David, age 15 months, is recovering from surgery to remove Wilms’ tumor. Which findings best indicates that the child is free from pain?

Correct Answer: D

Rationale: In the context of pediatric nursing and pharmacology, it is crucial to understand how pain manifests in children and how to assess pain in non-verbal patients. In the case of David, a 15-month-old recovering from surgery, the best indicator that he is free from pain is "D) Increased interest in play." Children, especially toddlers like David, often express their well-being and comfort through play. When a child is in pain, they are more likely to be irritable, withdrawn, or disinterested in activities like playing. An increased interest in play suggests that David is feeling comfortable, pain-free, and is engaging in typical developmental behaviors. Option A, decreased appetite, can be a sign of pain or distress but is not as specific as increased interest in play for a young child like David. Option B, increased heart rate, could be a physiological response to pain but may not always correlate directly with pain relief. Option C, decreased urine output, is not a reliable indicator of pain in this context and could be influenced by various factors post-surgery. Educationally, this question highlights the importance of understanding pediatric pain assessment and the significance of behavioral cues in assessing pain in non-verbal patients. By recognizing how children like David communicate their comfort through play, nurses and healthcare providers can better evaluate and address their pain management needs to promote optimal recovery and well-being.

Correct Answer: C

Rationale: In pediatric nursing, it is crucial to understand the correct timing for evaluating different diagnostic tests to ensure accurate results. In the case of a tuberculosis intradermal skin test, the correct answer is option C) In 48 to 72 hours. This timeframe allows for the proper immune response to develop and manifest as a visible reaction if the individual has been infected with tuberculosis. Option A) Immediately is incorrect because immediate evaluation does not allow adequate time for the body's immune response to occur and may lead to a false negative result. Option B) Within 24 hours is also incorrect as this timeframe may still be too early to observe a reaction, potentially resulting in an inaccurate interpretation. Option D) After 5 days is incorrect because waiting this long may lead to excessive induration, making it challenging to accurately interpret the test results due to potential non-specific reactions. Educationally, understanding the timing of result evaluation for diagnostic tests like the tuberculosis skin test is essential for nurses caring for pediatric patients. This knowledge ensures accurate assessment and interpretation of results, leading to appropriate interventions and treatment plans based on reliable diagnostic information. By grasping these principles, nurses can provide optimal care and support for pediatric patients at risk for tuberculosis infection.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Worsening dyspnea. Excessive IV fluid intake can lead to fluid overload, causing pulmonary congestion and worsening dyspnea due to increased fluid in the lungs. Understanding the signs and symptoms of fluid overload is crucial in pediatric nursing as it can lead to serious complications. Option B) Gastric distension is incorrect because it is more indicative of gastrointestinal issues rather than excessive IV fluid intake. Option C) Nausea and vomiting are nonspecific symptoms and can be caused by various factors, not specifically related to excessive IV fluid intake. Option D) Temperature of 102°F (38.9°C) is more indicative of a fever or infection rather than excessive IV fluid intake. Educationally, it is important for nurses to closely monitor pediatric patients receiving IV fluids, especially at higher rates, to identify signs of fluid overload promptly. Understanding the signs and symptoms of fluid overload and differentiating them from other conditions is essential for providing safe and effective care to pediatric patients with cardiovascular disorders.

Correct Answer: A

Rationale: In a newborn infant suspected to have a ventricular septal defect (VSD), the assessment finding that would lead the nurse to suspect this condition is a loud, harsh murmur with a systolic thrill (Option A). This is because a VSD causes abnormal blood flow between the ventricles, resulting in turbulent blood flow and the characteristic murmur and thrill. Option B, cyanosis when crying, is more indicative of a cyanotic heart defect rather than a VSD. VSDs typically present with a systolic murmur rather than cyanosis. Option C, blood pressure higher in the arms than in the legs, is suggestive of coarctation of the aorta, a different cardiovascular disorder, not VSD. Option D, a machinery-like murmur, is associated with patent ductus arteriosus (PDA), not VSD. PDA murmur is continuous, unlike the systolic murmur heard in VSD. Educationally, understanding these assessment findings is crucial for pediatric nurses caring for infants with cardiovascular disorders. Recognizing specific murmurs and associated clinical manifestations aids in early identification, appropriate referral, and timely intervention, ultimately improving outcomes for infants with congenital heart defects.

Correct Answer: B

Rationale: In pediatric nursing, understanding cardiovascular disorders, such as carditis from rheumatic fever, is crucial for providing effective care. The correct answer is B) Heart muscle and the mitral valve. Rheumatic fever can lead to carditis, which is an inflammation of the heart. In this condition, the heart muscle and the heart valves, especially the mitral valve, are commonly affected. The inflammation can lead to damage and scarring of these structures, impacting the heart's ability to function properly. Option A) Coronary arteries are not typically affected by carditis from rheumatic fever. Coronary arteries supply blood to the heart muscle itself and are not a primary target of the inflammatory process in rheumatic fever. Option C) Aortic and pulmonic valves are less commonly affected in carditis compared to the mitral valve. While these valves can be impacted in some cases, the mitral valve is the most commonly affected valve in rheumatic fever-related carditis. Option D) Contractility of the ventricles is not a specific area affected by carditis. While inflammation of the heart muscle can impact overall heart function, the primary focus in carditis is on the heart muscle and valves rather than the contractility of specific heart chambers. Educationally, understanding the specific areas affected by carditis is essential for nurses caring for pediatric patients with rheumatic fever. Recognizing the signs and symptoms of cardiac involvement, such as murmurs or heart failure, can prompt timely interventions and prevent complications. By grasping the pathophysiology behind carditis, nurses can provide comprehensive care and support to pediatric patients with cardiovascular disorders.