N410 Peds Ch 29 Oxygenation

Question 1

The nurse is assessing a child with a cardiac problem. The child’s extremities are cool with thready pulses, and urinary output is diminished. This is most suggestive of which of the following?
  Increased afterload
  Decreased contractility
  Increased stroke volume
  Decreased cardiac output

Answer 1

Deacreased Cardiac Contractility = extremities cool; thready pulses; Low UO urinary
Hypoxia & acidosis depress contractility.

Increased blood pressure is indicative of higher afterload.

Increased stroke volume and decreased cardiac output will not produce the symptoms described.

Question 2

Which of the following heart defects causes hypoxemia and cyanosis because desaturated venous blood is entering the systemic circulation?
  Coarctation of the aorta
  Atrial septal defect
  Patent ductus arteriosus
  Tetralogy of Fallot

Answer 2

Tetralogy of Fallot is a cardiac defect that has a mixed blood circulation. Hypoxemia and Cyanosis result because desaturated venous blood is entering the SYSTEMIC circulation.

Atrial septal defect and patent ductus arteriosus =
Increased flow of blood to the PULMONARY system. The pressure gradient allows for oxygenated blood to return to the lungs.

Coarctation of the aorta is an obstructive defect. There is no mixing of oxygenated and unoxygenated blood.

Question 3

Which of the following is an important nursing consideration when chest tubes will be removed from a child?
Explain that it is not painful.
Administer analgesics before procedure.
Explain that only a Band-Aid will be needed.
Expect bright red drainage for several hours after removal.

Answer 3

Removal of chest tubes can be an uncomfortable, frightening experience. Analgesics should be used.

Children are forewarned that they will feel a sharp, momentary pain. A petrolatum-covered gauze dressing is immediately applied over the wound and securely taped to the skin on all four sides to form an airtight seal. No drainage is anticipated on the dressing.

Question 4

Therapeutic management of the child with rheumatic fever includes
administration of penicillin.
avoidance of salicylates (aspirin).
strict bed rest for 4 to 6 weeks.
administration of corticosteroids if chorea develops.

Answer 4

Penicillin remains the drug of choice (oral or intramuscular injections), with macrolides or cephalosporins as a substitute in penicillin-sensitive children. Initial therapy includes a full 10-day course of penicillin or an alternative antibiotic.

Salicylates may be used to reduce the inflammatory process after diagnosis.

Bed rest is not indicated. Children can resume regular activities after the febrile stage is over. The chorea is transient, and pharmacologic intervention is not indicated.

Question 5

The primary therapy for secondary hypertension in children is
  a low-salt diet.
  weight reduction.
  increased exercise and fitness.
  treatment of underlying cause.

Answer 5

treatment of underlying cause
Secondary hypertension is a result of an underlying disease process or structural abnormality.

It is usually necessary to treat the problem before the hypertension will be resolved.

A low-salt diet, weight reduction, and increased exercise and fitness therapies are usually effective for essential hypertension.

Question 6

Which of the following is an important nursing responsibility when a dysrhythmia is suspected?
Order an immediate electrocardiogram.
Count the radial rate every 1 minute for 5 minutes.
Count the apical rate for 1 full minute and compare with radial rate.
Have someone else take the radial rate simultaneously with the apical rate.

Answer 6

Counting the apical rate for 1 full minute and compare with radial rate is the nurse’s first action.
If a dysrhythmia is occurring, the radial pulse may be lower than the apical rate.

Ordering an immediate electrocardiogram may be indicated after conferring with the practitioner.
It is the nurse’s responsibility to check both rates, radial and apical.