Question 1

An 8-month-old infant is scheduled for a femorally inserted balloon angioplasty of a congenital pulmonic stenosis in the cardiac catheterization laboratory.  Which finding should the nurse report to the health care provider that could possibly delay the procedure?

Accepted Answer

Pulmonic stenosis causes increased pressure in the right side of the heart as the ventricle tries to push blood through the narrowed pulmonary area to the lungs. In severe pulmonic stenosis, higher pressure in the right side of the heart causes unoxygenated blood to travel to the left side through the foramen ovale (or other congenital defect) and into the systemic circulation, leading to chronic hypoxia and cyanosis and requiring repair (interventional catheterization or surgery). The presence of severe diaper rash should be reported to the health care provider (HCP). This could delay the procedure if the rash is in the groin area where access is planned for a femorally inserted arterial cannula. Yeast or bacteria may be present on the rash and could be introduced into the bloodstream with the arterial stick (Option C). (Option A) A loud heart murmur can be an expected finding in a child with pulmonic stenosis. (Option B) Children are NPO for 4-6 hours or longer before the procedure. Younger children and infants may have a shorter period of NPO status and should be fed right up to the time recommended by the HCP. (Option D) Cyanosis indicates severe pulmonic stenosis with right-to-left shunt and the need for interventional catheterization or surgery without delay. Educational objective: The nurse should report the presence of severe diaper rash in an infant who has an interventional catheterization procedure planned. The rash may delay the procedure due to possible contamination at the insertion site.

Question 2

The nurse is planning care for a child being admitted with Kawasaki disease and should give priority to which nursing intervention?

Accepted Answer

Kawasaki disease (KD) is a childhood condition that causes inflammation of arterial walls (vasculitis). The coronary arteries are affected in KD, and some children develop coronary aneurysms. The etiology of KD is unknown; there are no diagnostic tests to confirm the disease, and it is not contagious. KD has 3 phases: Acute - sudden onset of high fever that does not respond to antibiotics or antipyretics. The child becomes very irritable and develops swollen red feet and hands. The lips become swollen and cracked, and the tongue can also become red (strawberry tongue). Subacute - skin begins to peel from the hands and feet. The child remains very irritable. Convalescent - symptoms disappear slowly. The child's temperament returns to normal. Initial treatment consists of IV gamma globulin (IVIG) and aspirin. IVIG creates high plasma oncotic pressure, and signs of fluid overload and pulmonary edema develop if it is given in large quantities. Therefore, the child should be monitored for symptoms of heart failure (eg, decreased urinary output, additional heart sounds, tachycardia, difficulty breathing). (Option A) During the acute phase (swollen hands and feet), skin discomfort can be eased with cool compresses and lotions. No treatment is needed in the subacute phase (skin peeling), but the new skin might be very tender. (Option C) The child will be very irritable during the acute phase of KD. A non-stimulating, quiet environment will help to promote rest. After a KD episode, it is important for parents to understand that their child's irritability may last for up to 2 months and that follow-up appointments for cardiac evaluation are important. (Option D) During the acute phase (painful swollen lips and tongue), the child should be given soft foods and clear liquids as these are tolerated best. Educational objective: Kawasaki disease causes inflammation of the arterial walls and can lead to scarring of the coronary arteries or development of coronary aneurysms. Treatment consists of aspirin and substantial infusion of IV gamma globulin. The affected child must be monitored for signs of heart failure.

Question 3

The school nurse evaluates a 9-year-old who is sweating, trembling, and pale. The client has type 1 diabetes managed with insulin glargine and NPH. What is the most appropriate action by the nurse?

Accepted Answer

11ecbb05_ca9c_15c6_b433_2763503eaf61_MD0009_00 Clients experiencing hypoglycemia may develop shakiness, palpitations, sweating, pallor, and altered mental status (eg, difficulty speaking, confusion). If manifestations of hypoglycemia are present, the nurse should check the client's blood glucose (BG) level immediately. A BG of <70 mg/dL (3.9 mmol/L) requires treatment; however, if glucose testing is not readily available, the client should be treated based on symptoms. Hypoglycemia treatment in a conscious client is administration of 15 g of a quick-acting carbohydrate (Option D). After treatment, the nurse should recheck BG every 15 minutes, repeating treatment if it remains low. Quick-acting carbohydrate options include: 4 oz (120 mL) of a regular soft drink or fruit juice 8 oz (240 mL) of low-fat milk 1 tablespoon (15 mL) of honey or syrup 6 hard candies Commercial dextrose products (Option A) The nurse should hold the client's scheduled insulin until the client's BG is normal and symptoms resolve. (Option B) An emergency glucagon IM injection is indicated if the client is somnolent, unconscious, seizing, or unable to swallow. (Option C) After the client's BG improves, the client should eat a meal. However, if the next meal is more than an hour away, the nurse should give the client a serving of carbohydrate plus protein or fat (eg, peanut butter, cheese) to maintain glucose levels. Educational objective: Clients with diabetes mellitus should be monitored for signs of hypoglycemia (eg, shakiness, sweating, pallor, alterations in mental status). Conscious clients experiencing hypoglycemia should receive a snack of 15 g of a quick-acting carbohydrate.

Question 4

The home health nurse is visiting an infant who recently had surgery to repair tetralogy of Fallot. Which of the following signs of heart failure should the nurse teach the parents to report to the health care provider? Select all that apply.

Accepted Answer

11ecbb05_ca97_5ad0_b433_ab46986a1c8d_MD0009_00 Following repair of tetralogy of Fallot, clients often develop chronic pulmonary regurgitation. Insufficient flow into the pulmonary vasculature causes the right ventricle to work harder, leading to right ventricular hypertrophy and a subsequent reduction in right ventricular function and cardiac output. The decrease in forward blood flow causes blood to back up into venous circulation, resulting in heart failure. Clinical manifestations of heart failure include: Pale, cool extremities due to reduced perfusion to the systemic circulation (Option A) Periorbital edema (puffiness around the eyes) and rapid weight gain due to systemic venous congestion and fluid retention (Options C and E) Reduction in the number of wet diapers due to reduced perfusion to the kidneys (Option D) (Option B) Infants with heart failure generally have decreased appetite and feeding due to dyspnea and fatigue. Educational objective: Following repair of tetralogy of Fallot, clients often develop chronic pulmonary regurgitation, leading to right ventricular hypertrophy, decreased cardiac output, and heart failure. Clinical manifestations of heart failure include signs of poor perfusion (eg, pale, cool extremities; reduced urinary output) and fluid overload (eg, periorbital edema, rapid weight gain).

Question 5

A nurse is assisting a new mother as she is breastfeeding her infant. The infant has been diagnosed with tetralogy of Fallot. During feeding, the infant becomes cyanotic and is having difficulty breathing. What should be the nurse's first action?

Accepted Answer

11ecbb05_ca96_be8f_b433_e527154bdabe_MD0009_00 Tetralogy of Fallot is a congenital cardiac defect that typically has 4 characteristics: pulmonary stenosis, right ventricular hypertrophy, overriding aorta, and ventricular septal defect. This infant is experiencing a hypercyanotic episode, or "tet spell," which is an exacerbation of tetralogy of Fallot that can happen when a child cries, becomes upset, or is feeding. The child should first be placed in a knee-to-chest position. Flexion of the legs provides relief of dyspnea as this angle improves oxygenation by reducing the volume of blood that is shunted through the overriding aorta and the ventricular septal defect. (Option A) Morphine may be considered if the dyspnea is not relieved by the knee-to-chest position. (Option B) If oxygen saturation remains low, oxygen may need to be administered. (Option C) Vital signs and pulse oximetry may be checked after the infant has been placed in the knee-chest position. Educational objective: To relieve a hypercyanotic episode, or "tet spell," the nurse should place the infant or child in the knee-chest position.

Question 6

The nurse is planning a client care conference with the parents of a 3-year-old with newly diagnosed type 1 diabetes mellitus. What is the priority outcome for the caregivers?

Accepted Answer

Management of type 1 diabetes mellitus requires understanding of blood sugar regulation. If the child becomes hypoglycemic or hyperglycemic, complications could develop. The priority for caregivers should be to focus on the child's safety. Managing the child's blood sugars should be the initial goal. (Option A) Dealing with a new diagnosis will require time. Although acquiring coping skills is important, this is more of a long-term goal. (Option C) Consistent menus, appropriate eating times, and adequate intake based on age are all important parts of meal planning. However, checking the child's blood sugars and keeping these stable with the correct insulin dose is the priority. (Option D) Frequent follow-up visits are important to prevent long-term complications of diabetes. However, preventing hypoglycemia and hyperglycemia at home is the priority. Educational objective: Initial teaching of the parents of a child with newly diagnosed type 1 diabetes should focus on basic safety and survival skills, including proper insulin administration and adequate monitoring of blood sugars. Information should be introduced slowly, repeated often, and given based on the child's developmental age.

Question 7

The nurse has been providing care for the past month to a 7-year-old client recently diagnosed with type 1 diabetes mellitus.  Initially, the family seemed devastated about the diagnosis and the client's parent stated, "Our lives will never be the same."  Which statement made by the parent indicates that nursing interventions and education have been effective?

Accepted Answer

Parents experience a variety of emotions when a child is diagnosed with a chronic illness (eg, diabetes mellitus). Reactions include shock, denial, helplessness, anger, fear, anxiety, and often guilt about perceived contribution or failure to prevent the development of the disease. Parents' emotional response, adaptation, and coping strategies impact the child's perception of self and ability to manage the disease. In providing diabetes education, the nurse should emphasize that with planning and preparation, diabetes can be managed and controlled and the child can resume regular day-to-day activities and have an independent life (Option C). (Option A) Clients with diabetes can participate in a wide variety of sports and should continue pursuing age-appropriate physical activities. (Option B) The diagnosis and management of diabetes in a child can affect the whole family; however, the word "sacrifice" suggests that the parent is feeling victimized by the disease. (Option D) Nutritional management of diabetes does not require special foods. Nutrition education should emphasize healthy food choices, consistent amounts of carbohydrates, and a balance of food choices, with insulin and exercise for blood glucose control. Educational objective: The diagnosis of a chronic illness (eg, diabetes) in a child will have an impact on the entire family. When parents see themselves and the child as capable of being independent and in control of the disease, there is an increased likelihood that the disease will be managed and controlled and the child can have an independent life.

Question 8

A 3-month-old who weighs 8.8 lb (4 kg) has just returned to the intensive care unit after surgical repair of a congenital heart defect. Which finding by the nurse should be reported immediately to the health care provider?

Accepted Answer

Chest tubes may be placed during cardiac surgery to help drain fluid and air and to ensure room for lung expansion. The chest tube and chamber should be assessed every hour for color and quantity of drainage. Drainage >3 mL/kg/hr for 3 consecutive hours or >5-10 mL/kg in 1 hour should be reported immediately to the health care provider (Option A). This could indicate postoperative hemorrhage and requires immediate intervention. Cardiac tamponade can develop rapidly in children and can be life-threatening. This child weighs 4 kg and an output of 50 mL in 1 hour is excessive. (Option B) For infants age 1-12 months, the normal heart rate is 90-160/min. (Option C) Hypothermia is common after surgery. Warmers may be used to correct the client's temperature. (Option D) Hourly urine output should be measured in the postoperative infant. A urinary catheter is often placed during surgery, allowing for accurate measurement. Urine output should be 1-2 mL/kg/hr. Educational objective: The nurse should immediately report chest tube drainage >3 mL/kg/hr over 3 consecutive hours or >5-10 mL/kg over 1 hour, which could indicate postoperative hemorrhage. Cardiac tamponade can occur rapidly in children and can be life-threatening.

Question 9

Which of the following statements made by the mother of a child recently diagnosed with celiac disease indicates a need for further teaching?

Accepted Answer

The following are important principles to teach clients with celiac disease: All gluten-containing products should be eliminated from the diet. These include wheat, barley, rye, and oats. Rice, corn, and potatoes are gluten free and are allowed on the diet. Processed foods (eg, chocolate candy, hot dogs) may contain "hidden" sources of gluten such as modified food starch, malt, and soy sauce. Food labels should indicate that the product is gluten free. Clients will need to be on a gluten-free diet for the rest of their lives. Eliminating gluten from the diet reduces the risk of nutritional deficiencies and intestinal cancer (lymphoma). Eating even small amounts of gluten will damage the intestinal villi although the client may have no clinical symptoms. All sources of gluten must be eliminated from the diet (Option C). Educational objective: All sources of gluten must be eliminated from the diet of a client with celiac disease; consuming small amounts, even in the absence of clinical symptoms, will increase the risk of damage to the intestinal villi. Clients can have foods containing rice, corn, and potatoes. They should read food labels and follow the diet for the rest of their lives.

Question 10

When monitoring an infant with a left-to-right-sided heart shunt, which findings would the nurse expect during the physical assessment? Select all that apply.

Accepted Answer

11ecbb05_ca9b_0454_b433_ff46538b62d6_MD0009_00 Congenital heart defects that cause blood to shunt from the higher pressure left side of the heart to the lower pressure right side (eg, patent ductus arteriosus, atrial septal defect, ventricular septal defect) increase pulmonary blood flow. Left-to-right shunting results in pulmonary congestion, causing increased work of breathing and decreased lung compliance. Compensatory mechanisms (eg, tachycardia, diaphoresis) result from sympathetic stimulation. Clinical manifestations of acyanotic defects may include: Tachypnea Tachycardia, even at rest Diaphoresis during feeding or exertion (Option C) Heart murmur or extra heart sounds (Option D) Signs of congestive heart failure Increased metabolic rate with poor weight gain (Option E) (Option A) Clubbing of the fingertips is associated with chronic hypoxia caused by decreased pulmonary circulation as occurs with right-to-left heart defects. (Option B) Right-to-left congenital heart defects (eg, cyanotic defects) impede pulmonary blood flow (eg, tetralogy of Fallot, transposition of the great vessels) and cause cyanosis, which is evident shortly after birth and during periods of physical exertion. Educational objective: Left-to-right cardiac shunts (eg, patent ductus arteriosus, atrial septal defect, ventricular septal defect) result in excess blood flow to the lungs. Manifestations include heart murmur, poor weight gain, diaphoresis with exertion, and signs of heart failure.

Question 11

The nurse is providing discharge instructions to the parent of a child with Kawasaki disease. The nurse informs the parent that the presence of which symptom should be immediately reported to the health care provider?

Accepted Answer

Kawasaki disease (KD) is a systemic vasculitis of childhood that presents with ≥5 days of fever, nonexudative conjunctivitis, lymphadenopathy, mucositis, hand and foot swelling, and a rash. First-line treatment consists of IV immunoglobulin and aspirin to prevent coronary artery aneurysms. When children with KD are discharged home, parents are instructed to monitor them for fever by checking the temperature (orally or rectally) every 6 hours for the first 48 hours following the last fever. Temperature should also be checked daily until the follow-up appointment. If the child develops a fever, the health care provider should be notified as this may indicate the acute phase of KD recurrence. The child may require additional treatment with IV immunoglobulin to prevent development of coronary artery aneurysms and occlusions. (Option B) Irritability is a hallmark finding in a child with KD, especially during the acute phase (due to fever and inflammation). Parents should be advised that irritability can last up to 2 months. (Option C) Temporary joint pain and other manifestations of arthritis (eg, stiffness, decreased range of motion) may occur and persist for several weeks. Parents should be informed that range of motion exercises and warm baths will help reduce these symptoms and minimize discomfort. (Option D) Desquamation (skin peeling) of the hands and feet is an expected finding in KD. Parents should be informed that the peeling itself is not painful but that the new skin underneath may be red and sore. Educational objective: Once children with KD are discharged home, parents should be instructed to check their temperature every 6 hours for the first 48 hours following the last fever and then daily until the follow-up visit. The health care provider should be notified if the child has fever as this may indicate a need for further treatment.

Question 12

The nurse is reinforcing education to the caregivers of a 9-year-old client diagnosed with scarlet fever.  The client has a history of type 1 diabetes mellitus.  Which statement by the caregivers indicates that further teaching is needed?

Accepted Answer

An acute illness (eg, scarlet fever) in clients with type 1 diabetes may trigger the release of stress hormones, which leads to higher blood glucose and ketone levels (sometimes leading to ketoacidosis). Clients with type 1 diabetes do not produce any insulin (unlike those with type 2 diabetes), so clients should not skip administration of external insulin even if not eating. Insulin therapy should be continued as prescribed during an acute illness (Option D). Additional sick-day management includes: Increasing frequency of blood glucose level checks (every 1-4 hours) Increasing or decreasing the dose of insulin as needed based on blood glucose levels Maintaining adequate hydration Testing for urinary ketones frequently (Options A and C) Stress hormones released during illness cause increased insulin resistance and lead the body to break down fat for energy. Ketones are produced when fat is broken down, which can lead to diabetic ketoacidosis (DKA). The client's urine should be monitored frequently for ketones while the client is sick. Fluids are encouraged to clear ketones from the system and prevent dehydration. (Option B) Blood glucose should be assessed frequently while the client is ill due to the potentially unpredictable and rapidly changing levels caused by illness and/or fasting. Educational objective: Clients with type 1 diabetes should not discontinue insulin usage during an illness. Encouraging fluids and monitoring glucose and ketone levels are priorities for this client.

Question 13

A nurse is assessing a 1-month-old infant with an atrial septal defect (ASD).  Which assessment finding does the nurse expect?

Accepted Answer

11ecbb05_ca97_d001_b433_8f558333352d_MD0009_00 The nurse would expect to hear a murmur with an atrial septal defect. This defect is an abnormal opening between the right and left atria, allowing blood from the higher pressure left atrium to flow into the lower pressure right atrium. The back-and-forth flow of blood between the 2 chambers causes a vibration that is heard as a murmur on auscultation. ASD has a characteristic systolic murmur with a fixed split second heart sound. Some clients may also have a diastolic murmur. (Option A) Muffled heart tones are not typical in ASD. Muffled heart tones that are heard postsurgical intervention are concerning for cardiac tamponade. (Option C) Atrial and ventricular septal defects are acyanotic congenital heart defects because the blood from the high pressure left side (oxygenated blood) goes to the low pressure right side. (Option D) Weak lower and strong upper extremity pulses are present in coarctation of the aorta. Educational objective: In a child with atrial septal defect, the nurse would expect to hear a heart murmur on auscultation of heart sounds.

Question 14

A nurse is teaching the parents of an infant with tetralogy of Fallot. Which of the following actions should the nurse include to reduce the incidence of hypercyanotic spells? Select all that apply.

Accepted Answer

11ecbfba_3717_c701_8458_39836670f0df_MD0009_11Tetralogy of Fallot is a complex heart defect that results in decreased pulmonary blood flow, mixing of oxygenated and unoxygenated blood, and inadequate blood flow into the left side of the heart. Hypercyanotic episodes (ie, "tet" spell) occur when unoxygenated blood enters the systemic circulation, resulting in cyanosis and hypoxemia. Tet spells usually occur during stressful or painful procedures; on waking; and with hunger, crying, and feeding. Home interventions to reduce the incidence of tet spells include: Providing a calm environment, particularly on waking (Option C) Soothing and quieting the infant when crying or distressed Offering a pacifier (Option B) Swaddling or holding the infant during procedures or times of stress (Option D) Providing frequent smaller feedings to reduce frustration due to hunger and limit sucking fatigue (Option A) During an acute tet spell, the infant may be placed in the knee-chest position to improve pulmonary blood flow by increasing systemic vascular resistance; older children may assume a squatting position. Intermittent oxygen can also be used to treat the spell, if necessary. (Option E) Tet spells occur more often during stressful situations or on waking, so sleep should not be interrupted whenever possible. Educational objective: Hypercyanotic or tet spells usually occur during stressful or painful procedures; on waking; and with hunger, crying, and feeding. Providing a calm environment; reducing hunger with small, frequent meals; and swaddling during procedures can help prevent hypercyanotic spells.

Question 15

A nurse is caring for a 1-month-old client who is being evaluated for congenital hypothyroidism. The nurse should recognize which of the following as clinical manifestations of hypothyroidism in infants? Select all that apply.

Accepted Answer

11ecbb05_ca9e_1198_b433_0759a521436e_MD0009_00 11ecbb05_ca9e_1199_b433_0da41195adab_MD0009_00 Congenital hypothyroidism occurs when abnormal development of the thyroid gland causes complete or decreased secretion of thyroid hormone (TH). Untreated hypothyroidism can cause severe intellectual disability in infants if undetected. Screening occurs after birth for all infants in the United States and Canada to prevent disability and encourage early treatment (ie, levothyroxine). TH plays an important role in growth, development, and regulation of many bodily functions (eg, heat production, muscle tone, skin function, cardiac function, metabolism). Clinical manifestations in affected infants reflect the pathophysiology of decreased TH and may include: Difficulty awakening, lethargy, or hyporeflexia due to alterations in central nervous system function (Option A) Dry skin due to alterations in skin function (Option B) Hoarse cry caused by swelling of the vocal cords due to fluid retention (Option D) Constipation due to slowed metabolism Bradycardia due to the effect of TH on cardiac function (Options C and E) Hyperthyroidism (Graves disease) is an autoimmune condition related to increased production of TH. Neonatal Graves disease is uncommon and usually occurs secondary to maternal hyperthyroidism. Tachycardia and increased bowel motility (frequent or loose stools) are features of hyperthyroidism and are related to an increase in metabolic processes. Educational objective: Congenital hypothyroidism is a partial or complete loss of thyroid function that affects growth, development, and regulation of bodily functions. Clinical manifestations in affected infants may include dry skin, hoarse cry, or difficulty awakening beginning a few months after birth. If untreated, intellectual disability may occur.

Question 16

The nurse is assisting with an education conference for graduate nurses about infant CPR. Which of the following statements are appropriate to include in the teaching? Select all that apply.

Accepted Answer

11ecbb05_ca9b_7985_b433_95e04e53f898_MD0009_00 Although rare, cardiac arrest in infants can occur and usually stems from a respiratory etiology. The American Heart Association provides guidelines for basic life support of infants (<12 months), including certain CPR modifications (eg, the location of pulse check) and the timing of emergency services notification and retrieval of the automatic external defibrillator (AED). The rescuer should check the infant's brachial pulse for no longer than 10 seconds (Option E). During an unwitnessed collapse, a single rescuer should shout for nearby help, activate the emergency response system (eg, call emergency services via mobile device if located outside a health care setting), and then provide approximately 2 minutes of CPR at a rate of at least 100 compressions/min before retrieving the AED (Option A). brachial pulse (Option B) The rescuer should deliver chest compressions to an infant at a depth equal to one-third of the chest's anterior-posterior diameter (ie, ~1.5 in [4 cm]) and allow for recoil between compressions. (Option C) The rescuer should perform infant chest compressions using either two fingers or two thumbs on the sternum just below the nipple line. (Option D) Single rescuers performing infant CPR should use a 30:2 compression-to-breath ratio. A compression-to-breath ratio of 15:2 is used when two rescuers are involved. Educational objective: The American Heart Association provides guidelines for basic life support of infants, including initial client evaluation (eg, assess brachial pulse) and retrieval of automatic external defibrillator (ie, after 2 min of CPR during an unwitnessed collapse with a single rescuer).

Question 17

The nurse is caring for a newborn with patent ductus arteriosus.  Which assessment finding should the nurse expect?

Accepted Answer

11ecbb05_ca99_cbd2_b433_dba1d73c96b5_MD0009_00 Patent ductus arteriosus (PDA) is an acyanotic congenital defect more common in premature infants. When fetal circulation changes to pulmonary circulation outside the womb, the ductus arteriosus should close spontaneously. This closure is caused by increased oxygenation after birth. If a PDA is present, blood will shunt from the aorta back to the pulmonary arteries via the opened ductus arteriosus. Many newborns are asymptomatic except for a loud, machine-like systolic and diastolic murmur. The PDA will be treated with surgical ligation or IV indomethacin to stimulate duct closure. (Option A) A harsh systolic murmur is heard in the setting of ventricular septal defect, an opening between the ventricles of the heart. Ventricular septal defect is an acyanotic defect. (Option C) A diastolic murmur is heard in mitral stenosis and aortic regurgitation but not in PDA. (Option D) A systolic ejection murmur is heard in pulmonic stenosis. Right ventricular hypertrophy will develop if this defect is not repaired. In adults, systolic ejection murmur is usually due to aortic stenosis. Educational objective: The ductus arteriosus of a newborn should close spontaneously when fetal circulation changes to pulmonary circulation. If the ductus arteriosus remains open, blood will shunt from the aorta to the pulmonary arteries. The child will be acyanotic but will have a machine-like murmur heard on both systole and diastole.

Question 18

A 6-year-old client was diagnosed with type 1 diabetes mellitus 2 years ago. The nurse would like to encourage the client to participate in disease management. Which of the following diabetes care tasks are appropriate for the child to perform? Select all that apply.

Accepted Answer

The nurse should offer school-aged children (age 6-12) as much opportunity as possible to participate in care to promote psychosocial development (industry versus inferiority) and provide a sense of control. Parents should transfer management of care to the child in small steps based on the child's skill level and cognitive ability. School-aged children are in the concrete operational stage of development and are most successful performing simple, concrete tasks with a limited number of steps. Appropriate diabetes management tasks for school-aged children include: Choosing and cleaning a finger for blood glucose testing before a parent or caregiver performs the puncture (Option C) Selecting the site for insulin injection, with a parent or caregiver verifying appropriate site rotation (Option A) Pushing the syringe plunger to administer insulin after a parent or caregiver inserts the needle (Option B) Identifying signs and symptoms of hypoglycemia and hyperglycemia (Option E) (Option D) Adjusting insulin doses based on glucose readings is too complicated for school-aged children, and mistakes can be life-threatening. Children develop the cognitive ability to analyze test results and adjust insulin doses at approximately age 14. Educational objective: Children should participate in their diabetes management. The school-aged child can choose and clean a finger for a blood glucose reading, select the insulin injection site, push the plunger to administer insulin after parents or caregivers insert the needle, and identify signs of hypoglycemia and hyperglycemia.

Question 19

The nurse has received report on 4 pediatric clients on a telemetry unit. Which client should the nurse assess first?

Accepted Answer

11ecbb05_ca9a_4103_b433_59854088fd56_MD0009_00 Ventricular septal defect (VSD) is a congenital abnormality in which a septal opening between ventricles causes left-to-right shunting, leading to excess blood flow to the lungs. This places the client at risk for congestive heart failure (CHF) and pulmonary hypertension. Clinical manifestations of VSD include a systolic murmur auscultated near the sternal border at the third or fourth intercostal spaces, and hallmark CHF signs (eg, diaphoresis, tachypnea, dyspnea). The client is currently showing signs of increased respiratory exertion (eg, grunting) and requires further assessment for CHF (Option B). (Option A) Coarctation of the aorta (COA) is an abnormal aortic narrowing that results in decreased cardiac output. The client will exhibit elevated pulse pressure in the upper extremities and diminished pressures in the lower extremities. Further assessment is needed, but this client is not the current priority. (Option C) A systolic murmur with a machine sound and poor feeding are expected, nonurgent findings in clients with patent ductus arteriosus (PDA). PDA commonly resolves within 48 hours and requires no intervention in full-term newborns. (Option D) Tetralogy of Fallot (TOF) is a cyanotic congenital heart defect commonly manifested by signs of irritability and clubbing of fingers due to oxygen saturation chronically remaining between 65-85% until the client can undergo surgical repair. Further evaluation of the client's oxygenation is necessary but not urgently required. Educational objective: Ventricular septal defect is a cardiac abnormality, with a septal opening between ventricles, that may progress to congestive heart failure (CHF). The client should be closely monitored for respiratory exertion and signs of CHF (eg, dyspnea, tachypnea).

Question 20

The school nurse is caring for 4 clients with type 1 diabetes mellitus. Which of these clients should the nurse assess first?

Accepted Answer

11ecbb05_ca9d_9c67_b433_cb6a83e95a3f_MD0009_00 Hypoglycemia (blood glucose <70 mg/dL [3.9 mmol/L]) presents an immediate danger to the client as life-threatening neurologic impairment (eg, lethargy, seizures, coma) can occur when the brain becomes glucose depleted. If a client with diabetes has symptoms of hypoglycemia (eg, sweating, irritability, tremor, tachycardia, hunger), the nurse should immediately assess the client, check capillary blood glucose, and provide a simple carbohydrate snack that can be digested rapidly (eg, juice, soft drink, candy) (Option C). (Option A) A client with blood glucose of 71 mg/dL (3.9 mmol/L) should be monitored for hypoglycemia; blood glucose should be reassessed within 30 minutes. However, a client displaying symptoms of hypoglycemia should be assessed first. (Option B) Skipping a meal could cause a client with diabetes to become hypoglycemic. The nurse should assess the client and redirect the client to eat; however, this client is not the highest priority. (Option D) Insulin glargine (Lantus) is a long-acting (basal) insulin with a duration of 24 hours. It has no peak and is not used to correct acute hyperglycemic events. This medication should be given as close to the scheduled time as possible, but this client does not take priority over a client with symptomatic hypoglycemia. Educational objective: A client with symptoms of hypoglycemia (eg, sweating, irritability, tremor, tachycardia, hunger) should be assessed immediately. Without treatment, hypoglycemia may progress to life-threatening neurologic impairment (eg, lethargy, seizures, coma) as the brain becomes glucose depleted.

Exam 2: Child Health

An 8-month-old infant is scheduled for a femorally inserted balloon angioplasty of a congenital pulmonic stenosis in the cardiac catheterization laboratory. Which finding should the nurse report to the health care provider that could possibly delay the procedure?

The nurse is planning care for a child being admitted with Kawasaki disease and should give priority to which nursing intervention?

The school nurse evaluates a 9-year-old who is sweating, trembling, and pale. The client has type 1 diabetes managed with insulin glargine and NPH. What is the most appropriate action by the nurse?

The home health nurse is visiting an infant who recently had surgery to repair tetralogy of Fallot. Which of the following signs of heart failure should the nurse teach the parents to report to the health care provider? Select all that apply.

A nurse is assisting a new mother as she is breastfeeding her infant. The infant has been diagnosed with tetralogy of Fallot. During feeding, the infant becomes cyanotic and is having difficulty breathing. What should be the nurse's first action?

The nurse is planning a client care conference with the parents of a 3-year-old with newly diagnosed type 1 diabetes mellitus. What is the priority outcome for the caregivers?

A 3-month-old who weighs 8.8 lb (4 kg) has just returned to the intensive care unit after surgical repair of a congenital heart defect. Which finding by the nurse should be reported immediately to the health care provider?

Which of the following statements made by the mother of a child recently diagnosed with celiac disease indicates a need for further teaching?

When monitoring an infant with a left-to-right-sided heart shunt, which findings would the nurse expect during the physical assessment? Select all that apply.

The nurse is providing discharge instructions to the parent of a child with Kawasaki disease. The nurse informs the parent that the presence of which symptom should be immediately reported to the health care provider?

The nurse is reinforcing education to the caregivers of a 9-year-old client diagnosed with scarlet fever. The client has a history of type 1 diabetes mellitus. Which statement by the caregivers indicates that further teaching is needed?

A nurse is assessing a 1-month-old infant with an atrial septal defect (ASD) . Which assessment finding does the nurse expect?

A nurse is teaching the parents of an infant with tetralogy of Fallot. Which of the following actions should the nurse include to reduce the incidence of hypercyanotic spells? Select all that apply.

A nurse is caring for a 1-month-old client who is being evaluated for congenital hypothyroidism. The nurse should recognize which of the following as clinical manifestations of hypothyroidism in infants? Select all that apply.

The nurse is assisting with an education conference for graduate nurses about infant CPR. Which of the following statements are appropriate to include in the teaching? Select all that apply.

The nurse is caring for a newborn with patent ductus arteriosus. Which assessment finding should the nurse expect?

A 6-year-old client was diagnosed with type 1 diabetes mellitus 2 years ago. The nurse would like to encourage the client to participate in disease management. Which of the following diabetes care tasks are appropriate for the child to perform? Select all that apply.

The nurse has received report on 4 pediatric clients on a telemetry unit. Which client should the nurse assess first?

The school nurse is caring for 4 clients with type 1 diabetes mellitus. Which of these clients should the nurse assess first?