(Test Bank) PEDIATRICS EXAM 4 EXAM QUESTIONS AND ANSWERS

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COMPLETE TEST BANK PEDIATRICS EXAM 4 EXAM QUESTIONS AND A NSWERS 1. Which postoperative intervention should be questioned for a child after a cardiac catheterization? a. Continue intravenous (IV) fluids until the infant is tolerating oral fluids. b. Check the dressing for bleeding. c. Assess peripheral circulation on the affected extremity. d. Keep the affected leg flexed and elevated. - CORRECT ANSWER ANS: D The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure. The other interventions are appropriate. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1092 OBJ: Nursing Process: Implementation MSC: Client Needs: Physio logic Integrity 2. Which information should be included in the nurse's discharge instructions for a child who underwent a cardiac catheterization earlier in the day? a. Pressure dressing is changed daily for the first week. b. The child may soak in the tu b beginning tomorrow. c. Contact sports can be resumed in 2 days. d. The child can return to school on the third day after the procedure. - CORRECT ANSWER ANS: D The child can generally return to school on the third day after the procedure. The day after the cardiac catheterization, the pressure dressing is removed and replaced with a Band -Aid. Bathing is limited to a shower, a sponge bath, or a brief tub bath (no soaking) for the first 1 to 3 days after the procedure. Strenuous exercise such as contact spo rts, swimming, or climbing trees is avoided for up to 1 week after the procedure. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1092 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 3. The nurse is admitting a child to the hospital for a cardiac workup. What is the first step in a cardiac assessment? a. Percussion b. Palpation c. Auscultation d. History and inspection - CORRECT ANSWER ANS: D The assessment should begin with the least threatening interventions —the history and inspection. Assessment progression includes inspection, auscultation, and palpation because each step includes more touching. Percussion of the chest is usually deferred. Palpation can be threatening to the child because it requires a significant amount of physical contact. For this reason it is not the initial step in a cardiac assessment. Auscultation requires touching the child and is not the initial step in a cardiac as sessment. PTS: 1 DIF: Cognitive Level: Application REF: p. 1089 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)? a. Trisomy 21 detected on amniocentesis b. Family history of myocardial infarction c. Father has type 1 diabetes mellitus d. Older sibling born with Turner syndrome - CORRECT ANSWER ANS: A The incidence of congenital heart disease is approximately 50% in chil dren with trisomy 21 (Down syndrome). A family history of congenital heart disease, not acquired heart disease, increases the risk of giving birth to a child with CHD. Infants born to mothers who are insulin dependent have an increased risk of CHD. Infants identified as having certain genetic defects, such as Turner syndrome, have a higher incidence of CHD. A family history is not a risk factor. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1081 OBJ: Nursing Process: Assessment MSC: Client Need s: Physiologic Integrity 5. Before giving a dose of digoxin the nurse checked an infant's apical heart rate and it was 114 beats/minute. What should the nurse do next? a. Administer the dose as ordered. b. Hold the medication until the next dose. c. Wait and recheck the apical heart rate in 30 minutes. d. Notify the physician about the infant's heart rate. - CORRECT ANSWER ANS: A The infant's heart rate is above the lower limit for which the medication is held (100 beats/minute in an infant). The dose can be given. No other action is needed. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1084 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 6. What intervention shou ld be included in the plan of care for an infant with the nursing diagnosis of excess fluid volume related to congestive heart failure? a. Weigh the infant every day on the same scale at the same time. b. Notify the physician when weight gain exceeds more than 20 g/day. c. Put the infant in a car seat to minimize movement. d. Administer digoxin as ordered by the physician. - CORRECT ANSWER ANS: A Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency. An excessive weight gain for an infant is an increase of more than 50 g/day. With fluid volume excess, skin will be edematous. The infant's position should be changed frequently to prevent undesirable pooling of fluid in certain areas. Digoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1084 OBJ : Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 7. The nurse assessing a premature newborn infant auscultates a continuous machinery -like murmur. What action by the nurse is most appropriate? a. Educate parents on daily low -dose aspirin regime. b. Prepare to administer indomethacin. c. Administer next dose of enalapril early. d. Position infant in the knee -chest position. - CORRECT ANSWER ANS: B This murmur is characteristic of a patent ductus arteriosus, which is treated medically with indomethacin. A daily low -dose aspirin is indicated for 6 months following repair of an ASD. ACE inhibitors (enalapril) are used to reduce afterload in a VSD. The knee -chest position is helpful in tet spells that occur in tetralogy of Fallot. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: p. 1093 | Table 46.3 OBJ: Nursing Process: Assessment !! ANS: D The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures b etween the upper and lower extremities. Orthostatic hypotension is not present with coarctation of the aorta. Systolic hypertension may be detected in the upper extremities. The left arm may not accurately reflect systolic hypertension because the left sub clavian artery can be involved in the coarctation. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1091 | Table 46.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 9. A child with pulmonary atresia exhibits cyanosis w ith feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality? a. Polycythemia b. Infection c. Dehydration d. Anemia - CORRECT ANSWER ANS: A Polycythemia is a compensatory response to chronic hypoxia. The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen -carrying capacity of the blood. Infection, dehydration, and anemia are not clinical consequences of cyanosis. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1088 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 8. What is an expected assessment finding in a child with coarctation of the aorta? a. Orthostatic hypotension b. Systolic hypertension in the lower extremities c. Blood pressure higher on the left side of the body d. Disparity in blood pressure between th e upper and lower extremities MSC: Client Needs: Physiologic Integrity - CORRECT ANSWER 10. Which statement made by a parent indicates understanding of restrictions for a child after cardiac surgery? a. "My child needs to go to bed early for a few weeks. " b. "My son is really looking forward to riding his bike next week." c. "I'm so glad we can attend religious services as a family this coming Sunday." d. "I am going to keep my child out of day care for 6 weeks." - CORRECT ANSWER ANS: D Settings where lar ge groups of people are present should be avoided for 4 to 6 weeks after discharge, including day care and other public places such as churches. The child should resume his regular bedtime and sleep schedule after discharge. Due to fatigue, the child may initially need some naps during the day. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1104 | Patient -Centered Teaching Box OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity 11. A child had an aortic stenosis defect sur gically repaired 5 months ago. Which antibiotic prophylaxis is indicated for an upcoming tonsillectomy? a. No antibiotic prophylaxis is necessary. b. Amoxicillin is taken orally 1 hour before the procedure. c. Oral penicillin is given for 7 to 10 days before the procedure. d. Parenteral antibiotics are administered for 5 to 7 days after the procedure. - CORRECT ANSWER ANS: B The standard prophylactic agent is amoxicillin given orally 1 hour before the procedure. Antibiotic prophylaxis is indicated for the first 6 months after surgical repair. Antibiotic prophylaxis is not given for 7 to 10 days nor is it given parenterally. PTS: 1 DIF: Cognitive Level : Knowledge/Remembering REF: p. 1105 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 12. The nurse discovers a heart murmur in an infant 1 hour after birth. What does the nurse know about when fetal shunts close in the neonate? a. When the umbilical cord is cut b. Within several days of birth c. Within a month after birth d. By the end of the first year of life - CORRECT ANSWER ANS: B In the normal neonate, fetal shunts functionally close in response to pressure changes in the systemic and pulmonary circulations and to increased oxygen content. This process may take several days to complete. With the neonate's first breath, gas exchange is transferred from the placenta to the lungs. The separation of the fetus from the umbilical cord does not contribute to the establishment of neonatal circulation. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1079 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 13. When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure? a. The right arm b. The left arm c. All four extremities d. Both arms while the child is crying - CORRECT ANSWER ANS: C When a CHD is suspected, the blood pressure should be measured in all four extremities while the child is quiet. Discrepancies between upper and lower extremities may indicate cardiac disease. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1091 | Table 46.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 14. What is the nurse's first action when planning to teach the parents of an infant with a CHD? a. Assess the parents' anxiety level and readiness to learn. b. Gather literature for the parents. c. Secure a quiet place for teaching. d. Discuss the plan with the nursing team. - CORRECT ANSWER ANS: A Any effort to organize the right environment, pl an, or literature is of no use if the parents are not ready to learn or have high anxiety. Decreasing level of anxiety is often needed before new information can be processed. A baseline assessment of prior knowledge should be taken into consideration befo re developing any teaching plan. Locating a quiet place for meeting with parents is appropriate; however, an assessment should be done before any teaching is done. Discussing a teaching plan with the nursing team is appropriate after an assessment of the p arents' knowledge and readiness. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1085 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 15. Which statement best describes patent ductus arteriosus? a. Patent ductu s arteriosus involves a defect that results in a right -to-left shunting of blood in the heart. b. Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close. c. Patent ductus arteriosus is a stenotic lesion that must be surgically corrected at birth. d. Patent ductus arteriosus cause s an abnormal opening between the four chambers of the heart. - CORRECT ANSWER ANS: B Patent ductus arteriosus is failure of the fetal shunt between the aorta and the pulmonary artery to close. Patent ductus arteriosus allows blood to flow from the high -pressure aorta to the low -pressure pulmonary artery, resulting in a left -to-right shunt. Patent ductus arteriosus is not a stenotic lesion. Patent ductus arteriosus can be closed both medically and surgically. Atrioventricular defect occurs when fetal devel opment of the endocardial cushions is disturbed, resulting in abnormalities in the atrial and ventricular septa and the atrioventricular valves. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1093 | Table 46.3 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 16. For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right -to-left shunt receive prostaglandin E1? a. To decrease inflammation b. To control pain c. To decrease respirations d. To improve oxygenation - CORRECT ANSWER ANS: D Prostaglandin E1 is given to infants with a right -to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation. It is not given for inflammation, pain, or to dec rease respirations. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1089 | p. 1091 | Table 46.3 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 17. Which CHD results in increased pulmonary blood flow? a. Ventricular septal defect b. Coarctation of the aorta c. Tetralogy of Fallot d. Pulmonary stenosis - CORRECT ANSWER ANS: A Ventricular septal defect causes a left -to-right shunting of blood, thus increasing pulmonary blood flow. Coarctation of the aorta is a stenotic lesion that causes increased resistance to blood flow from the proximal to distal aorta. The defects associated with tetralogy of Fallot result in a right -to-left shunting of blood, th us decreasing pulmonary blood flow. Pulmonary stenosis causes obstruction of blood flow from the right ventricle to the pulmonary artery. Pulmonary blood flow is decreased. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1094 | Table 46.3 OBJ: N ursing Process: Assessment MSC: Client Needs: Physiologic Integrity 18. Which statement suggests that a parent understands how to correctly administer digoxin? a. "I measure the amount I am supposed to give with a teaspoon." b. "I put the medicine in the baby's bottle." c. "When she spits up right after I give the medicine, I give her another dose." d. "I give the medicine at 8 in the morning and evening every day." - CORRECT ANSWER ANS: D For maximum effectiveness, the medication should be given at the sa me time every day. The maintenance dose is given in two divided doses daily. To ensure the correct dosage, the medication should be measured with a syringe. To prevent toxicity, the parent should not repeat the dose without contacting the child's physician . PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1083 OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity 19. What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well? a. Recheck the infant's blood pressure. b. Alert the provider. c. Withhold oral feeding. d. Increase the oxygen rate. - CORRECT ANSWER ANS: B These are signs of early congestive heart failure, and the provider should be notified. Rechecking the blood pressure is not necessary. Withholding the infant's feeding is an incomplete response to the problem. Incr easing oxygen may alleviate symptoms, but medications such as digoxin and furosemide are necessary to improve heart function and fluid retention. Notifying the provider is the priority nursing action. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1084 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 20. Nursing care for the child in congestive heart failure includes which of the following activities? a. Counting the number of saturated diapers b. Putting the infant in the Trendelenburg position c. Removing oxygen while the infant is crying d. Organizing care to provide rest periods - CORRECT ANSWER ANS: D Nursing care should be planned to allow for periods of undisturbed rest. Diapers must be weighed for an accurate record of output. The head of the bed should be raised to decrease the work of breathing. Oxygen should be administered during stressful periods such as when the child is crying if needed. PTS: 1 DIF: Cognitive Level: Application REF: p. 1084 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 21. Which strategy is appropriate when feeding the infant with congestive heart failure? a. Continue the feeding until a sufficient amount of formula is taken. b. Limit feeding time to no more than 30 minutes. c. Always bottle feed every 4 hours. d. Feed larger volumes of concentrated formula less frequently. - CORRECT ANSWER ANS: B The infant with congestive heart failure may tire easily, so the feeding should not continue beyond 30 minutes. If inadequate amounts of formula are taken, gavage feedings should be considered. The infant is fed smaller volumes of concentrated formula every 3 hours. PTS: 1 DIF: Cognitive Level: Application REF: p. 1085 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 22. A nurse is teaching an adolescent about primary hypertension. Which statement made by the adolescent indicates an unde rstanding of primary hypertension? a. Primary hypertension should be treated with diuretics as soon as it is detected. b. Congenital heart defects are the most common cause of primary hypertension. c. Primary hypertension may be treated with weight reducti on. d. Primary hypertension is not affected by exercise. - CORRECT ANSWER ANS: C Primary hypertension in children may be treated with weight reduction and exercise programs. Primary hypertension is usually treated with weight reduction and exercise. If ine ffective, pharmacologic intervention may be needed. An exercise program in conjunction with weight reduction can be effective in managing primary hypertension in children. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1113 OBJ: Nursing Process : Evaluation MSC: Client Needs: Health Promotion and Maintenance 23. An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. T he initial treatment of secondary hypertension initially involves a. weight control and diet. b. treating the underlying disease. c. administration of digoxin. d. administration of beta -adrenergic receptor blockers. - CORRECT ANSWER ANS: B Identification and treatment of the underlying disease should be the first step in treating secondary hypertension. Weight control and diet are non -pharmacologic treatments for primary hypertension. Digoxin is indicated in the treatment of congestive heart failure. Beta-adrenergic receptor blockers may be indicated in the treatment of secondary hypertension, but the main focus is on identifying and treating the underlying cause. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1114 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 24. What should the nurse include in discharge teaching as the highest priority for the child with a cardiac dysrhyt hmia? a. CPR instructions b. Repeating digoxin if the child vomits c. Resting if dizziness occurs d. Checking the child's pulse after digoxin administration - CORRECT ANSWER ANS: A This could potentially be life -saving for the child. The parents and signif icant others in the child's life should have CPR training. The digoxin dose is not repeated if the child vomits. Dizziness is a symptom the child should be taught to report to adults so that the physician can be notified. It is not the priority interventio n. The child's pulse should be counted before the medication is given. The dose is withheld if the pulse is below the parameters set by the physician. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1108 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity 25. A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic? a. Place the infant in a knee -chest position. b. Administer oxygen. c. Administer morphine sulfate. d. Calm the infant. - CORRECT ANSWER ANS: D Calming the crying infant is the first response. An infant with unrepaired tetralogy of Fallot who is crying and agitated may eventually lose consciousness. Placing the infant in a knee-chest position will decrease venous return so that smaller amounts of highly saturated blood reach the heart. This should be done after calming the infant. Administering oxygen is indicated after placing the infant in a knee -chest position. Administering morphine sulfate calms the infant and depresses respirations. It may be indicated sometime after the infant has been calmed. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1088 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 26. The nurse caring for a child diagnosed with acute rheumatic fever should assess the child for which of the following? a. Sore throat b. Elevated blood pressure c. Desqu amation of the fingers and toes d. Tender, warm, inflamed joints - CORRECT ANSWER ANS: D Arthritis, characterized by tender, warm, erythematous joints, is one of the major manifestations of acute rheumatic fever in the first 1 to 2 weeks of the illness. Th e child may have had a sore throat previously associated with a group A beta -hemolytic streptococcal infection a few weeks earlier. A sore throat is not a manifestation of rheumatic fever. Hypertension is not associated with rheumatic fever. Desquamation o f the fingers and toes is a manifestation of Kawasaki syndrome. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1109 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 27. The nurse is admitting a child who has been diagnosed with Kawasaki disease. What is the most serious complication for which the nurse should assess in Kawasaki disease? a. Cardiac valvular disease b. Cardiomyopathy c. Coronary aneurysm d. Rheumatic fe ver - CORRECT ANSWER ANS: C Coronary artery aneurysms are seen in 20% to 25% of children with untreated Kawasaki disease. Cardiac valvular disease can occur in rheumatic fever. Cardiomyopathies are diseases of the heart muscle, which can occur as a result of congenital heart disease, coronary artery disease, or other systemic disease. Rheumatic fever is not a complication of Kawasaki disease. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1111 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 28. A nurse is conducting a class for nursing students about fetal circulation. Which statement is accurate about fetal circulation and should be included in the teaching session? a. Oxygen is carried to the fetus by the umbilical ar teries. b. Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale. c. Pulmonary vascular resistance is high because the lungs are filled with fluid. d. Blood flows from the ductus arteriosus to the pulmonary artery. - CORRECT ANSWER ANS: C Resistance in the pulmonary circulation is very high because the lungs are collapsed and filled with fluid. Oxygen and nutrients are carried to the fetus by the umbilical vein. The inferior vena cava empties blood into the r ight atrium. The direction of blood flow and the pressure in the right atrium propel most of this blood through the foramen ovale into the left atrium. Most of the blood in the pulmonary artery flows though the ductus arteriosus into the descending aorta. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1079 OBJ: Integrated Process: Teaching -Learning MSC: Client Needs: Physiologic Integrity 29. Which defect results in increased pulmonary blood flow? a. Pulmonic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries - CORRECT ANSWER ANS: C The atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then t o the lungs via the pulmonary artery. The other three diseases do not result in increased pulmonary blood flow. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1093 | Table 46.3 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiolog ic Integrity 30. A beneficial effect of administering digoxin is that it a. decreases edema. b. decreases cardiac output. c. increases heart size. d. increases venous pressure. - CORRECT ANSWER ANS: A Digoxin improves cardiac output, which will lead to de creased edema although it is not a diuretic. It does not increase heart size or increase venous pressure. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1083 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity 31. Which drug is an angiotensin -converting enzyme (ACE) inhibitor? a. Captopril b. Furosemide c. Spironolactone d. Chlorothiazide - CORRECT ANSWER ANS: A Capoten is an ACE inhibitor. Furosemide is a loop diuretic. Spironolactone blocks the action of aldosterone. Chlorothiazide is a diuretic. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1083 OBJ: Nursing Process: Implementation MSC: Client Need s: Physiologic Integrity 32. What is the most common causative agent of bacterial endocarditis? a. Staphylococcus albus b. Streptococcus hemolyticus c. Staphylococcus albicans d. Streptococcus viridans - CORRECT ANSWER ANS: D S. viridans and S. aureus are the most common causative agents in bacterial (infective) endocarditis. The others are not common causative agents. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1104 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 33. The primary nursing intervention to prevent bacterial endocarditis is which of the following? a. Institute measures to prevent dental procedures. b. Counsel parents of high -risk children about prophylactic antibiotics. c. Observe children for complicat ions, such as embolism and heart failure. d. Encourage restricted mobility in susceptible children. - CORRECT ANSWER ANS: B The objective of nursing care is to counsel the parents of high -risk children about both the need for prophylactic antibiotics for d ental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. Observing children for complications should be done, but maintaining good oral health and prophylactic antibiotics is important. Restricted mobility may or may not be necessary. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1105 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity 34. A common, serious complication of rheumatic fever is a. seizures. b. cardiac dysrhythmias. c. pulmonary hypertension. d. cardiac valve damage. - CORRECT ANSWER ANS: D Cardiac valve damage is the most significant complication of rheumatic fever. The other three are not common complications of rheumatic fever. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1109 OBJ: Nursing Process: Assessment MSC: Client Ne eds: Physiologic Integrity 35. The nurse is caring for a child with Kawasaki disease. The child weighs 33 pounds. When initiating aspirin therapy, what dose does the nurse prepare to administer? a. 75 mg orally once a day b. 81 mg orally twice a day c. 200 mg three times a day d. 375 mg orally four times a day - CORRECT ANSWER ANS: D When initiating aspiring for Kawasaki disease, it is started at the anti -inflammatory dose of 80 to 100 mg/kg divided into four doses a day. This child weighs 15 kg so 100 mg × 15 kg = 1500 mg. Divided into four doses is 375 mg four times a day. 75 mg once a day is the maintenance dose used for antiplatelet aggregate purposes. 81 mg a day is the adult antiplatelet aggregate dose. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: p. 1111 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity MULTIPLE RESPONSE 1. The nurse working in the newborn nursery notices an infant who is having circumoral cyanosis. W hich CHD does the nurse suspect the child may have? (Select all that apply.) a. Patent ductus arteriosus (PDA) b. Tetralogy of Fallot c. Pulmonary atresia d. Transposition of the great arteries e. Ventricular septal defect - CORRECT ANSWER ANS: B, C, D Tetralogy of Fallot is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Pulmonary atresia is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Transposition of the great arteries is a cyanotic lesion with i ncreased pulmonary blood flow. PDA is failure of the fetal shunt between the aorta and the pulmonary artery to close. PDA is not classified as a cyanotic heart disease. Prostaglandin E1 is often given to maintain ductal patency in children with cyanotic he art diseases. VSD is the most common type of cardiac defect. The VSD is a left -to-right shunting defect; however, it may be accompanied by other defects. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: pp. 1193 -1197 | Table 46.3 OBJ: Nursing Proces s: Assessment MSC: Client Needs: Physiologic Integrity 2. A child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to the child and the child's parents? (Select all that apply.) a. Replace whole milk with 1% milk. b. Increase servings of red meat. c. Increase servings of fish. d. Avoid excessive intake of fruit juices. e. Limit servings of whole grain. - CORRECT ANSWER ANS: A, C, D A low -fat diet includes using nonfat or low -fat dairy products, limiting red meat intake, and increasing intake of fish, vegetables, whole grains, and legumes. Children should avoid excessive intake of fruit juices and other sweetened drinks, sugars, and saturated fats. PTS: 1 DIF: Cognitive Level: Compr ehension/Understanding REF: p. 1115 OBJ: Integrated Process: Teaching -Learning MSC: Client Needs: Health Promotion and Maintenance 3. A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instr ucts the parents to notify the physician if which conditions occur? (Select all that apply.) a. Respiratory rate of 36 at rest b. Appetite slowly increasing c. Temperature above 37.7° C (100° F) d. New, frequent coughing e. Turning blue or bluer than norma l - CORRECT ANSWER ANS: C, D, E The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C; new, frequent coughing; and any episodes of the infant turning blue or bluer than normal. A respi ratory rate of 36 at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1104 | Patient -Centered Teaching Box OBJ: Nursing Process: Im plementation MSC: Client Needs: Health Promotion and Maintenance COMPLETION 1. A child who weighs 37 pounds needs a dose of lidocaine prior to cardioversion for ventricular tachycardia. What dose does the nurse prepare to administer? Write your answer using a whole number. _____ mg - CORRECT ANSWER ANS: 17 First determine the chil d's weight in kg: 37/2.2 = 16.6666. Lidocaine is dosed at 1 mg/kg 16.6666 × 1 = 16.6666. Round up to the nearest whole number = 17 mg. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1107 OBJ: Nursing Process: Implementation MSC: Client Needs: Ph ysiologic Integrity 1. What is the best response to a parent who asks the nurse whether her 5 -month -old infant can have cow's milk? a. "You need to wait until she is 8 months old and eating solids well." b. "Yes, if you think that she will eat enough meat to get the iron she needs." c. "Infants younger than 12 months need iron -rich formula to get the iron they need." d. "Try it and see how she tolerates it." - CORRECT ANSWER ANS: C Infants younger than 12 months need iron -fortified formula or breast milk. Infants who drink cow's milk do not get adequate iron and are at risk for iron -deficiency anemia. A 5 -month - old infant cannot get adequate iron without drinking an iron -fortified formula or taking an iron supplement. Counseling a parent to give a 5 -month -old infant cow's milk is inappropriate. PTS: 1 DIF: Cognitive Level: Application/Applying REF: pp. 1120 -1121 | p. 1122 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 2. An assessment of a 7 -month -old infant with a hemoglobin level of 6.5 mg/dL is likely to reveal an infant who is a. lethargic, pale, and irritable. b. thin, energetic, and sleeps little. c. anorexic, vomiting, and has watery stools. d. flushed, fussy, and tired. - CORRECT ANSWER ANS: A Pallor, lethargy, irritability, and tachycardia are clinical manifestations of iron -deficiency anemia. A child with a hemoglobin level of 6.5 mg/dL has anemia. Typically these children