The Child with Cardiovascular and Hematologic Health Problems
Quiz
Which of the following nursing diagnoses would the nurse identify as the priority for a 4-year-old child diagnosed with a ventricular septal defect who will be undergoing a cardiac catheterization?
Pain related to the structural defect.
Deficient Knowledge (parental) related to cardiac catheterization.
Risk for Infection related to decreased oxygenation.
Decreased Cardiac Output related to the structural defect
When developing the plan of care for a 3-year-old child diagnosed with ventricular septal defect, the nurse would include actions that foster the development of which of the following psychosocial tasks according to Erikson?
Autonomy versus shame and doubt.
Identity versus role diffusion.
Initiative versus guilt.
Industry versus guilt.
When teaching the parents of a child with a ventricular septal defect who is scheduled for a cardiac catheterization, the nurse explains that this procedure involves the use of which of the following?
Ultra-high-frequency sound waves.
Catheter placed in the right femoral vein.
Cutdown procedure to place a catheter.
General anesthesia
When developing the discharge teaching plan for the parents of a child who has undergone a cardiac catheterization for ventricular septal defect, which of the following would the nurse expect to include?
Restriction of the child's activities for the next 3 weeks.
Use of sponge baths until the stitches are removed.
Use of prophylactic antibiotics before receiving any dental work.
Maintenance of a pressure dressing until a return visit with the physician.
A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/minute. Which of the following actions would the nurse do first?
Obtain an order for sedation for the child.
Assess for an irregular heart rate and rhythm.
Explain to the child that it will only hurt for a short time.
Place the child in a knee-to-chest position.
When teaching a child how to perform coughing and deep-breathing exercises before corrective surgery for tetralogy of Fallot, which of the following teaching and learning principles would the nurse address first?
Organizing information to be taught in a logical sequence.
Arranging to use actual equipment for demonstrations.
Building the teaching on the child's current level of knowledge.
Presenting the information in order from simplest to most complex.
When planning care for a child before corrective surgery for tetralogy of Fallot, which of the following would the nurse identify as the priority nursing diagnosis?
Ineffective Coping related to upcoming surgery and complications.
Pain related to surgical incision required to correct the defect.
Deficient Knowledge related to upcoming surgery and postoperative events.
Impaired Gas Exchange related to structural cardiac defect.
When assessing a child after heart surgery to correct tetralogy of Fallot, which of the following would alert the nurse to suspect a low cardiac output?
Bounding pulses and mottled skin.
Altered level of consciousness and thready pulse.
Capillary refill of 2 seconds and blood pressure of 96/67 mm Hg.
Extremities warm to the touch and pale skin.
When developing the teaching plan for the parents of a child who has had open heart surgery to repair tetralogy of Fallot with a patch, which of the following would the nurse expect to include?
Antibiotic therapy administration before any invasive procedures.
Intake of at least 10 glasses of water per day before the next appointment.
Need for frequent nap and rest periods for the first 4 weeks at home.
Restriction of ingestion of bananas and citrus fruits.
Which of the following would the nurse expect to include in the plan of care for a child diagnosed with tetralogy of Fallot who has undergone corrective surgery?
Two to 3 g of sodium in the diet each day.
Physical activity restrictions.
Visits limited to a selected few.
Assignment to an isolation room.
After surgery to correct tetralogy of Fallot, the child's parents express concern to the nurse that their 4-year-old child wants to be held more frequently than usual. The nurse interprets the child's behavioral response to stress as which of the following?
Repression.
Depression.
Regression.
Discomfort.
The mother of a child diagnosed with tetralogy of Fallot who is hospitalized tells the nurse that the child's 3-year-old sibling has become quiet and shy and demonstrates more than the usual amount of sexual curiosity since her other child has been hospitalized. The nurse responds to the mother based on the interpretation that these behaviors reflect which of the following?
Usual behavior for a 3-year-old.
Need for more attention.
Exposure to a sexual experience.
Indication of depression.
Which of the following would the nurse expect to include in the plan of care for a child who is diagnosed with rheumatic fever and carditis and admitted to the hospital?
Ensuring continuous parental presence at the child's bedside.
Providing the child with periods of rest.
Encouraging participation in age-appropriate activities.
Advising the child to eat as much as possible.
Which of the following outcomes indicates that the activity restriction necessary for a 7-year-old child with rheumatic fever during the acute phase has been effective?
Joints demonstrate absence of permanent injury.
The resting heart rate is between 60 and 100 bpm.
The child exhibits a decrease in chorea movements.
The subcutaneous nodules over the joints are no longer palpable.
Which of the following initial physical findings would indicate the development of carditis in a child with rheumatic fever?
Heart murmur.
Low blood pressure.
Irregular pulse.
Anterior chest wall pain.
The physician orders pulse assessment several times through the night for a child with rheumatic fever who has a daytime heart rate of 120 bpm. The nurse explains to the mother that the primary reason for obtaining a sleeping pulse rate is to ensure that the elevation in the child's pulse rate is unrelated to which of the following?
Morning dose of digitalis.
Normal activity during waking hours.
Warmer environment during the day than at night.
Variations in pulse rates obtained during day and evening hours.
Which of following would the nurse perform to help alleviate a child's joint pain associated with rheumatic fever?
Maintaining the joints in an extended position.
Applying gentle traction to the child's affected joints.
Supporting proper alignment with rolled pillows.
Using a bed cradle to avoid the weight of bed linens on joints.
When developing the plan of care for a newly admitted 2-year-old child with the diagnosis of Kawasaki disease (KD), which of the following would be the priority?
Taking vital signs every 6 hours.
Monitoring intake and output every hour.
Minimizing skin discomfort.
Providing passive range-of-motion exercises.
A child with Kawasaki disease is receiving low dose aspirin. The mother calls the clinic and states that the child has been exposed to influenza. Which recommendations would the nurse make? Select all that apply.
Stop the aspirin.
Alternate aspirin and acetaminophen.
Watch for fever.
Weigh the child daily.
A 16-month-old child diagnosed with KD is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. Which of the following would the nurse interpret as the priority?
Applying lotion to the hands and feet.
Offering foods the toddler likes.
Placing the toddler in a quiet environment.
Encouraging the parents to get some rest.
Which of the following would the nurse include when completing discharge instructions for the parents of a 12-month-old child diagnosed with KD and being discharged to home?
Offer the child extra fluids every 2 hours for 2 weeks.
Take the child's temperature daily for several days.
Check the child's blood pressure daily until the follow-up appointment.
Call the physician if the irritability lasts for 2 more weeks.
The nurse explains to the parents of a 1-year-old child admitted to the hospital in sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following?
Autoimmune reaction complicated by hypoxia.
Lack of oxygen in the red blood cells.
Obstruction to circulation.
Elevated serum bilirubin concentration.
The mother asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse would be most appropriate?
"The placenta bars passage of the hemoglobin S from the mother to the fetus."
"The red bone marrow does not begin to produce hemoglobin S until several months after birth."
"Antibodies transmitted from you to the fetus provide the newborn with temporary immunity."
"The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."
Which of the following would the nurse identify as the priority nursing diagnosis during a toddler's vasoocclusive sickle cell crisis?
Ineffective Coping related to presence of a life-threatening disease.
Decreased Cardiac Output related to abnormal hemoglobin formation.
Pain related to tissue anoxia.
Excess Fluid Volume related to infection.
A mother asks the nurse if her child's iron-deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following?
Little is known about iron-deficiency anemia and its relationship to infection in children.
Children with iron-deficiency anemia are more susceptible to infection than are other children.
Children with iron-deficiency anemia are less susceptible to infection than are other children.
Children with iron-deficiency anemia are equally as susceptible to infection as are other children.
Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? Select all that apply.
"He drinks over three cups of milk per day."
"I can't keep enough apple juice in the house; he must drink over 10 ounces per day."
"He refuses to eat more than two different kinds of vegetables."
"He doesn't like meat, but he will eat small amounts of it."
Which of the following foods would the nurse encourage the mother to offer to her child with iron-deficiency anemia?
Rice cereal, whole milk, and yellow vegetables.
Potato, peas, and chicken.
Macaroni, cheese, and ham.
Pudding, green vegetables, and rice.
The physician has ordered several laboratory tests to help diagnose an infant's bleeding disorder. Which of the following tests, if abnormal, would the nurse interpret as most likely to indicate hemophilia?
Bleeding time.
Tourniquet test.
Clot retraction test.
Partial thromboplastin time (PTT).
A diagnosis of hemophilia A is confirmed in an infant. Which of the following instructions would the nurse provide the parents as the infant becomes more mobile and starts to crawl?
Administer one-half of a children's aspirin for a temperature higher than 101° F (38.3° C).
Sew thick padding into the elbows and knees of the child's clothing.
Check the color of the child's urine every day.
Expect the eruption of the primary teeth to produce moderate to severe bleeding.
Which of the following assessments in a child with hemophilia would lead the nurse to suspect early hemarthrosis?
Child's reluctance to move a body part.
Cool, pale, clammy extremity.
Ecchymosis formation around a joint.
Instability of a long bone on passive movement.
Because of the risks associated with administration of factor VIII concentrate, the nurse would teach the child's family to recognize and report which of the following?
Yellowing of the skin.
Constipation.
Abdominal distention.
Puffiness around the eyes.
The mother tells the nurse she will be afraid to allow her child with hemophilia to participate in sports because of the danger of injury and bleeding. After explaining that physical fitness is important for children with hemophilia, which of the following activities would the nurse suggest as ideal?
Snow skiing.
Swimming.
Basketball.
Gymnastics.
After teaching the parents of a child newly diagnosed with leukemia about the disease, which of the following descriptions given by the mother best indicates that she understands the nature of leukemia?
"The disease is an infection resulting in increased white blood cell production."
"The disease is a type of cancer characterized by an increase in immature white blood cells."
"The disease is an inflammation associated with enlargement of the lymph nodes."
"The disease is an allergic disorder involving increased circulating antibodies in the blood."
Laboratory findings indicate that a child with leukemia is also anemic. The nurse interprets this finding as most likely resulting from which of the following?
Inadequate dietary folic acid intake.
Decreased red blood cell production.
Increased destruction of red blood cells by lymphocytes.
Progressive replacement of bone marrow with scar tissue.
Which of the following statements would the nurse use to describe to the parents why their child with leukemia is at risk for infections?
Play activities are too strenuous.
Vitamin C intake is reduced over a period of time.
The number of red blood cells is inadequate for carrying oxygen.
Immature white blood cells are incapable of handling an infectious process.
Which of the following beverages would the nurse plan to give a child with leukemia if nausea should occur?
Orange juice.
Weak tea.
Plain water.
A carbonated beverage.
Which of the following medication orders to help relieve discomfort in a child with leukemia would the nurse question?
Acetaminophen (Tylenol).
Acetaminophen with codeine (Tylenol with Codeine).
Ibuprofen (Motrin).
Propoxyphene hydrochloride (Darvon).
After teaching a child with leukemia scheduled for a bone marrow aspiration about the procedure, the nurse determines that the teaching has been successful when the child identifies which of the following as the puncture site?
Right lateral side of the right wrist.
Middle of the chest.
Distal end of the thigh.
Back of the hipbone.
Which of the following nursing diagnoses would the nurse identify as the priority when dealing with a child newly diagnosed with leukemia and the child's family?
Risk for Injury related to malignant process.
Pain related to treatment modalities.
Imbalanced Nutrition: Less Than Body Requirements, related to loss of appetite.
Anticipatory Grieving related to diagnosis and potential loss of child.
The nurse and parents are planning for the discharge of a child with leukemia who is receiving dactinomycin (actinomycin D) and vincristine (Oncovin). Which of the following would the nurse expect to teach the parents to do?
Encourage increased fluid intake.
Keep the child out of the sun.
Monitor the child's heart rate.
Observe the child for drowsiness.
After doing well for a period of time, a child with leukemia develops an overwhelming infection. The child's death is imminent. Which of the following statements offers the nurse the best guide in making plans to assist the parents in dealing with their child's imminent death?
Knowing that the prognosis is poor helps prepare relatives for the death of children.
Relatives are especially grieved when a child does well at first but then declines rapidly.
Trust in health care personnel is most often destroyed by a death that is considered untimely.
It is more difficult for relatives to accept the death of an older child than that of a toddler.