ATI PEDIATRIC NURSING PROCTORED FINAL EXAM
The nurse is caring for a child after heart surgery. What should be done
if there is evidence of cardiac tamponade?
a. Increase analgesia.
b. Apply warming blankets.
c. Immediately report this to the physician.
d. Encourage the child to cough, turn, and breathe deeply. – ANSWERANS: C
Rationale: If evidence is noted of cardiac tamponade, caused by
blood or fluid in the pericardial space constricting the heart, the
physician must be notified immediately of this life-threatening
complication. Increasing analgesia may be done before the physician
drains the fluid, but the physician must be notified first. Warming
blankets are not indicated at this time. Encouraging the child to
cough, turn, and breathe deeply should be deferred until after the
physician’s evaluation.
What is one important thing the nurse should do when removing chest
tubes from a child?
a. Explain that it is not painful.
b. Explain that only a Band-Aid will be needed.
c. Administer analgesics before the procedure.
d. Expect bright red drainage for several hours after removal. –
ANSWER- ANS: C
Rationale: It is appropriate to prepare the child for the removal of
chest tubes with analgesics. Short-acting medications can be used
that are administered through an existing intravenous line. The
chest tube removal will cause a sharp, momentary pain, and this
should not be misrepresented to the child. A petroleum gauze/airtight dressing is needed, but it is not a pain-free procedure. Little or
no drainage should be found on removal.
What is the most common causative agent of bacterial endocarditis?
a. Staphylococcus albus
b. Streptococcus hemolyticus
c. Staphylococcus albicans
d. Streptococcus viridans – ANSWER- ANS: D
Rationale: Streptococcus viridans is the most common causative
agent in bacterial (infective) endocarditis. Staphylococcus albus,
Streptococcus hemolyticus, and Staphylococcus albicans are not
common causative agents.
What is the name of the painful, pea-sized nodules that may appear on
the pads of the fingers or toes in bacterial endocarditis?
a. Osler nodes
b. Janeway lesions
c. Subcutaneous nodules
d. Aschoff nodes – ANSWER- ANS: A
Rationale: Osler nodes are red, painful, intradermal nodes found on
pads of the phalanges in bacterial endocarditis. Janeway lesions are
painless hemorrhagic areas found on the palms and soles in
bacterial endocarditis. Subcutaneous nodules are non-tender
swellings located over bony prominences, commonly found in
rheumatic fever. Aschoff nodules are small nodules composed of
cells and leukocytes found in the interstitial tissues of the heart in
rheumatic myocarditis.
What is the primary nursing intervention for preventing bacterial
endocarditis?
a. Institute measures to prevent dental procedures.
b. Counsel parents of high-risk children about prophylactic antibiotics.
c. Observe children for complications such as embolism and heart
failure.
d. Encourage restricted mobility in susceptible children. – ANSWERANS: B
Rationale: The nurse must counsel the parents of high-risk children
about both the need for prophylactic antibiotics for dental
procedures and the necessity of maintaining excellent oral health.
The child’s dentist should be aware of the child’s cardiac condition.
Dental procedures should continue to be done to maintain a high
level of oral health. Observing for complications and encouraging
restricted mobility in susceptible children should be done, but
maintaining good oral health and prophylactic antibiotics is the
most important.
What is a common, serious complication of rheumatic fever?
a. Seizures
b. Cardiac arrhythmias
c. Pulmonary hypertension
d. Cardiac valve damage – ANSWER- ANS: D
Rationale: Cardiac valve damage is the most significant
complication of rheumatic fever. Seizures, cardiac arrhythmias, and
pulmonary hypertension are not common complications of
rheumatic fever.
What is a major clinical manifestation of rheumatic fever?
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