NR-328 Pediatric Nursing - Set 2 - Part 2

Correct Answer: The inflammation involving the heart valves

Carditis is the only manifestation that scars, and mitral or aortic valve damage becomes chronic rheumatic heart disease. Everything else in the picture resolves without leaving a permanent mark. Option a is incorrect because the arthritis moves from joint to joint, responds quickly to salicylates, and heals without deformity. Painful as it is, it leaves the knees and ankles intact. Option c is incorrect because Sydenham chorea surfaces weeks to months later with clumsy purposeless motions and mood swings, then fades on its own. Nursing effort goes to safety and reassurance during that stretch. Option d is incorrect because erythema marginatum comes and goes over hours, shifting position on the skin without scarring or itching. A rash that transient cannot account for heart problems decades later.

Correct Answer: Stopping early can lead to rheumatic fever

An incompletely treated group A streptococcal pharyngitis is what sets up acute rheumatic fever two to four weeks later. Completing the ten day course is the whole prevention strategy. Option b is incorrect because resistance is a broad worry with every antibiotic and misses what threatens this child. Surviving streptococci can trigger antibodies that turn on her own heart and joints. Option c is incorrect because throat pain usually settles within a day or two of starting the drug, which is exactly why families quit early. The danger sits weeks past the sore throat. Option d is incorrect because a rash appearing with a strep infection points to scarlet fever or a drug reaction. Neither belongs in a warning about what an unfinished prescription actually costs this child.

Correct Answer: A murmur that has become noticeably softer

During a spell less blood crosses the narrowed outflow tract, so the turbulence that makes the sound falls away. A murmur fading in a suddenly blue, hyperpneic infant is the paradoxical warning sign. Option a is incorrect because a louder murmur means more blood is still moving through the pulmonary outflow. That is the reassuring direction, and it argues against the sudden rise in obstruction that defines a spell. Option b is incorrect because pink mucous membranes and dry warm skin show adequate systemic saturation and perfusion. Those findings would relieve the nurse rather than prompt an emergency response in a crying infant. Option c is incorrect because spells bring deep rapid breathing, not the calm slow pattern described. Quiet respirations suggest the infant is settling, so this observation would not send the nurse rushing for the knee-chest position.

Correct Answer: Encase the mattress and wash bedding in hot water

Dust mites live in mattresses and bedding and are a leading indoor trigger. Zippered encasements plus hot water washes strip the reservoir out of the sleeping space where this child spends hours. Option b is incorrect because added humidity encourages mold and dust mite growth in the very room the family is trying to clear. Damp air and damp bedding hold allergens instead of settling them. Option c is incorrect because carpet and wool fibers trap dander, pollen, and mite debris that get stirred up with every step. Bare washable floors near the bed are the better choice. Option d is incorrect because animal dander is one of the strongest triggers in an allergic child, and a pet sleeping nearby guarantees exposure all night. Comfort cannot outweigh nightly attacks.

Correct Answer: Deliver abdominal thrusts until the object clears

A child of one year or older with no air movement receives abdominal thrusts, repeated until the object comes out or the child becomes unresponsive. Only then does resuscitation with compressions begin. Option a is incorrect because compressions are started once the child collapses and stops responding, which has not yet happened. This toddler is still conscious and upright, so thrusts come first in the sequence. Option c is incorrect because back blows paired with chest thrusts are the technique for an infant younger than one year, whose abdomen offers no safe target. Age decides the maneuver, and this child is past that point. Option d is incorrect because breaths cannot pass an object wedged in the airway, and forcing them wastes seconds while pushing air into the stomach. Clear the blockage first, then worry about ventilation.

Correct Answer: Closure of the ductus arteriosus

With no outlet from the right ventricle, the duct is the only path carrying blood to the lungs. As it constricts over the first days, pulmonary flow collapses and cyanosis deepens sharply. Option a is incorrect because the atrial flap shuts within hours as left atrial pressure climbs, and in this newborn that opening actually helps by decompressing the right side. Its closure is not what triggered the crisis. Option b is incorrect because lung resistance falls after birth rather than rising. That downward trend explains why left to right shunts worsen over weeks, a slow pattern unlike the abrupt change seen here. Option d is incorrect because a shunt running toward the lungs would keep the newborn pink and cause congestion instead. Blood in this baby is moving the other way, bypassing lungs it cannot enter.

Correct Answer: Suction the tube to clear the obstruction

A plugged tube is the most common tracheostomy emergency, so the nurse suctions first. If suction does not restore airflow, the tube comes out and the same size spare goes in, with the smaller one held ready. Option b is incorrect because the smaller tube is the backup for a stoma that has narrowed, not the first choice. Suction may clear the plug in seconds and spare the child a tube change entirely. Option c is incorrect because compressions treat a pulseless child, and this one is restless with a beating heart. Clearing the blocked airway is what prevents the arrest that compressions would then be answering. Option d is incorrect because the upper airway has been bypassed, so oxygen at the nose never reaches the lungs. Gas must go through the tracheostomy, and the tube is blocked until someone clears it.

Correct Answer: A saturation that barely improves at all

Blood is bypassing the lungs entirely, so enriching alveolar gas cannot reach it. Saturation stays low because the problem is a diverted route, not impaired gas exchange across the alveolar membrane. Option a is incorrect because full saturation follows oxygen only when diseased lungs are the limiting step. Blood shunted past the alveoli never contacts the delivered oxygen, so the reading remains stubbornly low. Option b is incorrect because oxygen does not slow an infant's heart. A falling rate in a cyanotic newborn signals late decompensation and demands resuscitation, which is a separate emergency from the shunt physiology described. Option c is incorrect because a shunted newborn does not reach the readings of a healthy baby. Values in the seventies or eighties are often the realistic goal until the defect is surgically addressed.

Correct Answer: Bounding brachial pulses with weak femoral pulses

The narrowing sits past the vessels feeding the arms, so upper body flow stays forceful while blood reaching the legs is reduced and delayed. Simultaneous palpation exposes that difference quickly. Option a is incorrect because uniformly bounding pulses reflect a wide pulse pressure from a patent ductus arteriosus. A coarctation splits the body into a forceful upper half and a poorly perfused lower half. Option b is incorrect because it reverses the expected pattern. Blood leaves the aorta for the arms before it reaches the narrowed segment, so brachial pulses are the strong ones and femoral pulses lag behind. Option d is incorrect because crying does not blunt pulses in a healthy circulation, and equality across the limbs argues against any narrowing. This choice describes normal findings rather than the hallmark of coarctation.

Correct Answer: Arm pressure well above leg pressure

Narrowing beyond the left subclavian artery leaves the upper body hypertensive while flow past the coarctation falls, so arm readings exceed leg readings. That reversal of the normal pattern demands prompt evaluation. Option a is incorrect because leg pressure normally equals or slightly exceeds arm pressure in a child. Finding the expected relationship offers reassurance and gives the nurse no reason to interrupt the provider. Option c is incorrect because symmetry between the two arms is what the nurse hopes to find. Coarctation is caught by comparing upper with lower limbs, so an arm to arm match settles nothing alarming. Option d is incorrect because both legs sit downstream of the same narrowing and should read alike. A small gap between them carries no meaning; the telling comparison runs between the upper and lower halves.

Correct Answer: Review with him which doses he misses and why

Returning steatorrhea with weight loss usually means enzymes are missed or under-dosed, so adherence is assessed before anything is changed. Asking an adolescent to describe his own routine also opens the negotiation that improves it. Option a is incorrect because enzymes work in the gut, not the lungs, and correcting that idea does not solve the missed doses. Lecturing an adolescent about a regimen he already resents tends to harden the refusal. Option b is incorrect because tube feeding is reserved for growth failure that persists despite a working oral regimen. Jumping to an invasive option before checking whether the prescribed doses are taken skips the obvious explanation. Option c is incorrect because raising a dose that is never swallowed changes nothing, and high lipase totals carry their own bowel risk. The gap is in delivery at school rather than in the prescription.

Correct Answer: Mark the pedal pulses with an X

Pedal and posterior tibial pulses are located and marked beforehand so the same spot can be found quickly afterward. That baseline makes a weakened pulse obvious rather than debatable. Option a is incorrect because hair removal has no place in this preparation. What the nurse does ask about is an allergy to iodine or contrast dye, since the dye is injected during the study. Option b is incorrect because identification must stay on through the whole perioperative period. Removing the band strips away the check used at every handoff, and skin care is no reason to break that rule. Option d is incorrect because the child stays without food or drink for several hours beforehand, per the ordered protocol. Feeding a preschooler now would push the catheterization to another day.

Correct Answer: Cystic fibrosis presenting as meconium ileus

Thick, dehydrated meconium plugs the newborn intestine in a substantial share of infants with cystic fibrosis, so failure to stool with distention and bilious vomiting points strongly toward that diagnosis. Option a is incorrect because an intestinal virus produces loose stools and fever rather than an absence of stool. Nothing about this picture suggests infection, and obstruction is what the distention and bilious vomit describe. Option c is incorrect because swallowing difficulty shows up during feeding as choking or coughing, not as a blocked bowel. The problem here sits low in the intestine, well past anything the mouth controls. Option d is incorrect because healthy newborns stool within a day or two of birth. Waiting longer than that while the belly swells and bile appears in the vomit is a surgical emergency, not a variation.

Correct Answer: Competitive sports are restricted with this lesion

A tight aortic valve caps the output the heart can deliver during hard exertion, and that mismatch brings a real risk of fainting or sudden death. Competitive play is therefore off limits. Option b is incorrect because murmur intensity is a poor guide to severity here, and a quieter sound can even accompany falling output. Clearance depends on the gradient measured by echocardiography, not on listening. Option c is incorrect because the danger exists precisely while the obstruction remains unrelieved. Waiting for an operation before restricting sports leaves the child exposed during the interval when exertional collapse is most likely. Option d is incorrect because pacing does not protect a child whose valve cannot open wide enough. Games pull adolescents into bursts of maximal effort, which is exactly the setting for syncope on the court.

Correct Answer: Contact and droplet precautions with gown and mask

The virus spreads in large droplets and survives for hours on surfaces and hands, so the nurse wears a gown, gloves, and a mask. Hand hygiene remains the single most effective control. Option a is incorrect because respiratory syncytial virus does not travel in tiny suspended particles, so a fitted respirator adds nothing. Reserve that level of protection for tuberculosis, measles, and varicella instead. Option b is incorrect because gloves alone leave the gown and mask off while secretions spray during suctioning and coughing. Standard measures underprotect staff and let the organism ride hands and equipment to the next crib. Option c is incorrect because protective isolation shields a child whose own defenses have failed, such as one receiving chemotherapy. This infant is the source of the organism, so the barrier faces outward instead.

Correct Answer: Let the parent hold the child upright

Keeping the child calm and upright in a caregiver's arms preserves the airway while help is summoned. Agitation and forced positioning can convert a partial obstruction into a complete one within minutes. Option a is incorrect because undressing and handling a frightened preschooler provokes crying, and crying raises turbulent airflow through an already swollen inlet. A full survey waits until the airway is protected. Option c is incorrect because swabbing the throat is precisely the maneuver that can close this airway. Testing for streptococcus answers a different clinical question and offers nothing for a child who is drooling and toxic. Option d is incorrect because needle sticks before the airway is secured cause struggling at the worst possible moment. Antibiotics matter greatly, yet they follow intubation rather than preceding it in this sequence.

Correct Answer: A new murmur heard at the apex

Carditis shows itself as a new murmur, most often mitral regurgitation heard at the apex, along with tachycardia beyond what the fever explains. It is the manifestation that leaves lasting damage. Option a is incorrect because the rash of this illness, erythema marginatum, does not itch and sits on the trunk with a pale center and a wavy border. Palms are spared. Option b is incorrect because subcutaneous nodules do occur, though they are small, firm, and painless over bony prominences such as elbows and knuckles. A boggy shin swelling suggests injury or infection. Option d is incorrect because widespread bruising points toward a platelet or clotting problem. Nothing in the streptococcal antibody response damages blood vessels in that way, and bleeding is not part of the Jones criteria.

Correct Answer: Delay this vaccine for about eleven months

Immune globulin delivers passive antibody that blocks the response to a live vaccine. Measles, mumps, and rubella immunization is therefore postponed roughly eleven months so the child mounts real protection. Option b is incorrect because giving the live vaccine on schedule wastes the dose. Circulating donor antibody neutralizes the vaccine virus before the immune system ever sees it, leaving the toddler unprotected against measles. Option c is incorrect because no injected substitute exists for this combined live vaccine. Changing the route would not remove the problem, since the interference comes from antibody already circulating in the blood. Option d is incorrect because a one month gap falls far short of the interval needed. Passive antibody lingers for the better part of a year, and an early repeat exposes the child to needless injections.

Correct Answer: "I will call if his foot turns cool or pale."

A cool or discolored extremity means flow past the site is threatened, and it belongs on the call list along with fever, bleeding, redness, swelling, or drainage at the puncture. Option a is incorrect because soaking in a tub is off limits for about three days, along with swimming. A quick shower or sponge bath keeps the site clean without softening the healing puncture. Option c is incorrect because strenuous play and sports wait roughly a week. Running and kicking pull on the groin, and a puncture that looks sealed can still open under that kind of strain. Option d is incorrect because the dressing comes off the day after the procedure once the site is dry. Leaving it in place for seven days traps moisture and hides the redness the family should be watching for.

Correct Answer: The child is deteriorating toward respiratory failure

Agitation gives way to lethargy as carbon dioxide climbs and the muscles tire, so a slowing rate in an exhausted child signals failure. Support ventilation and call for help rather than letting the child rest. Option a is incorrect because sleep does not make a child hard to wake. A sleeping preschooler rouses to voice and touch and keeps a steady breathing pattern, neither of which describes this one. Option b is incorrect because genuine relief from oxygen brings a brighter child with easier effort and a stable rate. Improvement never arrives packaged with dulled responsiveness, which points the other direction entirely. Option c is incorrect because fatigue in a struggling child is dangerous, not harmless. Tired respiratory muscles are exactly how children slide from distress into arrest, and the falling rate is the warning.