Nurs 226 Exam 7 Ch. 45, 46, 47 & 48

Ch. 45

100

Answer: This handheld device measures the maximum speed of expiration, helping to monitor asthma control and detect early signs of an exacerbation in children.

Question: What is a peak flow meter?

200

Answer: These signs, including nasal flaring, use of accessory muscles, and wheezing, indicate respiratory distress and may require immediate medical attention.

Question: What are common indicators of respiratory distress in children?

300

Answer: This critical substance, produced by type II alveolar cells, reduces surface tension in the lungs and is often deficient in premature infants, leading to respiratory distress syndrome (RDS).

Question: What is pulmonary surfactant?

400

Answer: This condition is characterized by cold symptoms lasting more than 10 days, low-grade fever, purulent nasal discharge, and may cause irritability in young children.

Question: What is sinusitis?

500

Answer: This condition involves fluid and infection in the middle ear, characterized by symptoms such as earache, fever, and a bulging tympanic membrane.

Question: What is acute otitis media?

600

Answer: This approach involves using a bronchodilator before physical activity, ensuring proper warm-up, and monitoring symptoms to prevent asthma attacks during exercise.

Question: What are strategies for managing exercise-induced asthma in children?

700

Answer: This condition involves inflammation of the pharynx and surrounding tissues, often presenting with sore throat and difficulty swallowing.

Question: What is pharyngitis?

800

Answer: This critical precaution advises against examining a child's throat if this condition is suspected, as stimulation could lead to complete airway obstruction.

Question: What is epiglottitis?

900

Answer: This device, commonly used in children with conditions like cystic fibrosis, utilizes positive expiratory pressure to help mobilize mucus through forced exhalation.

Question: What is a Flutter valve?

1000

Answer: This skin test result indicates a positive Mantoux test for children aged 4 years and older, defined by an area of induration measuring 15 mm or greater.

Question: What is the threshold for a positive Mantoux skin test in children aged 4 years and older?

Ch. 46

100

1. Answer: This condition is characterized by four heart defects, including ventricular septal defect and pulmonary stenosis, leading to decreased blood flow to the lungs and cyanosis in affected infants. 

Question: What is Tetralogy of Fallot?

200

1. Answer: In this congenital defect, the tricuspid valve fails to develop properly, resulting in the absence of blood flow from the right atrium to the right ventricle. 

Question: What is tricuspid atresia?

300

1. Answer: This condition involves a complete blockage of blood flow from the right ventricle to the pulmonary artery, while the ventricular septum remains intact, leading to severe cyanosis. 

Question: What is pulmonary atresia with intact ventricular septum?

400

Answer: This condition is characterized by a single arterial trunk that arises from the heart, supplying both the systemic and pulmonary circulation, leading to mixing of oxygenated and deoxygenated blood. 

Question: What is truncus arteriosus?

500

Answer: In this severe congenital defect, the left side of the heart is underdeveloped, resulting in inadequate systemic blood flow and reliance on right-to-left shunting for survival. 

What is hypoplastic left heart syndrome?

600

Answer: This condition involves the aorta and pulmonary artery being switched, causing desaturated blood to circulate through the body while oxygenated blood returns to the lungs, leading to significant cyanosis.

Question: What is transposition of the great arteries?

700

Answer: This condition results from the failure of the ductus arteriosus to close after birth, leading to signs of heart failure, a continuous machinery-like murmur, and bounding pulses.

Question: What is patent ductus arteriosus (PDA)?

800

Answer: This condition, characterized by an abnormal opening between the atria, may be asymptomatic in early childhood but can lead to fatigue, dyspnea, and increased risk of stroke if not repaired.

Question: What is an atrial septal defect (ASD)?

900

Answer: This condition, the most common type of cardiac defect, is characterized by an abnormal opening between the ventricles, often presenting with a loud, harsh systolic murmur and potential heart failure.

Question: What is a ventricular septal defect (VSD)?

1000

Answer: This condition may present in asymptomatic children with differences in pulse and blood pressure between the upper and lower extremities, often leading to symptoms like weakness and cramps in the legs.

Question: What is coarctation of the aorta?

Ch. 47

100

Answer: This condition, often seen in children with sickle cell disease, presents with symptoms like low-grade fever, tachycardia, and chest pain, and can lead to a serious complication known as acute chest syndrome.

Question: What is a vaso-occlusive crisis (VOC)?

200

Answer: This condition, often caused by decreased iron intake, increased blood loss, or periods of rapid growth, is the most common cause of anemia in children, particularly affecting infants and adolescents.

Question: What is iron deficiency anemia?

300

Answer: This group of congenital disorders is characterized by the presence of sickled hemoglobin, chronic hemolytic anemia, and ischemic tissue injury, resulting from an autosomal recessive inheritance pattern.

Question: What is sickle cell disease?

400

Answer: Key laboratory findings in this condition include decreased hemoglobin, low mean cell volume (MCV), and elevated iron-binding capacity due to low serum iron levels.

Question: What are the diagnostic indicators of iron deficiency anemia?

500

Answer: Common manifestations of this condition include pallor, jaundice, fatigue, and complications such as avascular necrosis and cholelithiasis.

Question: What are the symptoms of sickle cell disease?

600

Answer: This condition is characterized by distinct facial features such as frontal bossing, maxillary prominence, wide-set eyes with a flattened nose, hepatosplenomegaly, and a greenish-yellow skin tone.

Question: What is beta-thalassemia?

700

Answer: This acquired hemorrhagic syndrome is triggered by factors such as trauma, shock, and overwhelming infections, leading to simultaneous clotting and bleeding.

Question: What is Disseminated Intravascular Coagulation (DIC)?

800

Answer: This condition is characterized by symptoms such as pale skin, tachypnea, fatigue, and irritability, along with laboratory findings of decreased hemoglobin, low mean cell volume (MCV), and elevated iron-binding capacity.

Question: What is iron deficiency anemia?

900

Answer: This condition is characterized by bone marrow failure leading to pancytopenia, with decreased granulocytes, erythrocytes, and megakaryocytes, and is diagnosed through a bone marrow biopsy showing hypocellular marrow.

Question: What is aplastic anemia?

1000

Answer: This essential mineral should be administered in one to two divided doses between meals, preferably with vitamin C-rich fluids, and care should be taken to avoid staining teeth and binding with calcium-rich foods.

Question: What is iron supplementation for anemia?

Ch. 48

100

Answer: Children undergoing this treatment are at increased risk for infection due to neutropenia, necessitating prompt culture collection and antibiotic administration upon suspicion of infection.

Question: What is chemotherapy?

200

Answer: This condition can manifest in children with symptoms such as elevated liver enzyme levels, diarrhea, and maculopapular skin reactions, and is often managed with antirejection medications like prednisone and cyclosporine.

Question: What is graft-versus-host disease (GVHD)?

300

Answer: These alarming symptoms may indicate childhood cancer and include a mass, purpura, pallor, weight loss, a whitish reflex in the eyes, early morning vomiting, and recurrent or persistent fever.

Question: What are the overt signs of childhood cancer?

400

Answer: This procedure involves obtaining a sample from the iliac crest, often requiring sedation, and may use distraction techniques like singing to ease discomfort. What is it?

Question: What is a bone marrow biopsy?

500

Answer: This condition, resulting from radiation treatment, requires close monitoring for signs of infection and unusual bruising due to its impact on blood cell counts. What is it?

Question: What is bone marrow suppression?

600

Answer: This type of cancer is characterized by the abnormal proliferation of white blood cells, leading to bone marrow suppression and symptoms such as fever, excessive bruising, and bone pain. What is it?

Question: What is leukemia?

Symptoms to Watch For:Fever and Pallor: These can indicate the body's response to infection or anemia.Excessive Bruising: This occurs due to low platelet counts.Bone or Joint Pain: Often felt in the legs or knees.Lymphadenopathy and Hepatosplenomegaly: Swelling of lymph nodes and enlargement of the liver or spleen may occur Monitoring: Regular check-ups and blood tests are essential to manage and monitor the condition.

700

Answer: This is the second most common childhood cancer, often presenting with hallmark symptoms such as morning vomiting and headaches, especially when the child gets out of bed. What is it?

Question: What is a brain tumor?

Headaches and Morning Vomiting: These are often the first signs noticed.Ataxia and Poor Coordination: Watch for unsteady gait or difficulty with balance.Visual Changes and Head Tilt: Changes in vision or unusual head positioning may occur.Lethargy and Irritability: Increased tiredness and mood changes can be indicators.Seizures and Neurologic Deficits: These symptoms require immediate medical attention.

800

Answer: This type of lymphoma is characterized by the presence of Reed-Sternberg cells, has a more indolent course, and is staged to determine the extent of the disease. What is it?

Question: What is Hodgkin disease?

Non-Hodgkin Lymphoma (NHL):

• Includes types like Burkitt lymphoma and large cell lymphomas.
• Known for rapid onset and widespread involvement, often spreading from lymph nodes to other sites.
• Increased risk of Tumor Lysis Syndrome, which can lead to elevated electrolyte levels due to rapid cell death.
• Hodgkin Disease:
  • Typically presents with a slower progression.
  • Identified by the presence of giant multinucleated Reed-Sternberg cells.
  • Staging is crucial for treatment planning and prognosis.

900

Answer: This common side effect of radiation therapy can lead to painful sores in the mouth and throat, making it difficult for patients to eat and drink. What is it?

Question: What is mucositis?

1000

Answer: These subtle symptoms may indicate childhood cancer and include bone pain, persistent lymphadenopathy, headaches, changes in balance or personality, and general fatigue or malaise.

Question: What are the covert signs of childhood cancer?

Care of children...

100

Answer: A child just had a cardiac catheterization; this type of care includes inspecting the catheter insertion site for signs of infection, limiting bathing to showers or sponge baths for the first few days, and avoiding strenuous activities for up to a week.

Question: What are the key components of post-cardiac catheterization care for children?

200

Answer: This 8-year-old boy presented with symptoms including persistent fever, excessive bruising, and bone pain in his legs. Blood tests revealed abnormal white blood cell counts and significant anemia. What is the likely diagnosis?

Question: What is leukemia?

• Symptoms to Recognize: Common signs of leukemia in children include:
  • Fever and Pallor: Indicating possible infection or anemia.
  • Excessive Bruising: Due to low platelet counts.
  • Bone Pain: Often felt in the legs or joints.
• Diagnosis and Treatment: Diagnosis typically involves blood tests and possibly a bone marrow biopsy. Treatment may include chemotherapy and supportive care.

300

Answer: This 6-year-old girl underwent a tonsillectomy and presented with throat pain, difficulty swallowing, and a low-grade fever on the second postoperative day. What is the most common postoperative complication she may be experiencing?

Question: What is bleeding or infection?

• Postoperative Symptoms to Monitor:
  • Throat Pain: Common after tonsillectomy; pain management is essential.
  • Difficulty Swallowing: This can occur due to swelling and discomfort.
  • Fever: A low-grade fever may indicate inflammation or infection.
• Complications to Watch For:
  • Bleeding: This can happen within the first few days post-surgery.
  • Infection: Signs include increased pain, fever, or unusual discharge.

400

Answer: This 5-year-old boy presented with fatigue, pallor, and a craving for non-food items like ice and dirt. Blood tests confirmed low hemoglobin levels and decreased ferritin. What is the likely diagnosis?

Question: What is iron deficiency anemia?

• Symptoms to Recognize:
  • Fatigue and Pallor: Common signs indicating low iron levels.
  • Pica: Craving for non-food items can be a unique symptom of iron deficiency.
• Diagnosis and Treatment:
  • Diagnosis typically involves blood tests to check hemoglobin and ferritin levels.
  • Treatment may include iron supplements and dietary changes to increase iron intake.

500

Answer: This 4-year-old girl presented with a harsh, metallic barky cough, sore throat, and inspiratory stridor. Her parents noted she was increasingly agitated and had difficulty taking oral fluids. What is the most appropriate action for her condition?

Question: What is to seek emergency medical care?

• Croup Overview: Croup is characterized by inflammation of the upper airway, leading to the classic symptoms.
• Key Symptoms to Monitor:
  • Barky Cough and Stridor: Indicative of airway narrowing.
  • Cyanosis and Severe Agitation: Signs of respiratory distress that require immediate attention.
  • Fatigue and Retractions: Indicate the child is struggling to breathe.

600

Answer: This 2-year-old boy presented with wheezing, a persistent cough, and difficulty breathing. His parents reported a recent upper respiratory infection, and he exhibited signs of dehydration. What is the likely diagnosis?

Question: What is bronchiolitis caused by respiratory syncytial virus (RSV)?

• Bronchiolitis Overview: This condition is common in young children and is often caused by RSV.
• Symptoms to Monitor:
  • Wheezing and Coughing: Indicative of airway inflammation.
  • Difficulty Breathing: Look for signs of respiratory distress, such as rapid breathing or retractions.
  • Dehydration: Ensure the child is taking in enough fluids, as illness can lead to decreased intake.

700

Answer: This 5-year-old girl presents with cyanosis, difficulty breathing during play, and clubbing of her fingers. Her parents report episodes of fainting and a history of heart murmurs. What is the likely diagnosis?

Question: What is unrepaired Tetralogy of Fallot?

• Tetralogy of Fallot Overview: This congenital heart defect consists of four abnormalities that affect blood flow through the heart.
• Key Symptoms to Monitor:
  • Cyanosis: A bluish tint to the skin, especially during exertion.
  • Breathing Difficulties: Increased effort during physical activity.
  • Clubbing: Enlargement of the fingertips due to chronic low oxygen levels.
  • Fainting Episodes: Can occur due to decreased blood flow.

800

Answer: This 3-month-old infant presents with signs of heart failure, including a continuous machinery-like murmur, widened pulse pressure, and bounding pulses. The ductus arteriosus has failed to close after birth. What is the likely diagnosis?

Question: What is a patent ductus arteriosus (PDA)?

• PDA Overview: This condition occurs when the ductus arteriosus, a blood vessel that connects the pulmonary artery to the aorta, remains open after birth.

• Key Symptoms to Monitor:

  • Signs of Heart Failure: These can vary based on the size of the PDA and the amount of blood shunted from left to right.
  • Continuous Murmur: A characteristic sound heard during a physical exam.
  • Widened Pulse Pressure: Indicates an increased difference between systolic and diastolic blood pressure.
  • Bounding Pulses: Strong pulses felt in the extremities.

• Management Options:

  • Indomethacin: A medication used to help close the ductus in premature infants.
  • Interventional Cardiac Catheterization: A procedure where a coil is placed to occlude the ductus.

900

Answer: This 10-year-old boy presents with a persistent cough, frequent lung infections, and difficulty gaining weight despite a high-calorie diet. Sweat testing reveals elevated chloride levels. What is the likely diagnosis?

Question: What is cystic fibrosis?

• Cystic Fibrosis Overview: This genetic disorder affects the lungs and digestive system, leading to thick, sticky mucus production.

• Key Symptoms to Monitor:

  • Respiratory Issues: Persistent cough and frequent infections are common due to mucus buildup in the lungs.
  • Nutritional Challenges: Difficulty gaining weight can occur because the thick mucus obstructs pancreatic enzymes needed for digestion.
  • Sweat Test: Elevated chloride levels in sweat are a hallmark of cystic fibrosis.

• Management Strategies:

  • Airway Clearance Techniques: Regular physiotherapy to help clear mucus from the lungs.
  • Nutritional Support: High-calorie diets and enzyme supplements to aid digestion.
  • Regular Monitoring: Frequent check-ups with a healthcare team to manage lung health and nutrition

1000

Answer: This 7-year-old boy presents with hypertension in the upper extremities, weak pulses in the lower extremities, and complaints of intermittent leg pain during physical activity. A chest X-ray shows a "figure 3 sign." What is the likely diagnosis?

Question: What is coarctation of the aorta?

• Coarctation of the Aorta Overview: This condition involves a narrowing of the aorta, which can lead to significant cardiovascular issues.

• Key Symptoms to Monitor:

  • Hypertension in the Arms: Elevated blood pressure readings in the upper body compared to the lower body.
  • Weak Pulses in the Legs: Indicates reduced blood flow to the lower extremities.
  • Intermittent Claudication: Leg pain during exertion due to insufficient blood flow.

• Diagnosis and Management:

  • Imaging Studies: Chest X-rays and echocardiograms are commonly used for diagnosis.
  • Treatment Options: May include surgical repair or balloon angioplasty to correct the narrowing.