Test 11

Question 1

1. Rheumatic fever: causes

Answer 1

 Group A strep

Question 2

1. Rheumatic fever: Diagnostics

Answer 2

 Elevated ESR
 Elevated WBC
 + Group A Strep culture

Question 3

1. Rheumatic fever: manifestations

Answer 3

 Carditis
- Polyarthritis
 Chorea (disorder characterized by emotional instability, purposeless movement, and muscular weakness)

Question 4

1. Rheumatic fever: nursing care

Answer 4

 Conserving energy
 Reducing pain
 Providing diversional activities and sensory stimulation
 Preventing injury

Question 5

2. Iron supplements for toddler’s client education(slide 10)

Answer 5

 Inform patient/parent that iron salts change stool to dark green or black.
 Advise patient/parent to take liquid forms of iron via a straw, rinse mouth with water, and dilute with juice, avoid staining.
 Take between meals and not with milk.
 Provide iron rich foods.(Eat with vitamin C for better absorption (OJ and strawberries)
 Lock solution up! Iron toxicity

Question 6

3. Iron deficiency anemia client education(slide 10)

Answer 6

 Administer IM or IV iron when oral iron is poorly absorbed.
 Z-track for parenteral injections (do not massage)

Question 7

4. Thalassemia manifestations(slide 8)

Answer 7

 Anemia
 Fatigue
 Pallor
 Irritability
 Failure to thrive.
 Bone pain and fractures
 Lethargy
 Enlargement of spleen
 Skin bronze color or jaundice

Question 8

4. Thalassemia client education

Answer 8

 Diet: avoid foods high in iron (red meats, lentils/beans, egg yolks, spinach, dried fruit, dark leafy greens, peanut butter, poultry) (7-10mg of iron is needed daily)
 Child and family support important
 Assist with RBC transfusion and iron-chelating therapy: deferoxamine.

Question 9

5. Hemophilia manifestation

Answer 9

 Bruising
 Bleeding
 Pain

Question 10

5. Hemophilia priority

Answer 10

 Nursing care is focused on stopping the bleeding, decreasing pain, increasing mobility and preventing injury.

Question 11

5. Hemophilia nursing actions

Answer 11

 Subcutaneous injections, when possible, with smallest needle, apply pressure and monitor for excessive bleeding.
 Monitor urine, stool for blood.
 No ASA or NSAIDS
 Elevate and apply ice to affected joints during bleed.
 Immobilize and apply elastic wrap to reduce bleeding.
 Avoid activities that include high contact/ensure safety.

Question 12

6. CHF manifestations in infants

Answer 12

Infants: hard to detect in
 Tires easily, tachycardiac
 Rapid respirations with expiratory grunt
 Flaring of nares
 Sternal retractions
 May refuse bottle after 1 to 2oz.
 Periorbital edema; rapid weight gain

Question 13

6. CHF manifestations older child

Answer 13

 Tachycardia
 Failure to gain weight.
 Abdominal pain, nausea
 Vomiting, weakness, fatigue
 Restlessness, Irritability, pale, tachypnea, dyspnea
 Coughing, edema, enlargement of liver and heart

Question 14

6. CHF in actions and concerns(slide 3 &4)

Answer 14

 Administer medications digoxin, furosemide, ACE.
 Decreasing workload of heart
 Elevate HOB
 Small frequent feedings
 Allow for maximum chest expansion with loose clothing.

Question 15

7. Digoxin Kill hurt know(Old study guide)

Answer 15

Use: HF, A-fib, and flutters

Adverse Reactions
 Toxicity: nausea and vomiting, anorexia, irregular pulse(dysrhythmias), or decrease pulse rate (bradycardia)

Nursing Actions
 Check apical pulse for 1 minute, hold if less than (90-110 for infant and 70-85 for older children).
 Check digoxin levels 0.8-2.0
 Immune Fab is the antidote.
 Contraindicates with clients on loops and thiazides.
 St. John Wart (herb med) increases toxicity.

Question 16

8. Furosemide therapeutic response(Old study guide)

Answer 16

Use: HF, HTN, and Ascites (fluid in abdomen)*Most powerful

Adverse Reaction/Hurt
 Hyperglycemia
 Hypotension
 Hyponatremia
 Dehydration

Adverse Reaction/Kill
 Hypokalemia (sx. Bradycardia, fatigue, and muscle twitching)
 Toxicity (sx. Tinnitus, dizzy or any hearing changes)

Nursing Actions/client education
 Photosensitivity (Avoid sun and wear sunscreen)
 Increase potassium (bananas, potatoes, dried fruit, nuts, spinach and citrus fruit)
 Monitor potassium labs, toxicity, glucose, weight and output.
 Administer in the morning.

Question 17

9. Kawasaki disease manifestations

Answer 17

 Red eyes without drainage
 Red chapped lips
 Strawberry tongue
 Enlarged lymph nodes.

Question 18

9. Kawasaki disease nursing intervention

Answer 18

 Advise parents to keep cardiac evaluation.
 No live vaccines for 6 months

Question 19

9. Kawasaki disease client education(slide 6)

Answer 19

Kawasaki disease is an acute, febrile disease. Serious complication for MI if aneurysm is formed.
o Teach monitor for o2 deprivation; inconsolable crying; abdominal pain, restlessness, and pale skin
o Aspirin is used to control inflammation and fever-often for months.
- no live vaccine

Question 20

10. Sickle cell anemia manifestations(slide 12)

Answer 20

 Pain
 Fever
 Elevated WBC

Question 21

10. Sickle cell anemia complications

Answer 21

 The impaired circulation results in tissue damage and infarction-priority complication (sx.MI sudden onset of a headache and paralysis)

Question 22

10. Sickle cell anemia nursing actions

Answer 22

 Relieving pain
 Increasing fluid intake
 Conserving energy-to maintain o2 levels.
 Avoid strenuous activity following crisis.
 Improving physical mobility-mild activity is encouraged.
 Avoid infections and maintaining skin integrity.

Question 23

11. Leukemia client education related to vaccines(slide 16)

Answer 23

 NO LIVE VACCINES (MMR, varicella, Rotavirus, live influenza)

Question 24

12. Leukemia manifestations

Answer 24

 Fatigue and pallor
 Low-grade fever
 Bone and joint pain
 Petechiae, purpura, and bleeding
 Lymph nodes may be enlarged, and bruising is a constant problem.
 Low platelets, elevated WBC

Question 25

12. Leukemia client education

Answer 25

 Work with the child to help promote normal growth and development and improve body image.  Encourage caregivers to verbalize feelings and help them to increase their coping abilities. - No vaccine

Question 26

12. Leukemia neutropenic precautions and nursing care priority

Answer 26

 Preventing infection-strict handwashing  Preventing injury  Relieving pain and reducing fatigue  No fresh flowers, fruits, bottle waters only and no salad bar

Question 27

What is Digitalization

Answer 27

The use of large doses of digoxin, at the beginning of therapy, to build up the blood levels of the drug to a therapeutic level