PEDS Final and HESI

PEDS Final and HESI Already Rated A+ CNS, Cardio, Endocrine, Child Abuse, Ortho Ans- Topics covered on final on Thursday Which medications would the nurse expect the primary health care provider to prescribe for the patient who has symptoms of a butterfly rash across the nose and cheeks, seizures, esophageal dysfunction, nephrotic syndrome, abdominal pain, headache, and nausea? Aspirin Naproxen Azathioprine Methotrexate Indomethacin Ans- Azathioprine Methotrexate Methotrexate and azathioprine are effective immunosuppressive drugs used to treat systemic lupus erythematosus. 1. Differentiate between a right-to-left and a left-to-right shunt in cardiac disease. Ans- 1. A right-to-left shunt bypasses the lungs and delivers unoxygenated blood to the systemic circulation, causing cyanosis. A left-to-right shunt moves oxygenated blood back through the pulmonary circulation. 2. List the four defects associated with tetralogy of Fallot. Ans- 2. VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy 3. List the common signs of cardiac problems in an infant. Ans- 3. Poor feeding, poor weight gain, respiratory distress and infections, edema, and cyanosis 4. What are the two objectives in treating CHF? Ans- 4. Reduce the workload of the heart and increase cardiac output. 5. Describe nursing interventions to reduce the workload of the heart. Ans- 5. Give small, frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutral thermal environment. Organize activities to disturb child only as indicated. 6. What position would best relieve the child experiencing a tet spell? Ans- 6. Knee-chest position or squatting 7. What are the common signs of digoxin toxicity? Ans- 7. Diarrhea, fatigue, weakness, nausea, and vomiting; the nurse should check for bradycardia before administration 8. List five risks in cardiac catheterization. Ans- 8. Arrhythmia, bleeding, perforation, phlebitis, and obstruction of the arterial entry site 9. What cardiac complications are associated with rheumatic fever? Ans- 9. Aortic valve stenosis and mitral valve stenosis 10. What medications are used to treat rheumatic fever? Ans- 10. Penicillin, erythromycin, and aspirin 1. How is congenital hypothyroidism diagnosed? Ans- 1. Newborn screening revealing a low T4 and a high TSH 2. What are the symptoms of congenital hypothyroidism in early infancy? Ans- 2. Large, protruding tongue; coarse hair; lethargy; sleepiness; and constipation 3. What are the outcomes of untreated congenital hypothyroidism? Ans- 3. Mental retardation and growth failure 4. What are the metabolic effects of PKU? Ans- 4. CNS damage, mental retardation, and decreased melanin 5. What two formulas are prescribed for infants with PKU? Ans- 5. Lofenalac and Phenex-1 6. List foods high in phenylalanine. Ans- 6. Meat, milk, dairy products, and eggs 7. What are the three classic signs of diabetes? Ans- 7. Polydipsia, polyphagia, and polyuria 236 8. Differentiate the signs of hypoglycemia and hyperglycemia. Ans- 8. Hypoglycemia: tremors, sweating, headache, hunger, nausea, lethargy, confusion, slurred speech, anxiety, tingling around mouth, nightmares. Hyperglycemia: polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, and syncope 9. Describe the nursing care of a child with ketoacidosis. Ans- 9. Provide care for an unconscious child, administer regular insulin IV in normal saline, monitor blood gas values, and maintain strict I&O. 10. Describe developmental factors that would affect the school-age child with diabetes. Ans- 10. Need to be like peers; assuming responsibility for own care; modification of diet; snacks and exercise in school 11. What is the relationship between hypoglycemia and exercise? Ans- 11. During exercise, insulin uptake is increased and the risk for hypoglycemia occurs. HESI hint Ans- Fractures in older children are common because they fall during play and are involved in motor vehicle accidents. • Spiral fractures (caused by twisting) and fractures in infants may be related to child abuse. • Fractures involving the epiphyseal plate (growth plate) can have serious consequences in terms of the growth of the affected limb. 5 P's of signs of ischemia Ans- The five Ps (may indicate the presence of ischemia): 1. Pain 2. Pallor 3. Pulselessness 4. Paresthesia 5. Paralysis 1. Positive Ortolani sign Ans- ("clicking" with abduction; is the sound heard when the health care provider maneuvers the femoral head and it slips back into the acetabulum) Tx for transposition of the great arteries Ans- PROSTAGLANDINS Tx for hypoplastic left heart syndrome Ans- PROSTAGLANDINS Kawasaki Disease S/Sx Ans- High fever that lasts longer than 5 days Swollen lymph nodes in the neck A rash on the mid-section and genital area Red, dry, cracked lips and a red, swollen tongue Red, swollen palms of the hands and soles of the feet Redness of the eyes Acquired CV Disorders Ans- BACTERIAL ENDOCARDITIS ACUTE RHEUMATIC FEVER The Foley Family is caring for their youngest child, Justin, who is suffering from tetralogy of Fallot. Which of the following are defects associated with this congenital heart condition? Aorta exits from the right ventricle, pulmonary artery exits from the left ventricle, and two noncommunicating circulations Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy Coarctation of aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus Tricuspid valve atresia, atrial septal defect, ventricular septal defect, and hypoplastic right ventricle AnsVentricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy Bryce is a child diagnosed with coarctation of aorta. While assessing him, Nurse Zach would expect to find which of the following? Squatting posture Absent or diminished femoral pulses Severe cyanosis at birth Cyanotic ("tet") episodes Ans- Absent or diminished femoral pulses Which of the following instructions would Nurse Courtney include in a teaching plan that focuses on initial prevention for Sheri who is diagnosed with rheumatic fever? Treating streptococcal throat infections with an antibiotic Giving penicillin to patients with rheumatic fever Using corticosteroid to reduce inflammation Providing an antibiotic before dental work Ans- Treating streptococcal throat infections with an antibiotic The ductus arteriosus is another fetal structure that is important in the intrauterine life. It functions to: Shunts the combined cardiac output from the pulmonary artery to the aorta going to the lungs Shunts the combined cardiac output from the pulmonary artery to the systemic circulation Shunts the combined cardiac output from the aorta to the pulmonary artery and later to the pulmonary veins Shunts the combined cardiac output from the aorta to the pulmonary artery to the right ventricle AnsShunts the combined cardiac output from the pulmonary artery to the systemic circulation The healthcare provider has an order to administer indomethacin to an infant with a patent ductus arteriosus. Which intervention is a priority to implement? Assess peripheral pulses Auscultate lung sounds Monitor urine output Monitor heart rate and rhythm Ans- Monitor urine output. One function of endogenous prostaglandins is the maintenance of glomerular filtration, so the healthcare provider will want to ensure there is adequate urine output when giving this drug. The drug should be discontinued if there is a dramatic decrease in urine output. A 30-year-old patient with a congenital atrial septal defect has lived with the defect without significant problems until now. Which of the following is an indication that the patient is becoming hemodynamically symptomatic? Bronchoconstriction and wheezing Exertional dyspnea Intermittent claudation Blood pressure 140/90 Ans- Exertional dyspnea Because blood is shunted from left to right, pulmonary blood flow is increased. Pulmonary arteries become enlarged, and increased pulmonary pressure can result in pulmonary edema which interfes with gas exchange, especially when the patient is active. A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called _____________________. Ans- tetrallogy of falot machine like murmur Ans- patent ductus arteriosis A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. ... Ans- 1. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk for digoxin toxicity A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has _____________________. Ans- Kawasaki Disease Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA). Ans- 1, 2, 4, 6. 1. TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 4. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 6 TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta Patent ductus arteriosus causes what type of shunt? _____________________ Ans- Left to right. Blood flows from the higher pressure aorta to the lower pressure pulmonary artery, resulting in a left to right shunt Indomethacin may be given to close which congenital heart defect (CHD) in newborns? _____________________ Ans- Patent ductus arteriosus or PDA. Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome. Ans- 14. 1, 2, 3. 1. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 2. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 3. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. What associated manifestation might the nurse occasionally find in a child diagnosed with Wilms tumor? 1. Atrial fibrillation. 2. Hypertension. 3. Endocarditis. 4. Hyperlipidemia. Ans- Hypertension. 2. Because Wilms tumor sits on the kidney, it can be associated with secondary hypertension. It does not affect or cause the other conditions. The _____________________ serves as the septal opening between the atria of the fetal heart. Ansforamen ovale Which vaccines must be delayed for 11 months after the administration of gamma globulin? Select all that apply. 1. Diphtheria, tetanus, and pertussis. 2. Hepatitis B. 3. Inactivated polio virus. 4. Measles, mumps, and rubella. 5. Varicella. Ans- 4,5 4. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months. 5. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months What can an electrocardiogram (ECG) detect? Select all that apply. 1. Ischemia. 2. Injury. 3. Cardiac output (CO). 4. Dysrhythmias. 5. Systemic vascular resistance (SVR). 6. Occlusion pressure. 7. Conduction delay. Ans- 1, 2, 4, 7. 1. An electrocardiogram can indicate ischemia of the heart muscle. 2. An electrocardiogram can indicate injury to the heart muscle. 4. An electrocardiogram can show dysrhythmias. 7. An electrocardiogram does show conduction delays. A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________. Ans- patent ductus arteriosis The Norwood procedure is used to correct: 1. Transposition of the great vessels. 2. Hypoplastic left heart syndrome. 3. Tetralogy of Fallot (TOF). 4. Patent ductus arteriosus (PDA). Ans- 2. The Norwood procedure is specific to hypoplastic left heart syndrome The flow of blood through the heart with an atrial septal defect (ASD) is _____________________. AnsLeft to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF). Ans- 3. With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lowerthan- expected BP and weak pulses in the lower extremities. The most common cardiac dysrhythmia in pediatrics is: 1. Ventricular tachycardia. 2. Sinus bradycardia. 3. Supraventricular tachycardia. 4. First-degree heart block. Ans- 3. SVT Which of the following is an initial sign of carditis in a child diagnosed with rheumatic fever? Anterior chest wall pain Irregular heart rhythm Heart murmur Low blood pressure Ans- Heart murmur Doll's head maneuver Ans- Elicited by rotating the child's head quickly to one side and then to the other. Conjugate (paired or working together) movement of the eyes in the direction opposite to the head rotation is normal. Absence of this response suggests dysfunction of the brainstem or oculomotor nerve (CN III). Key reflexes that demonstrate neurologic health in youn