HESI Patient Review--Pediatrics-Chronic Pediatric Health Problems (Katie Mills)
Terms in this set (37)
1. When the heart is examined, both the diaphragm and bell stethoscope pieces are used for auscultation. In general, the diaphragm is best for hearing high-pitched sounds, and the bell is most useful for hearing low-pitched sounds.
2. S1 is heard loudest at which anatomical landmark?
Apex of the heart
3. The second heart sound, S2, represents the closure of two valves, the aortic valve and the _____ valve.
4. You know that a murmur is an abnormal vibratory sound heard anywhere in the cardiac cycle. A full description of a murmur should include: (Select 6)
5. Murmur intensity is graded using a classification system with six levels of intensity. The physician correctly grades Katie's murmur as:
6. You prepare to take four-point blood pressures on Katie. Which of the following are true about four-point blood pressures in newborns? (Select 4)
-Four-point blood pressures involve obtaining BP measurements on all four extremities
-BPs should be taken while the infant is resting quietly
-When BP is measured by auscultation, the point at which the first sound is heard is recorded as the systolic reading
-For accurate BP readings, the BP cuff should totally encircle the extremity
7. Coarctation of the Aorta (COA) is characterized by pulses and pressures that may be abnormal. Pulse and pressure variations expected with COA include: (Select 2)
-Higher blood pressures on both upper limbs
-Bounding pulses in the upper extremities
8. If untreated, a moderate to large Ventricular Septal Defect (VSD) can lead to:
Congestive heart failure
9. If Katie presented with cyanosis in the first days of life, which congenital heart defect would have been suspected?
Tetrology of Fallot (TOF)
10. Yesterday, you took care of Tom, a 15-month old toddler with Tetrology of Fallot (TOF). When blood was taken, he became upset and started to struggle and cry. His color turned blue, and his respiratory rate increased to 44 breaths per minute. Your initial action was correct. This was to:
Place Tom in the knee-chest position
11. Infants with congenital heart defects often require surgical repair. After surgery, assessing for low cardiac output is critical. Which of the following assessments could be associated with a low cardiac output? (Select 3)
-Extremities cool to touch
-Decreasing blood pressure
12. Katie's parents are made aware of her Ventricular Septal Defect (VSD) diagnosis. Katie's mother immediately begins to cry. Katie's father, who is standing beside his wife, does not respond. Which of the following would be most therapeutic?
Allow Katie's mother to cry and place your hand on her arm to comfort her
13. Ventricular Septal Defect (VSD) can cause congestive heart failure. Which of the following may be signs of congestive heart failure? (Select 4)
-Swelling of Katie's hand or feet
-Decrease in diaper wetting
-Change in sleep/wake habits
14. Katie is breastfeeding well prior to discharge, but Mrs. Mills' knowledge of breastfeeding needs reinforcement. Which statement by Mrs. Mills indicates the need for further breastfeeding teaching?
"I will breastfeed Katie every four hours around the clock."
15. When Katie is six weeks old, the visiting nurse appropriately becomes most concerned about which aspect of Katie's behavior and development?
Katie sweats and tires easily during feedings
16. Which set of vital signs, obtained for Katie, indicate a compromised state?
Heart rate 164, respirations 60, BP 78/48
17. Katie wakes up as the nurse weighs her. She weighs 9 pounds 8 ounces (4.4 kg). Last week she weighed 8 pounds (3.6 kg). In analyzing this data, the nurse determines that this weight gain is:
Unexpected for a 6-week-old infant
18. An appropriate weight gain for a 6-week-old infant is approximately:
1 ounce per day
19. Based on an analysis of the data obtained on Katie thus far, which of the following is relevant and has priority?
Potential Complication: Congestive Heart Failure
20. Katie is to be NPO. In addition, all of the following are ordered for Katie. Which should you implement FIRST?
30% O2 by nasal cannula
21. After applying a nasal cannula and starting oxygen, you insert an IV line and administer 8 mg Lasix (furosemide) IV push. Lasix (furosemide) is ordered for Katie to:
Decrease the workload of her heart
22. To evaluate for the expected effects of the Lasix (furosemide) on Katie's condition, your nursing care should include: (Select 2)
-Strict intake and output
23. You need to verify the accuracy of the prescribed drug doses. Your recent drug reference verifies that a loading dose of 50 mcg/kg Lanoxin (digoxin) in three divided doses is appropriate. Given Katie's weight of 4.4 kg, a loading dose of 220 mcg in three divided doses is:
Safe as ordered
24. Lanoxin (digoxin) is available in liquid form, and ordered for administration by mouth. Lanoxin (digoxin) is available at a strength of 0.05 mg per mL. To administer 88 mcg, what volume of the drug should be prepared in an oral syringe?
25. In administering liquid Lanoxin (digoxin) to Katie, you plan on implementing which of the following correct techniques of oral Lanoxin (digoxin) administration with infants?
Counting the apical pulse for one minute prior to administering the drug
26. Many of the infants and children you care for take Lanoxin (digoxin). If you prepared to administer Lanoxin (digoxin) to an awake newborn with congestive heart failure, and determined that the apical pulse rate was 140 beats per minute (last recorded rate was 150), what would you do?
Administer the Lanoxin (digoxin) as ordered
27. Katie's parents have been waiting to see her. Before allowing Katie's parents to see her, you should:
Explain what Katie will look like, and about the equipment that will be attached to her
28. Your nursing interventions should maximize Katie's cardiac functioning and help alleviate symptoms of congestive heart failure. Which of the following are important in achieving these goals? (Select 2)
-Providing frequent small feedings (when Katie is no longer NPO)
29. Katie's parents are instructed in proper use of an oral syringe. This involves placing the syringe in Katie's mouth and directing the flow of medication _______
Along the side of her tongue and cheek, a little at a time, allowing for her to swallow
30. On assessment, it is determined that Katie has fallen from her normal growth curve. Katie weighs 26 pounds (11.8 kg) and is 36.5 inches (93 cm) in length. Using a clinical growth chart for girls 0-36 months, what percentiles is Katie in for weight and length? (Select growth chart button at left to view relevant growth chart.)
Below 10th percentile for weight, and below 50th percentile for length
31. In working with Katie, her developmental stage is considered. She is almost 3 years old. According to Erikson, Katie is emerging from which psychosocial stage of development?
Autonomy vs. Shame and Doubt
32. Given Katie's stage of development and the knowledge that her thinking is concrete, which approaches are best to use when Katie is prepared for procedures and surgery? (Select 3)
-When accurate, reassure Katie that her mommy and daddy will be able to stay with her
-When possible, allow Katie to touch equipment
-When possible, allow Katie to do things for herself
33. Katie receives conscious sedation for heart catheterization, and tolerates the procedure well. She is now awake and alert, and her gag reflex has returned. Which of the following are indicated at this time? (Select 5)
-Frequent vital signs
-Bilateral lower extremity pulse assessments
-Maintenance of a pressure dressing at the catheter insertion site
-Encourage oral fluids
34. Which of the following principles of preoperative teaching are implemented with Katie and her family? (Select 3)
-Information provided should be repeated and reinforced
-Katie's parents should be provided with information about surgery well in advance of the surgery
-Previous experiences should be considered when new information is presented
35. During Katie's second postoperative day, she is less sedated and more awake. Determining if Katie has pain is a priority. Which of the following techniques is best for assessing whether or not Katie has pain?
Have Katie use the Wong-Baker FACES Pain Rating Scale
36. Katie's parents are made aware that she needs antibiotics if dental visits or invasive procedures are required in the next six months. The antibiotics are needed to protect against:
37. The experiences of hospitalization and surgery may have affected Katie in a number of ways. Her parents are made aware that these kinds of experiences often cause children of Katie's age to exhibit which of the following? (Select 2)
-Loss of some developmental milestones