WTF is going on?
Your VSD and PDA kids are usually not blue at first, but your TOF kid is. Classify the VSD/PDA pattern versus the TOF pattern by pulmonary blood flow and by cyanotic status.
Hint - $17
VSD and PDA are increased pulmonary blood flow and acyanotic. TOF is decreased pulmonary blood flow and cyanotic.
Your infant with CHF from a left-to-right shunt gets tired, sweaty, and tachypneic during feeds. Name the priority nursing interventions that help this baby eat and breathe with less cardiac workload.
Hint - $16
Small frequent feeds, rest breaks during feeds, cluster care, daily weights and strict I and O, monitor work of breathing and feeding tolerance.
Who do you see first?
1. A child waiting for fluids with Kawasaki disease, a child with rheumatic fever and joint pain
2. A child with suspected meningitis who now has a petechial rash, or
3. A child asleep after a brief absence seizure.
Hint - $14
The child with suspected meningitis who now has a petechial rash.
Why this patient first: Suspected meningitis with a petechial rash can point to meningococcal disease and rapidly progressing sepsis or meningococcemia. That child is at risk for shock, decreased tissue perfusion, and sudden deterioration, so this is the most time-sensitive and unstable choice.
If a large VSD or PDA keeps overloading the lungs and heart, what two big complications are you watching for over time?
Hint - $18
Heart failure and pulmonary hypertension.
Your CHF kid is on furosemide. What should you monitor, and what teaching point needs to stay on your radar at home?
Hint - $15
Monitor intake and output, daily weight, potassium, hydration status, and response to diuresis. Teach the family to watch for dehydration and keep follow- up weight monitoring
Match each hallmark finding to the correct cardiac defect:
1) loud harsh murmur with SWFT,
2) Machinery murmur with bounding pulses and rales,
3) exertional chest pain or syncope with faint pulsesfrom a tight outflow valve.
Hint - $34
1) VSD, 2) PDA, 3) Aortic stenosis.
A child starts actively seizing in front of you. Give the first priority nursing actions in order.
Hint - $37
Protect from injury, maintain airway and breathing, place side-lying if possible, time the seizure, keep nothing in the mouth, then do a postictal neuro check and assess temperature if appropriate.
Who do you see first?
1.A child with VSD who sweats with feeds but settles with breaks,
2. A baby with TOF who suddenly becomes deeply cyanotic after crying
3. A child with stable PDA and bounding pulses,
4. A child scheduled for echo tomorrow morning.
Hint - $33
Why this patient first: Sudden cyanosis after crying
in a child with Tetralogy of Fallot suggests a tet spell, which means acute worsening hypoxemia from decreased pulmonary blood flow. Oxygenation is the immediate life threat, so this child is the priority.
What is the big coronary complication that makes Kawasaki disease such a high-stakes fever diagnosis?
Hint - $31
Coronary artery aneurysm.
Before giving digoxin, what vital sign do you check and when do you hold it? Then name two toxicity clues and the nutrition teaching that matters most.
Hint - $36
Check the apical pulse for 1 full minute and hold for bradycardia based on age parameters. Toxicity clues include vomiting, poor feeding, bradycardia,dysrhythmias, and lethargy. Encourage potassium-rich nutrition because low potassium increases toxicity risk.
One child has fever for 5 days plus CRASH. Another got untreated strep and now has JONES findings and a new murmur. Name both diseases and the organism history behind the second one.
Hint - $58
Kawasaki disease; rheumatic fever after untreated Group A beta-hemolytic streptococcal infection.
You suspect bacterial meningitis, and the petechial rash makes you worry this could be meningococcal. Give the priority nursing interventions in order.
Hint - $52
Initiate droplet precautions, obtain cultures if possible, start IV antibiotics as soon as possible when bacterial meningitis is suspected, control fever, and use seizure precautions.
Who do you see first?
1. A child with a VP shunt who now has headache, vomiting, and lethargy,
2. a child with febrile seizure history who is afebrile and playing,
3.a child with focal seizure workup waiting for EEG,
4. A child asking when lunch comes after a normal LP.
Hint - $57
The child with a VP shunt who now has headache, vomiting, and lethargy.
Why this patient first: Headache, vomiting, and lethargy in a child with a VP shunt are classic signs of possible shunt malfunction or increased intracranial pressure. Neuro decline can progress quickly to decreased cerebral perfusion and herniation if not addressed fast.
Untreated GABHS can set up rheumatic fever. What long-term cardiac complication is the classic concern, and which valve is most often involved?
Hint - $54
Valvular disease from carditis, especially mitral valve damage.
Name the first-line med class used if a child is actively seizing, and give two things you monitor right after giving it. Then add one classic adverse effect pair for phenytoin or fosphenytoin.
Hint - $61
A benzodiazepine such as lorazepam. Monitor respiratory depression and hypotension or sedation.Phenytoin or fosphenytoin can cause gingival hyperplasia, ataxia, nystagmus, and IV dosing can cause hypotension or dysrhythmias.
Match the seizure term to the description:
a) brief staring and lip smacking with no postictal phase,
b) one-sided motor or sensory event that may or may not affect LOC,
c) repeated unprovoked seizures as a chronic diagnosis
d) seizure lasting more than 5 minutes or repeated seizures without recovery.
Hint - $79
a) Absence seizure, b) Focal seizure, c) Epilepsy, d) Status epilepticus.
Your TOF baby drops into a tet spell after crying. Give the priority nursing actions in order.
Hint - $86
Place in knee-chest position, calm and comfort the child to reduce stimulation, give oxygen, then administer morphine and IV fluids if ordered and prepare for surgical plan
Who do you see first?
1. A post-cardiac-cath child witha small bruise at the site,
2 a post-cardiac-cath child whose leg is cool with weak distal pulses,
3.a child with CHF due for daily weight,
4. or a child with rheumatic fever waiting for penicillin.
Hint - $83
The post-cardiac-cath child whose leg is cool with weak distal pulses.
Why this patient first: A cool leg with weak distal pulses after cardiac catheterization suggests impaired arterial perfusion to the extremity. That can signal vascular compromise from the cath site, and delayed intervention can lead to ischemia and tissue injury.
Your child with a VP shunt has fever and redness along the shunt tract one day, then another child with a VP shunt has vomiting, headache, and increasing sleepiness. Name the complication pattern for each child.
Hint - $77
The first child suggests shunt infection. The second child suggests shunt malfunction or obstruction with rising ICP
Kawasaki med combo. Name both meds and tell me what you monitor for with each one, plus the vaccine teaching that people always forget.
Hint - $84
IVIG and aspirin. Monitor IVIG for infusion reaction such as fever, chills, or hypotension. Monitor aspirin for bleeding, bruising, GI upset, or tinnitus. Avoid live vaccines for months after IVIG.
A child comes in after a head injury with morning vomiting,irritability, then later bradycardia, hypertension, irregular respirations, and decreased LOC. Name the neuro problem happening now and the big condition that may have started it.
Hint - $111
Increased intracranial pressure, likely from traumatic brain injury.
Two procedures, two priority plans. First, your child just returned from a femoral cardiac catheterization. Second, another child is being prepared for a lumbar puncture but has signs of severe increased ICP. Name the key nursing action set for each situation.
Hint - $118
After femoral cardiac catheterization: monitor the site for bleeding, check distal pulses, color, temperature, cap refill, keep the affected extremity straight as ordered, monitor for dysrhythmias and perfusion changes, and hydrate as ordered. For lumbar puncture with severe increased ICP signs: notify the provider and do not proceed until the child is evaluated because of herniation risk.
Who do you see first?
1. A child after TBI with bradycardia, hypertension, irregular respirations, and declining LOC,
2 a child with status epilepticus that stopped 30 minutes ago and is now sleeping but arousable,
3 A child with Kawasaki needing aspirin,
4 A child with stable aortic stenosis asking about gym class.
Hint - $127
The child after TBI with bradycardia, hypertension,irregular respirations, and declining LOC.
Why this patient first: Bradycardia, hypertension,irregular respirations, and declining LOC after TBIare late signs of increased intracranial pressure, also known as Cushing triad. This can mean impending brain herniation, making this the most Critical patient to assess and escalate immediately.
Name both neuro emergencies:
1) the seizure emergency defined by more than 5 minutes or repeated seizures without return to baseline, and 2) the late increased-ICP emergency pattern after TBI marked by hypertension, bradycardia, and irregular respirations.
Hint - $119
1) Status epilepticus. 2) Cushing triad signaling severe late increased ICP and possible impending herniation.
Medication mash-up. Name the medication used to eradicate the organism after GABHS-triggered rheumatic fever concerns, then match these neuro meds to what you watch: valproate, carbamazepine, levetiracetam, and mannitol.
Hint - $122
Penicillin is used to eradicate the streptococcal organism. Valproate: liver toxicity, pancreatitis, bleeding. Carbamazepine: low WBC and dizziness.Levetiracetam: mood and behavior changes.Mannitol: urine output and electrolytes while lowering ICP.