March 29, 2013 Name: Sterloie Inn A.

Dulfina BSN II

Chapter 40 Fill in the Blanks: 1. The upper respiratory tract functions to warm, humidifies and filters air. 2. Identify the normal values for each of these blood gas components (a) Po2 80-100 mmHg; (b) Pco2 35-45 mmHg; (c) O2 saturation 95-100%; (d) pH 7.35-7.45; (e) HCO3 2226mEq/L. 3. The most dangerous periods following a tonsillectomy are the are the first 24 hours, when the clots covering the denuded surgical area are forming, and days 5 to 7, when the clots begin to lyse or dissolve. 4. If a child has no complications following a tonsillectomy, he or she is discharged the same day or the following morning. Three danger signs you would tell the parents to watch for are FREQUENT SWALLOWING, CLEARING THE THROAT, INCREASING RESTLESNESS. 5. Children with symptoms of epiglottitis should never be examined with a tongue blade because the gagging might cause COMPLETE OBSTRUCTION OF THE GLOTTIS, RESPIRATORY FAILURE, AND EDEMATOUS. 6. Three symptoms of epiglottitis are INSPIRATORY STRIDOR, COUGH and FEVER. 7. The first indicator of airway obstruction in children is CHOKING AND HARD, FORCEFUL COUGHING. 8. The respiratory centers are located in the MEDULLA OF THE BRAIN AND PERIPHERAL RECEPTORS. Matching Type: Column I 1. 2. 3. 4. 5. 6. 7. 8. E Hypoxia C Cyanosis H Hypoventilation A Apnea B Hyperventilation D Anoxia F Tachypnea G Hypoxemia Column II a. Lack of respiration. `b. Rapid deep breathing. c. Bluish tint to the skin. `d. Decreased oxygen in body cells. e. Reduction below adequate levels of oxygen in tissue. f. Rapid respiration. g. Deficit oxygen content in the blood. h. Shallow breathing.

9.

K Bronchopulmonary dysplasia i. Fine crackling sounds. j. Harsh high-pitched sound heard on inspiration. k. A chronic lung condition in infants w/ acute respiratory distress at birth. l. Expiratory whistling sound due to obstruction of lower trachea or bronchioles

10. J Stridor 11. I Rales

12. L Wheezing

Multiple Choice: B1. Which of the following infants is least likely to develop sudden infant death syndrome (SIDS)? a. An infant who was premature b. A sibling of an infant who died of SIDS c. An infant with prenatal; drug exposure d. An infant who sleeps on his back B2. Which of the following respiratory conditions is always considered a medical emergency? a. Laryngotracheobronchitis (LTB) b. Epiglottiditis c. Asthma d. Cystic fibrosis (CF) A3. Immunization of children with the Haemophilus influenza type B (Hib) vaccine decreases the incidence of which of the following conditions? a. Laryngotracheobronchitis (LTB) b. Epiglottiditis c. Pneumonia d. Bronchiolitis B4. In a child with asthma, beta-adrenergic agonists, such as albuterol, are administered primarily to do which of the following? a. Decrease postnasal drip b. Dilate the bronchioles c. Reduce airway inflammation d. Reduce secondary infections B5. An acute, severe prolonged asthma attack that is unresponsive to usual treatment is referred to as which of the following? a. Intrinsic asthma b. Status asthmaticus c. Reactive airway disease d. Extrinsic asthma A6. When developing a care plan for the child diagnosed with cystic fibrosis (CF), which of the following must the nurse keep in mind? a. CF is an autosomal dominant hereditary disorder b. Pulmonary secretions are abnormally thick c. Obstruction of the endocrine glands occurs d. Elevated levels of potassium are found in the sweat

Chapter 41 Fill in the Blanks: 1. In heart defects in which a connection exists between the right and left heart, the blood through the connective structure flows FROM STRONGER HEART ACTION TO THE AREA OF WEAKER HEART ACTION. 2. Newborns and infants with heart disease are commonly brought to the health care facility by parents because the child is having TACHYCARDIA AND TACHYPNEA.

3. Chest tubes inserted in a child during open heart surgery will include an upper tube draining AIR and a lower one draining FLUIDS. 4. Rejection after cardiac transplant can occur as HYPERACUTE, ACUTE AND CHRONIC FORMS.

5. CARDIOMYOPATHY refers to a structural or functional abnormality of the ventricular myocardium that occurs after an infection and results in severe dilation of the left or both ventricles.

6. RESPIRATORY FAILURE is the most frequent cause of cardiac arrest in children.

7. Identify the name of the congenital heart disorder described. a. Includes pulmonary artery stenosis, ventricular septal defect, dextroposition of the aorta and right ventricular hypertrophy. DISORDERS WITH INCREASED BLOOD FLOW b. The aorta rises from the right ventricle instead of the left ventricle; usually accompanied by atrial and septal defects. TRANSPOSITION OF THE GREAT ARTERIES c. The tricuspid valve is closed and the foramen ovale and ductus arteriosus remain patent. TRICUSPID ATRESIA. 8. One of the first signs in congestive heart failure in children is TACHYCARDIA.

Matching Type: Column I 1. C Endocarditis Column II a. Agent used to increased heart contractility, possibly in place of epinephrine; contraindication for patients with digitalis toxicity. b. An extreme increase in red blood cells in an attempt to increase tissue oxygenation. c. Fever, splenomegaly, general malaise, and a maculopapular rash that occurs after open heart surgery. d. Condition involving increased fatty acid level in the blood.

2. D Dyslipidemia

3. G Patent ductus arteriosus

4. B Polycythemia

5. H Postperfusion syndrome

e. Infection of the valves of the heart, generally caused by streptococci. f. Abnormal communication between the two atria where blood flows from left to right. g. Left-to-right shunting of blood due to connection of the pulmonary artery to the aorta h. Autoimmune condition that typically results manifested a wide pulse pressure and systolic-diastolic murmur. i. Condition that involves a narrowing of the pulmonary valve. j. One major artery arises from the left and right ventricles instead of separate levels. k. Condition resulting when the myocardium of the heart cannot circulate and pump enough blood to supply the tissues of the body. l. Mucocutaneouslymph node syndrome occurring almost exclusively in children before puberty. m. A diagram of heart sounds translated into electrical energy by a microphone placed on the childs chest. n. An ultrasound produced by high-frequency sound waves used to locate and study the movements and dimensions of cardiac structures. o. Study that furnishes an accurate picture of the heart size and contour and size of the heart chambers.

6. O Chest radiography

7. F Atrial septal defect

8. M Phonocardiography

9. N Echocardiography 10.I Pulmonic stenosis

11.J

Truncus arteriosus

12.K Heart Failure

13.L Kawasaki disease

14. A Calcium chloride

15. E Rheumatic fever

Multiple Choice: B1. Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation? a. Patent ductus arteriosus (PDA) b. Tetralogy of Fallot c. Coarctation of aorta d. Aortic stenosis (AS) A2. Which of the following nursing interventions would be appropriate to promote optimal nutrition in an infant with heart failure? a. Offering formula that is high in sodium and calories b. Providing large feedings evenly spaced every 4 hours c. Replacing regular nipples with easy-to-suck ones d. Allowing the infant to feed for at least 1 hour B3. When developing a teaching plan for the parents of a child with pulmonic stenosis (PS), the nurse would keep in mind that this disorder involves which of the following?

a. b. c. d.

Return of blood to the heart without entry into the left atrium Obstruction of blood flow from the right ventricle Obstruction of blood from the left ventricle A single vessel arising from both ventricles

D4. Which of the following instructions would the nurse include in a teaching plan that focuses on initial prevention of rheumatic fever? a. Using a corticosteroid to reduce inflammation b. Treating streptococcal throat infections with an antibiotic c. Providing an antibiotic before dental work d. Giving penicillin to clients with rheumatic fever A5. Children with Kawasaki disease may develop: a. Aneurysm formation b. Mitral valve disease c. Sepsis d. Meningitis

Chapter 42 Fill in the Blanks: 1. Provide the types of primary immunodeficiency for each description. a. Cellular immune response remains adequate; child has resistance to viral, fungal, and parasitic infections, but all levels of immunoglobulins are abnormally low. HYPOGAMMAGLOBULINEMIA. b. Infection of surfaces exposed to the external environment and normally protected by mucus are common along with atopic diseases. COMMON VARIABLE IMMUNOGLOBULIN DEFICIENCIES. 2. Human immunodeficiency virus (HIV) is spread by two primary routes in the adult population SEXUAL contact and BLOOD contact. 3. AUTOIMMUNITY results from an inability to distinguish self from nonself, causing the immune system to carry out immune responses against normal cells and tissue.

4. Assessment of the exact symptoms of an allergy is important in helping to identify the underlying ________________________.

5. The three goals for therapy in childhood allergy situation are to REDUCE THE CHILDS EXPOSURE TO THE ALLERGEN, HYPOSENSITIZED THE CHILD TO PRODUCE A STATE OF INCREASED CLINICAL TOLERANCE ,And MODIFY THE CHILDS RESPONSE TO THE ALLERGEN WITH PHARMACOLOGIC AGENT.

6. The best way to identify the specific allergies in a child with food allergies is the use of a FOOD DIARYor an elimination diet.

7. Congenital immunodeficiencies usually manifest after the first 6 months of life.

8. When a child is stung by a bee, the immediate action should be to apply ICE PACK to the site to minimize the absorption of the venom.

Matching Type: Column I 1. C Antigen Column II a. The neutralization of pathogens through ingestion by white blood cells. b. Secretion by cytotoxic cells that contain or prevent migration of antigens. c. Foreign substance capable of stimulating an immune response. d. Responsible for retaining the formula or ability to produce specific immunoglobulins. e. A hypersensitivity reaction to a foreign serum antigen or drug. f. A nonantigenic substance that becomes antigenic when combined with a higher-weight molecule. g. T cells that reduce the production of immunoglobulins against a specific antigen. h. An antigen that can be readily destroyed by an immune response. i. When antibodies are formed in response to a particular antigen acquired through T-lymphocyte activity. j. Cells capable of resisting foreign invaders.

2. I Cell-mediated immunity 3. F Hapten formation 4. J Immunocompetent cells 5. H Immunogen 6. B Lymphokines

7. D Memory cell

8. A Phagocytosis

9. E Serum sickness

10.G Suppressor cells Multiple Choice:

A1. Which of the following immune responses is a nonspecific response to invasion? a. Inflammatory response b. Antibody response c. Humoral response d. Cell-mediated response B2. Which of the following would the nurse include in the care plan for a child with juvenile rheumatoid arthritis (JRA)? a. Administration of a corticosteroid to decrease joint damage b. Prevention of contractures by keeping extremeties in a flexed position

c. Vigorous range-of-motion (ROM) exercises with affected joints d. Application of heat to minimize pain and stiffness A3. Which of the following tests would be used to diagnose human immunodeficiency virus (HIV) in a 4month-old child whose mother is HIV positive? a. Enzyme-linked immunosorbent assay (ELISA) b. Western blot c. Virus assay d. Complete blood count (CBC) C4. When addressing a PTA group, a nurse is asked about the need to disallow children who are human immunodeficiency virus (HIV) positive to attend school. Which of the following statements by the nurse would be most appropriate? a. Because HIV is highly contagious, the children should be withheld from school. b. The child can attend school, but the child must be isolated from others. c. There is absolutely no risk of transmission between children at school. d. The risk of HIV transmission in school is minimal.

Chapter 43 Multiple Choice: C1. Which of the following types of immunity does an infant receive when given a diphtheria and tetanus toxoids and acellular pertussis (DTaP) injection? a. Natural, active b. Natural, passive c. Artificial, active d. Artificial, passive C2. Which of the following organisms is the most common cause of neonatal sepsis? a. Staphylococcus aureus b. Streptococcus viridans c. Group B streptococci d. Haemophilus influenza C3. Which of the following would the nurse expect to assess as a common early manifestation of meningitis in a 2-month-old infant? a. Opisthotonos b. Nuchal rigidity c. Kernings sign d. Hypothermia C4. A child, whose parents seek attention for the childs generalized confluent red -pink maculopapular rash, appears ill and exhibits conjunctivitis and photophobia. Which of the following would the nurse suspect? a. Rubella b. Roseola c. Rubeola d. Varicella

Chapter 44 Multiple Choice: C1. Which of the following if stated by the parents of a child with iron deficiency anemia, after they were instructed on foods to encourage on the childs diet, would indicate the need for further instruction? a. Lean meats b. Whole-grain breads c. Yellow vegetables d. Fish A2. In children with sickle cell disease, tissue damage results from which of the following? a. A general inflammatory response due to an autoimmune reaction from hypoxia b. Air hunger and respiratory alkalosis due to deoxygenated red blood cells c. Local tissue damage with ischemia and necrosis due to obstructed circulation d. Hypersensitivity of the central nervous system (CNS) due to elevated serum bilirubin levels D3. When planning a client education program for sickle cell disease, the nurse should include which of the following topics? a. Proper hand washing and infection avoidance b. A high-iron, high-protein diet c. Fluid restriction to 1 qt (1 L) day d. Aerobic exercises to increase oxygenation C4. The long-term complication seen in thalassemia major is related to which of the following? a. Hemochromatosis b. Splenomegaly c. Anemia d. Growth retardation C5. The physician orders desferoxamine (Desferal) for a child with thalassemia. Which of the following should alert the nurse to notify the physician? a. Decreased hearing b. Vomiting c. Red urine d. Hypertension B6. When administering a steroid to a child with idiopathic thrombocytopenic purpura, the nurse should monitor the child for which of the following? a. Anemia b. Bleeding c. Bruising d. Infection 7. A child with iron deficiency anemia is to receive elemental iron therapy at 6 mg/kg/day in three divided doses. The child weighs 44 lb. how many milligrams of iron should the child receive per dose? ______________

Chapter 45 Fill in the Blanks: 1. Metabolic ACIDOSIS is indicated when the arterial blood pH is less than 7.35 and HCO 3 is below 22 mEq/L. 2. A patient who is dehydrated with an arterial blood pH > 7.45 and a bicarbonate level greater than 28 mEq/L is experiencing metabolic ALKALOSIS. 3. Fluid loss that occurs from evaporation from the skin and lungs is called INSENSIBLE fluid loss. Matching Type: Column I 1. C Gastroesophageal reflux 2. B Aganglionic megacolon Column II a. Loss of body water and salt in proportion to each other. b. Hirschsprungs disease, the absence of nerve cells and peristaltic waves in a section of the bowel. c. Disorder due to a neuromuscular disturbance that causes a lax cardiac sphincter and lower esophagus. d. A disease caused by protein deficiency seen more frequently in children ages 1 to 3 years. e. A disease caused by deficiency of all food groups. f. Loss of body water out of proportion to salt. g. Intermittent protrusion of the stomach through the esophageal opening in the diaphragm. h. Sensitivity or abnormal immunologic response to protein, usually the gluten factor.

3. G Hiatal hernia

4. A Isotonic dehydration 5. D Kwashiorkor 6. E Marasmus 7. H Celiac disease 8. F Hypertonic dehydration

Chapter 46 Fill in the Blanks: 1. Glomerulonephritis involves the obstruction of the glomeruli because of complement fixation activated by an ANTIGEN-ANTIBODY reaction, stimulated most often by a streptococcal infection. 2. The four characteristic symptoms of nephrotic syndrome are PROTEINURIA, EDEMA, HYPOALBUMINEMIA, and HYPERLIPIDEMIA.

3. Children with hemolytic-uremic syndrome usually have PALE skin coloring as well as the major symptoms of OLIGURIA with proteinuria, HEMATURIA, and urinary casts in urine. 4. A POLYCYSTIC kidney is a condition involving abnormal development of the collecting tubules in which fluid-filled cysts, instead of kidney tissue, form in utero; it may be unilateral or bilateral.

5. An increase in blood levels of the products of cell metabolism such as ___________________________ may indicate poor kidney function. 6. HYDRONEPHROSIS refers to a retrograde flow of urine from the bladder into the ureters that may lead to a urinary tract infection.

Matching Type: Column I 1. H Prune belly syndrome 2. J Azotemia 3. D Cystoscopy Column II a. An autosomal dominant inherited disorder with chronic renal failure. b. A fistula between the bladder and the umbilicus. c. The opening of the urethra onto the ventral or lower surface of the penis. d. Direct viewing of the bladder or ureter openings for examination. e. Undescended testes often noted with hypospadias. f. Involuntary voiding past the age when a child is expected to have attained bladder control. g. Condition manifested by fever, proteinuria, oliguria, weight gain, and hypertension developing within 3 months following transplant. h. Urethral obstruction in utero from abnormal urethral valves.

4. E Cryptorchidism 5. F Enuresis 6. C Hypospadias 7. I Dialysis

8. G Acute transplant rejection

9. A Alports syndrome 10.B Patent urachus Chapter 47 Fill in the Blanks:

i. Separation and removal of solutes from body fluid by diffusion through a semipermeable membrane. j. The accumulation of nitrogen waste in the bloodstream, often due to oliguria.

1. A VARIOCELE is abnormal dilation of the veins of the spermatic cord. 2. GYNECOMASTIA is an enlargement of the male breast.

3. CRYPTORCHIDISM is failure of both testes to descend from the abdominal cavity to the scrotum. Testicular cancer has symptoms of heaviness of the SCROTUM. It is usually 4. occurs between ages 15 and 35 years and METASTISIZES rapidly. 5. DYSMENNORHEA is defined as experiencing abdominal pain during ovulation. The discomfort is felt on either side of the ______________________________, near an ovary. 6. BALANOPOSTHITIS is an inflammation of the glands and prepuce of the penis.

Matching Type: Column I 1. F Endometriosis 2. J Amenorrhea 3. C Anovulatory 4. H Hydrocele 5. K Metrorrhagia Column II a. An abnormally heavy menstrual flow. b. Removal of the testes. c. Menstrual cycles that occur without the release of an egg. d. Infant with some external features of both sexes, although only ovaries or testes are present. e. Condition most frequently caused by gonorrheal infections or chlamydia. f. Abnormal growth of extrauterine endometrial cells. g. An infection caused by toxin-producing strains of staphylococcus. h. Fluid collection in the space called the processusvaginalis. i. A membranous ring of tissue totally occluding the vagina. j. Absence of menstrual flow; may suggest pregnancy.

6. B Orchiectomy 7. D Pseudohermaphrodite

8. G Toxic shock syndrome

9. I Imperforate hymen 10.E Pelvic inflammatory disease

11.A Menorrhagia

k. Bleeding between menstrual periods.

Chapter 48 Fill in the Blanks: 1. Type I (insulin-dependent) diabetes is characterized by almost no INSULIN secretion. The lack of insulin secretion contributes to a buildup of GLUCOSE in the bloodstream. If exogenous insulin is not administered, this person will develop HYPERGLYCEMIA and KETOACIDOSIS. 2. Humulin- R insulin begins to work approximately 5 minutes after administration.

3. Hypertrophy of the thyroid gland in response to TSH secretion is called GOITER.

Matching Type: Column I 1. D Cushings syndrome 2. F Latent tetany 3. A Polydipsia 4. H Galactosemia 5. B Graves disease 6. E Kussmaul breathing 7. G PKU 8. C Aldosterone Column II a. Excessive thirst. b. Oversecretion of thyroid hormones. c. Substance secreted in response to renin-angiotensin. d. Overproduction of the adrenal hormone cortisol. e. Deep and rapid respirations. f. Neuromuscular irritability. g. Metabolic disease inherited as an autosomal recessive trait. h. Disorder of carbohydrate metabolism.

Chapter 49 Fill in the Blanks: 1. The nervous system consists of two separate systems, the PERIPHERAL and the CENTRAL nervous systems. 2. Tests for cerebellar function involve testing for normal BALANCE and COORDINATION.

3. Signs of COMATOSE, in which a child is unsure of time and place, may be the first indication of increased intracranial pressure. 4. Cerebral perfusion pressure is calculated by subtracting the mean intracranial pressure from the mean ARTERIAL pressure.

5. The major cause of meningitis in newborns is the group B hemolytic STREPTOCOCCI organism. 6. The treatment for infant botulism consist of SUPPORTIVE CARE.

7. Convulsions associated with high fever are most common in 6 months to 6 years- aged children. 8. Indicate if the following actions test sensory, motor, or cerebellar function.

a. Asking a child to touch each finger on one hand with the thumb of that hand in rapid succession. CEREBELLAR FUNCTION. b. Asking a child to resist your action as you push down or up on his or her hands. MOTOR FUNCTION. c. Touching the childs elbow with a vibrating tuning fork. SENSORY FUNCTION. 9. Identify the seizure described below as psychomotor, absence, tonic-clonic, or simple partial. a. Generalized seizures with a prodromal, aural, tonic, and clonic stages. TONIC-CLONIC SEIZURES. b. Involves only one area of the brain; no altered level of consciousness. SIMPLE PARTIAL SEIZURE c. May begin with a sudden change in posture, circumoral pallor, a 5-minute loss of consciousness without a postictal stage. PSYCHOMOTOR SEIZURE

d. Petit mal, generalized seizures involving a staring spell lasting for a few seconds. ABSENCE SEIZURE

Matching Type: Column I 1. D Electroencephalogram 2. C Graphesthesia Column II a. Awkward wide-base gait. b. Subcutaneous tumors along nerve pathways, with excessive skin pigmentation and possible optic or acoustic nerve degeneration. c. The ability to recognize a shape that has been traced on the skin. d. Depiction of electrical patterns of the brain. e. The ability to distinguish movement. f. Childs arms are abducted and flexed on the chest with wrists flexed. g. Spastic cerebral palsy involvement affecting primarily the lower extremities. h. The ability to recognize an object by touch. i. Indication of nonfunctional midbrain with rigid extension and adduction of arms and wrist pronation. j. Radiographic study of spinal cord involving the use of a contrast medium.

3. E Kinesthesia . 4. A Ataxic 5. B Neurofibromatosis 6. G Diplegia 7. H Stereognosis 8. F Decorticate posture 9. I Decerebrate posture 10.J Myelography

Chapter 50 Fill in the Blanks: 1. STEREOPSIS is the ability to locate an object in space relative to other objects. 2. Eye exercises are referred to as ORTHOPICS.

3. HYPEROPIA is a refractive error (farsightedness) in which vision is blurry at close range. 4. COLOBOMA is a congenital incomplete closure of the facial cleft.

Matching Type: Column I 1. H Accommodation 2. I Chalazion Column II a. Turning of both eyes medially. b. Infection of the eyelid margin.

3. F Dacryostenosis 4. G Cerumen 5. E Ptosis 6. B Blepharitis marginalia

c. Inflammation of the nasolacrimal duct. d. Rapid, irregular eye movements. e. The inability to raise the upper eyelid normally. f. Interruption of the tear flow; blockage of the lacrimal drainage system. g. Chief function of cleaning the external ear. h. Constriction of the pupil as it adjusts from focusing on a distant point to a near point. i. Low-grade granulation tissue tumor of the meibomian or tarsal gland on the eyelid. j. Reduction in vision due to disuse of a structurally normal eye; lazy eye.

7. J Amblyopia 8. D Nystagmus 9. A Convergence

10.C Dacryocystitis