hemoglobin level is usually decreased because of hemolysis of the sickle cells. Routine transfusions are used to maintain a hemoglobin level above 10 mg/dl.

    Sickled red blood cell destruction usually occurs within the internal organs and does not result in bruising or ecchymosis.
    (this multiple choice question has been scrambled)
  151. Katherine is a 16-year-old African-American admitted with vasoocclusive sickle cell crisis. Katherine complains of weakness and fatigue. On assessment, the nurse finds that Katherine has a fever of 38° C (100° F) with a right-upper-quadrant abdominal pain on palpation. While providing care to Katherine, the nurse should emphasize to her the importance of which measure?

    A) Saving all her urine for a 24-hour collection of urea and nitrogen
    B) Eating foods high in iron
    C) Drinking large amounts of fluids
    D) Remaining active by walking in the hall
    C) Drinking large amounts of fluids

    Twenty-four-hour urine analysis for urea and nitrogen is not a diagnostic evaluation for vasoocclusive crisis.

    Drinking large amounts of fluids provides hydration, which is important in decreasing the viscosity of the blood and preventing further obstruction of blood vessels.

    Multiple blood transfusions and hemolysis caused by a vasoocclusive crisis result in excessive serum iron concentrations; foods high in iron should be avoided.

    Walking in the hall increases cellular metabolism, resulting in tissue hypoxia, and should be avoided during a vasoocclusive crisis.
    (this multiple choice question has been scrambled)
  152. Katherine is a 16-year-old African-American admitted with vasoocclusive sickle cell crisis. Katherine complains of weakness and fatigue. On assessment, the nurse finds that Katherine has a fever of 38° C (100° F) with a right-upper-quadrant abdominal pain on palpation. Katherine’s parents are receiving instructions about their daughter’s disease. Your teaching should include to (Select all that apply.)

    A) provide them with factual information regarding sickle cell anemia.
    B) teach them the signs and symptoms of crises.
    C) tell them that any other children they have will be sure to have sickle cell disease.
    D) stress the need for their child to maintain her immunization schedule.
    A, B, and D

    Routine immunizations, including pneumococcal and meningococcal vaccines, should be maintained to protect the child from infection, which exacerbates a crisis.
  153. Katherine is a 16-year-old African-American admitted with vasoocclusive sickle cell crisis. Katherine complains of weakness and fatigue. On assessment, the nurse finds that Katherine has a fever of 38° C (100° F) with a right-upper-quadrant abdominal pain on palpation. In completing a nursing care plan for Katherine, which nursing diagnosis is most appropriate to include in her care plan?

    A) Altered Tissue Perfusion related to hypoxia

    B) Altered Nutrition: Less Than Body Requirements related to iron deficiency
    C) Fluid Volume Deficit related to nausea and vomiting
    D) Knowledge Deficit related to splenectomy
    A) Altered Tissue Perfusion related to hypoxia
    (this multiple choice question has been scrambled)
  154. Children and their families need specific instructions on how to minimize SCA crises, including:
    • preventing infections
    • maintaining adequate hydration
    • addressing environmental concerns, such as avoidance of extreme cold.
  155. A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's first action is to

    A) administer 100% oxygen to relieve hypoxia.
    B) notify practitioner because child may be having a stroke.
    C) administer pain medication to relieve symptoms.
    D) notify practitioner because chest syndrome is suspected.
    D) notify practitioner because chest syndrome is suspected.

    Severe chest pain, fever, a cough, and dyspnea are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately.

    Breathing 100% oxygen to relieve hypoxia may be ordered by the practitioner, but the first action is notification because these symptoms indicate a medical emergency.

    Pain medications may be indicated, but evaluation is necessary first.

    Severe chest pain, fever, cough, and dyspnea are not signs of a stroke.
    (this multiple choice question has been scrambled)
  156. The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted?

    A) Apply warm, moist compresses.
    B) Apply pressure for at least 1 minute.
    C) Elevate the area above the level of the heart.
    D) Begin passive range-of-motion unless the pain is severe.
    C) Elevate the area above the level of the heart.

    Cold should be applied to the arm. This will aid in vasoconstriction, minimizing blood loss.

    Pressure is effective in small areas but would not be as effective for an extremity.

    Passive range-of-motion is not recommended. The child can perform active range-of-motion after the bleeding episode has resolved.
  157. What is the most appropriate action to stop an occasional episode of epistaxis?

    A) Have the child sit up and lean forward.
    B) Apply ice under the nose and above the lip.
    C) Have the child lie down quietly with the feet elevated.
    D) Apply continuous pressure to the nose with the thumb and forefinger for at least 1 minute.
    A) Have the child sit up and lean forward.

    Sitting up and leaning forward is the position used to prevent the child from aspirating blood.Pressure, not ice, is indicated for an occasional episode of epistaxis, though that won't necessarily STOP it.

    Lying the child down with the feet elevated can potentially lead to aspiration.

    Continuous pressure for 10 minutes is recommended; 1 minute would not be long enough. This is an intervention aimed at STOPPING the epistaxis, but it is not the "Best" answer because it is not entirely correct in terms of time.  
  158. A child with β-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine (Desferal) therapy. The child’s parents ask the nurse what deferoxamine does. The most appropriate response by the nurse is

    A) “The medication stimulates red blood cell production.”
    B) “The medication helps to prevent iron overload.”
    C) “The medication helps to prevent blood transfusion reactions.”
    D) “The medication provides vitamin supplementation.”
    B) “The medication helps to prevent iron overload.”

    A side effect of hypertransfusion therapy is often iron overload. Deferoxamine is an iron-chelating drug that binds excess iron; therefore, it can be excreted by the kidneys.
    (this multiple choice question has been scrambled)
  159. T/F: Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents, including asparaginase (Elspar).
    True
  160. A child is status post hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse’s knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (Select all that apply.)

    A) Preparing the child to return to school within six weeks
    B) Keeping the child on a high-calcium diet
    C) Avoiding live plants and fresh vegetables
    D) Avoiding influenza vaccinations
    E) Practicing good hygiene
    B, C, and E

    Children should have a diet high in calcium or be placed on calcium supplements to reduce the risk of osteopenia.

    Live plants and fresh vegetables should be avoided because they carry bacteria.

    Practicing good hand hygiene is essential to prevent the spread of infection.

    Children cannot return to school for 6-12 months after HSCT. Either in-hospital or home schooling is required.

    Children and their families should be encouraged to get yearly influenza vaccination.

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