Question 1

A nurse is explaining a patent ductus arteriosus defect to the parents of a preterm infant. Theparents indicate understanding of the defect when they state that a patent ductus arteriosus:&#10;A) involves a defect that results in a right-to-left shunting of blood in the heart.&#10;B) involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close.&#10;C) is a stenotic lesion that must be surgically corrected at birth.&#10;D) causes an abnormal opening between the four chambers of the heart.

Accepted Answer

Patent ductus arteriosus is failure of the fetal shunt between the aorta and the pulmonary artery to close. A 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 development of the endocardial cushions is disturbed, resulting in abnormalities in the atrial and ventricular septa and the atrioventricular valves.

Question 2

A nurse should plan to implement which interventions for a child admitted with inorganicfailure to thrive? Select all that apply.&#10;A) Observation of parentchild interactions&#10;B) Assignment of different nurses to care for the child from day to day&#10;C) Use of 28 calorie per ounce concentrated formulas&#10;D) Administration of daily multivitamin supplements&#10;E) Role-modeling appropriate adultchild interactions

Accepted Answer

The nurse should plan to assess parentchild interactions when a child is admitted for nonorganic failure to thrive. The observations should include how the child is held and fed, how eye contact is initiated and maintained, and the facial expressions of both the child and the caregiver during interactions. Role modeling and teaching appropriate adultchild interactions (including holding, touching, and feeding the child) will facilitate appropriate parentchild relationships, enhance parents confidence in caring for their child, and facilitate expression by the parents of realistic expectations based on the childs developmental needs. Daily multivitamin supplements with minerals are often prescribed to ensure that specific nutritional deficiencies do not occur in the course of rapid growth. The nursing staff assigned to care for the child should be consistent. Providing a consistent caregiver from the nursing staff increases trust and provides the child with an adult who anticipates his or her needs and who is able to role model child care to the parent. Caloric enrichment of food is essential, and formula may be concentrated in titrated amounts up to 24 calories per ounce. Greater concentrations can lead to diarrhea and dehydration.

Question 3

A child with spina bifida is being admitted to the hospital for a shunt revision? The nurseadmitting the child anticipates which type of precautions to be ordered for the child?&#10;A) Latex&#10;B) Bleeding&#10;C) Seizure&#10;D) Isolation

Accepted Answer

Children with spina bifida are at high risk for developing latex allergies because of frequent exposure to latex during catheterizations, shunt placements, and other operations. The child with spina bifida does not have a risk for bleeding. Not all children with spina bifida are at risk for seizures and isolation would not be indicated in a child being admitted for a shunt revision.

Question 4

Which interventions should the nurse perform if a child is having a tonic-clonic seizure? Select all that apply.&#10;A) Place a padded tongue blade in the childs mouth.&#10;B) Place the child in a supine position.&#10;C) Time the seizure.&#10;D) Restrain the child.&#10;E) Stay with the child.&#10;F) Loosen the childs clothing.

Accepted Answer

As a seizure begins the nurse should look at his or her watch and time the seizure. The nurse should protect the child from injury by loosening clothing at the neck and turning the child gently onto the side, removing any obstacles in the childs environment. Do not restrain the child or insert any object into the childs mouth.

Question 5

Which statement made by a 14-year-old adolescent who is newly diagnosed with insulin-dependent diabetes mellitus (IDDM) indicates a need for further teaching?&#10;A) I should eat meals and snack at the same time every day.&#10;B) Exercise will decrease my insulin requirements.&#10;C) It is okay to drink chocolate milk with meals.&#10;D) I need to check my sugars before meals and at bedtime.

Accepted Answer

Chocolate milk is high in carbohydrates. Carbohydrates raise blood glucose levels. A beverage low in carbohydrates is a better choice. Meals and snacks should be eaten at regular times. Exercise decreases insulin requirements. Checking serum glucose before breakfast and dinner is appropriate.

Question 6

A nurse is preparing to administer 10 units of Regular insulin and 5 units of Lente insulin. Place in order the steps the nurse should follow to administer the total dosage of 15 units of insulin. Place the initial step first and end with the final step. Use the following format for your answers: A, B, C, D

A) Inject 5 units of air into the Lente insulin vial.
B) Draw up the 5 units of Lente insulin.
C) Inject 10 units of air into the Regular insulin vial.
D) Cleanse the insulin vials with alcohol wipes.
E) Draw up the 10 units of Regular insulin.

Accepted Answer

Cleanse the insulin vials with alcohol wipes initially. When mixing two different types of insulin, inject the appropriate amount of air into both vials and then withdraw the short-acting (clear) insulin first. So the steps should be to cleanse the insulin vials, inject air into the Lente, inject air into the Regular insulin vial, then draw the Regular (clear) insulin, and lastly draw the Lente (cloudy) insulin.

Question 7

What is the major difference between caring for an infant with burns and an adolescent with burns?&#10;A) An increased risk of cardiovascular problems in the infant&#10;B) A decreased need for caloric intake in the infant&#10;C) An increased risk for hypervolemia in the adolescent&#10;D) A decreased need for electrolyte replacement in the infant

Accepted Answer

The higher proportion of body fluid to body mass in infants increases the risk of cardiovascular problems because of a less effective cardiovascular response to changing intravascular volume. Infants are at an increased risk for protein and calorie deficiency because they have smaller muscle mass and lower body fat. Hypovolemia is a risk for all burn patients; however, the risk is higher for the infant than for the adolescent. There is an increased risk for electrolyte loss in the infant because of the larger body surface area.

Question 8

Which medication would be best for the nurse to administer before a dressing change for theseverely burned child?&#10;A) Codeine&#10;B) Benadryl&#10;C) Morphine&#10;D) Acetaminophen

Accepted Answer

Morphine is the drug of choice for pain management in the severely burned child. It should be administered intravenously. Codeine may be used to diminish pain between dressing changes. Benadryl is administered to relieve discomfort from itching. Acetaminophen can be given for discomfort between painful procedures.

Deck 2: Heart Failure, Failure to Thrive, Tonic-Clonic Seizures, Diabetes Mellitus Type 1 and Second-Degree Burns