Maternity and Pediatrics
How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the childs weakness and fatigue? (Select all that apply.)
a. Feeding more frequently with smaller feedings
b. Using a soft nipple with enlarged holes
c. Holding and cuddling the child during feeding
d. Substituting glucose water for formula
e. Offering high-caloric formula
a. Feeding more frequently with smaller feedings
b. Using a soft nipple with enlarged holes
c. Holding and cuddling the child during feeding
e. Offering high-caloric formula
R: Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft, large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held.
How long should a 4-year-old child recovering from rheumatic fever need to receive monthly injections of penicillin G?
5 years
R: Children who recover from rheumatic fever should have a chemoprophylaxis protocol of penicillin G injections (about 200,000 units per dose) for a minimum of 5 years or up to the age of 18 to prevent further bouts of rheumatic fever.
The nurse observes that the legs of a child with cerebral palsy cross involuntarily, and the child exhibits jerky movements with his arms as he tries to eat. The nurse recognizes that he has which type of cerebral palsy?
a. Athetoid
b. Ataxic
c. Spastic
d. Mixed
Answer: c. Spastic
Rationale: Spasticity is characterized by tension in certain muscle groups, which makes voluntary movements of muscles jerky and uncoordinated.
11. An appropriate nursing intervention for a hospitalized child who is autistic would be to:
A. Place the child in a location where she can watch all of the activity on the unit.
B. Use the child's chronological age as a guide for communication.
C. Keep the child's room free of toys or objects that she might want to take home with her.
D. Organize care to provide as few disruptions to the routine as possible.
ANS: D
During hospitalization, the nurse should provide a highly structured environment with few distractions for a child who is autistic.
16. Because young children cannot express themselves well, the nurse uses the therapeutic intervention that allows children to act out their feelings, which is
A. Art therapy.
B. Play therapy.
C. Music therapy.
D. Bibliotherapy.
ANS: B
Play therapy allows a young child to act out with dolls or figures concerns that the child may be unable to adequately express verbally.
A pediatric patient is scheduled for a noninvasive procedure to determine if his heart is structurally normal and to localize a murmur. What diagnostic test does the nurse anticipate?
Echocardiogram
R: Echocardiography is a noninvasive procedure that localizes murmurs and determines if theheart is structurally normal.
A child with rheumatic fever begins involuntary, purposeless movements of her limbs. What does the nurse recognize that this indicates?
Sydenhams chorea
R: As the effects of rheumatic fever affect the central nervous system, the child may develop Sydenhams chorea, manifested by involuntary, purposeless movements of the limbs.
What will the nurse teach parents when giving instructions for acute conjunctivitis?
a. Apply cool compresses to the affected eye several times a day.
b. Instill topical steroid eye drops for 1 week.
c. Clear drainage from the inner to the outer aspect of the eye.
d. Keep the eye patched until the inflammation resolves.
Answer: c. Clear drainage from the inner to the outer aspect of the eye.
Rationale: Eye secretions are always cleared from the inner canthus downward and away from the opposite eye (inner to outer direction).
12. A nurse planning to speak with a parent support group about childhood autism would include that:
A. Significant signs of the disorder manifest by 1 year of age.
B. The earliest signs of autism are impulsivity and overactivity.
C. Autism is usually diagnosed when the child goes to elementary school.
D. Medications can cure childhood autism.
ANS: A
Failure to use eye contact and look at others, poor attention span, and poor orienting to one's name are significant signs of dysfunction by 1 year of age.
17. The nurse explains that use of stimulants will decrease hyperactivity in the autistic child but has the negative aspect of:
A. Sedating the child.
B. Impairing cognition.
C. Causing hypotension.
D. Creating fluid retention.
ANS: B
Stimulants that decrease the hyperactivity in the autistic child also impair cognition and may increase the potential of self-injuring behavior.
The nurse is planning a hypertension-prevention program. What should be the main focus of the nurse when presenting information?
Patient education
R: The main focus of a hypertension-prevention program is patient education.
Through what does the infant born with hypoplastic left heart syndrome acquire oxygenated blood?
An atrial septal defect
R: Because the right side of the heart must take over pumping blood to both the lungs and systemic circulation, the ductus arteriosus must remain open to shunt the oxygenated blood from the lungs.
The nurse urges the mother of a 6-month-old to get her child inoculated with Haemophilus influenzae type B. What does this immunization protect against?
a. Encephalitis
b. Influenza
c. Bacterial meningitis
d. Otitis media
Answer: c. Bacterial meningitis
Rationale: H. influenzae type B and conjugated pneumococcal vaccines have decreased the incidence of bacterial meningitis.
13. An adolescent is brought to the emergency department after an automobile accident. When the nurse approaches the adolescent, he becomes combative. The nurse notes his speech is slurred and his gait is ataxic. The nurse suspects the adolescent has used:
A. Alcohol.
B. Cocaine.
C. Amphetamines.
D. PCP.
ANS: A
Behavioral signs of alcohol ingestion include slurred speech, short attention span, drowsiness, combativeness, and violence.
18. A 9-year-old has been admitted to the hospital after "huffing" lighter fluid and is in a high euphoric state. The nurse should assess for:
A. Depressed respiration.
B. Severe vomiting.
C. Frightening hallucinations.
D. Elevation of temperature.
ANS: A
Inhaling hydrocarbons depresses the central nervous system, including respiratory rate and general sensorium.
What should the school nurse recommend when encouraging a heart-healthy diet for a child with high cholesterol?
A fat intake reduction of 25-35% of total calories
R: For a child with increased cholesterol a fat reduction of 25-35% of total calories with less than 75 saturated fat and less than 200 mg of cholesterol per day is advised.
An infant with congestive heart failure is receiving digoxin (Lanoxin). What does the nurse recognize as a sign of digoxin toxicity?
Vomiting
R: Symptoms of digoxin toxicity include: nausea, vomiting, anorexia, irregularity in pulse rate and rhythm, and a sudden change in pulse.
The nurse is caring for a 3-year-old with a head injury. Which assessment would lead the nurse to report the probability of increasing intracranial pressure (ICP)?
a. Temperature increase from 37.2 C (99 F) to 37.7 C (100 F).
b. Increase in blood pressure with an attendant decrease in pulse.
c. Increase in respirations.
d. equilateral pupils
Answer: b. Increase in blood pressure with an attendant decrease in pulse.
Rationale: Increasing blood pressure, accompanied by decreasing pulse, and accompanied by unequal pupils are indicators of ICP.
14. When the nurse is collecting a nursing history, an adolescent states that she has tried speed. The nurse recognizes this as the street name for:
A. Barbiturates.
B. Cocaine.
C. Methamphetamine.
D. Marijuana.
ANS: C
"Speed" is the street name for methamphetamine.
19. As the pediatric nurse listens to a 9-year-old child read to his 6-year-old roommate, the nurse assesses possible dyslexia when the child:
A. Becomes hyperactive and ceases to read.
B. Reads the word dog as God.
C. Makes up a story rather than reading the text.
D. Stutters as he reads.
ANS: B
Dyslexics often transpose a word as they read; for example, the word is dog, but it appears to the dyslexic child as the word God.
What is accurate about the characteristics of high-density lipoproteins (HDLs)?
They have little cholesterol
R: HDLs have low amounts of triglycerides, large amounts of proteins, low amount of cholesterol, and are excreted via the liver. They have no role in the production of steroids.
A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever?
Painful, tender joints and carditis
R: The presence of two major Jones criteria would indicate a high probability of rheumatic fever.
A child is diagnosed with nonparalytic strabismus. How will this disorder most likely be corrected?
a. Patching the unaffected eye
b. Corrective lenses
c. Laser treatment
d. Surgery
Answer: b. Corrective lenses
Rationale: In nonparalytic strabismus the refractory error is usually corrected with eye glasses.
15. The member of the child guidance team who is a medical doctor with special training in psychoanalytic theory is the:
A. Psychiatrist.
B. Psychoanalyst.
C. Psychologist.
D. Counselor.
ANS: A
The psychiatrist is a medical doctor; the psychoanalyst may be a medical doctor or a psychologist. The psychologist is not a medical doctor, and neither is the counselor.
20. The nurse reminds concerned parents that gateway substance is defined as a:
A. Recreational drug used occasionally.
B. Nonaddictive drug used daily.
C. Drug used to wean from stronger drugs.
D. Substance that can lead to use of stronger drugs.
ANS: D
A gateway drug is a substance that creates a high that can lead to the use of stronger drugs.