Cardiovascular Dysfunction

What associated manifestation might the nurse occasionally find in a child diagnosed with Wilms tumor? 1. Atrial fibrillation. 2. Hypertension. 3. Endocarditis. 4. Hyperlipidemia.

2. Because Wilms tumor sits on the kidney, it can be associated with secondary hypertension. It does not affect or cause the other conditions

The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS).

2. In the older child, COA causes dizziness, headache, fainting, elevated blood pressure, and bounding radial pulses.

Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear , and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr. 2. 1 cc/kg/hr. 3. 30 cc/hr. 4. 1 oz/hr

2. Normal pediatric urine output is 1 cc/kg/hr.

While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left.

2. Polycythemia is the result of the body attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood cells to carry the oxygen.

What should the nurse assess prior to administering digoxin? Select all that apply. 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

2. The apical pulse rate is assessed because digoxin decreases the HR, and if the HR is <60, digoxin should not be administered.

A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of which drug? 1. Calcium channel blocker. 2. Beta blocker. 3. ACE inhibiter. 4. ARB.

2. The beta blocker not only affects the heart and lungs but also blocks the beta sites in the liver, reducing the amount of glycogen available for use, causing hypoglycemia. The lower HR and BP also suggest ingestion of a cardiac medication.

While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2. The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. Patent ductus arteriosus (PDA). 3. Ventricular septal defect (VSD). 4. Bronchopulmonary dysplasia.

2. The main identifier in the stem is the machine-like murmur, which is the hallmark of a PDA

The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse's best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for physicians to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

2. Usually a VSD will close on its own within the first year of life.

Congenital heart defects (CHDs) are classified by which of the following? Select all that apply. 1. Cyanotic defect. 2. Acyanotic defect. 3. Defects with increased pulmonary blood flow. 4. Defects with decreased pulmonary blood flow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.

3, 4, 5, 6. Heart defects are now classified as defects with increased or decreased pulmonary blood flow.

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? A. "You may need to increase the caloric density of your infant's formula." B. "You should feed your baby every 2 hours." C. "You may need to increase the amount of formula your infant eats with each feeding." D. "You should place a nasal oxygen cannula on your infant during and after each feeding."

A. "You may need to increase the caloric density of your infant's formula."

A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse be administering? A. Captopril (Capoten) B. Furosemide (Lasix) C. Spironolactone (Aldactone) D. Chlorothiazide (Diuril)

A. Captopril (Capoten)

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on which statement? A. Child needs opportunities to play with peers. B. Child needs to understand that peers' activities are too strenuous. C. Parents can meet all of the child's needs. D. Constant parental supervision is needed to avoid overexertion.

A. Child needs opportunities to play with peers.

The _____________________ serves as the septal opening between the atria of the fetal heart.

Foraman ovale

tetrology of fallot consists of these defects: a) VSD b) ASD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aorta f) patent ductus arteriosus

a) VSD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aorta

air embolism may form in the venous system, traveling directly to the brain in the child with: a) a right to left shunt b) a left to right shunt c) dehydration and hypoxemia d) hypernatremia and hypokalemia

a) a right to left shunt

The standard treatment for kawasaki disease is: a) aspirin and immune globulin b) aspirin and cryoprecipitate c) meperidine hydrochloride and immune globulin d) meperidine hydrochloride and cryoprecipitate

a) aspirin and immune globulin

In fetal circulation the majority of the oxygenated blood is pumped through the: a) foramen ovale b) lungs c) liver d) coronary sinus

a) foramen ovale

coarctation of the aorta should be suspected when: a) the blood pressure in the arms is different from the blood pressure in the legs b) the blood pressure in the right arm is different from the blood pressure in the left arm c) apical pulse is stronger than the radial pulse d) point of maximum impulse is shifted to the left

a) the blood pressure in the arms is different from the blood pressure in the legs

When obtaining a history from the parents of an infant suspected of having altered cardiac function, the nurse would expect: a) specific concerns related to palpitations the infant is having b) feeding difficulty, sweating with activity, and poor weight gain c) specific concerns about the infant's shortness of breath d) concerns related to the infant's lack of crying

b) feeding difficulty, sweating with activity, and poor weight gain

the process of the formation of the heart's atrial septum results in a temporary flap called the a) truncus arteriosus b) foramen ovale c) sinus venosus d) ductus venosus

b) foramen ovale

In children, the usual approach to the left ventricle of the heart in a cardiac catheterization is through the: a) left side of the heart b) right side of the heart

b) right side of the heart

the peak age for the incidence of kawasaki disease is in the: a) infant age group b) toddler age group c) school age group d) adolescent age group

b) toddler age group

which one of the following heart rates would be considered tachycardia in an infant? a) a resting hr of 120 bpm b) a crying hr of 200 bpm c) a resting hr of 170 bpm d) a crying hr of 180 bpm

c) a resting hr of 170 bpm

which one of the following defects has the best prognosis? a) tetrology of fallot b) ventricular septal defect c) atrial septal defect d) hypoplastic left heart syndrome

c) atrial septal defect

When children develop heart failure from a congenital heart defect, the failure is usually: a) right sided only b) left sided only c) both right and left sided

c) both right and left sided

In fetal circulation, the umbilical vein divides and sends blood directly to the inferior vena cava by way of the ductus venosus. This division occurs at the: a) heart b) lungs c) liver d) placenta

c) liver

Because of the medication used for long term therapy, children with kawasaki disease are at increased risk for: a) chickenpox b) influenza c) reye syndrome d) myocardial infarction

c) reye syndrome

An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. A. 60 B. 70 C. 90 D. 100

B. 70

A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy

1. CHD is found often in children with Down syndrome.

Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident. 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

1, 2, 3, 4, 6. 1. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 2. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 3. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 4. Developmental delays can be caused by multiple hospitalizations and surgeries. The child usually catches up to the appropriate level. 6. Brain damage can be caused by hypoxia, blood clots, and stroke.

Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

1, 2, 3. 1. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 2. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 3. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation.

Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

1, 2, 4, 6. 1. TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 3. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 4. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 5. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 6. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 7. PDA is not one of the defects in tetralogy of Fallot.

What can an electrocardiogram (ECG) detect? Select all that apply. 1. Ischemia. 2. Injury. 3. Cardiac output (CO). 4. Dysrhythmias. 5. Systemic vascular resistance (SVR). 6. Occlusion pressure. 7. Conduction delay.

1, 2, 4, 7, 1. An electrocardiogram can indicate ischemia of the heart muscle. 2. An electrocardiogram can indicate injury to the heart muscle. 3. An electrocardiogram does not indicate CO. 4. An electrocardiogram can show dysrhythmias. 5. An electrocardiogram does not show SVR. 6. An electrocardiogram does not show occlusion pressures. 7. An electrocardiogram does show conduction delays.

The following are examples of acquired heart disease. Select all that apply. 1. Infective endocarditis. 2. Hypoplastic left heart syndrome. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). 6. Transposition of the great vessels.

1, 3, 4, 5. 1. Infective endocarditis is an example of an acquired heart problem. 3. RF is an acquired heart problem. 4. Cardiomyopathy is an acquired heart problem. 5. KD is an acquired heart problem.

Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

1, 4, 5, 6, 7. 1. Rocking by the parents will comfort the infant and decrease demands. 4. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. 5. An infant sucking the fists could indicate hunger. 6. Change bed linens only when necessary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the child

Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)? 1. Chickenpox or influenza. 2. E. coli or staphylococcus. 3. Mumps or streptococcus A. 4. Streptococcus A or staphylococcus

1. Both chickenpox and influenza are viral in nature, so consider stopping the aspirin because of the danger of Reye syndrome.

A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using firm nipples with small openings to slow feedings.

1. Formula can be supplemented with extra calories, either from a commercial supplement, such as Polycose, or from corn syrup. Calories in formula could increase from 20 kcal/oz to 30 kcal/oz or more.

The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen.

1. High-dose immunoglobulin G and salicylate therapy for inflammation are the current treatment for KD.

Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.

1. The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia.

A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.

1. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk for digoxin toxicity.

Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."

3. Children can be irritable for 2 months after the symptoms of the disease start.

A heart transplant may be indicated for a child with severe heart failure and: 1. Patent ductus arteriosus (PDA). 2. Ventricular septal defect (VSD). 3. Hypoplastic left heart syndrome. 4. Pulmonic stenosis (PS).

3. Hypoplastic left heart syndrome is treated by the Norwood procedure, or heart transplant.

Which medication should the nurse give to a child diagnosed with transposition of the great vessels? 1. Ibuprofen. 2. Betamethasone. 3. Prostaglandin E. 4. Indocin.

3. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery.

Which assessment indicates that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr.

3. The 50th percentile height and weight for age shows good growth and development, indicating good nutrition and perfusion.

Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

3. The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so fluid in the lungs can go to the base of the lungs, allowing better expansion.

During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.

3. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow.

In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).

3. With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lowerthan- expected BP and weak pulses in the lower extremities.

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk? A. Minimize seizures. B. Prevent dehydration. C. Promote cardiac output. D. Reduce energy expenditure.

B. Prevent dehydration.

Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin indicates the need for further education? 1. "I will give the medication at regular 12-hour intervals." 2. "If he vomits, I will not give a make-up dose." 3. "If I miss a dose, I will not give an extra dose" 4. "I will mix the digoxin in some formula to make it taste better."

4. If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate.

During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.

4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery.

Which is the leading cause of death after heart transplantation? A. Infection B. Rejection C. Cardiomyopathy D. Heart failure

B. Rejection

The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? A. Seizures B. Vomiting C. Bradypnea D. Tachycardia

B. Vomiting

As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: A. chlorides. B. potassium. C. sodium. D. vitamins.

B. potassium.

Causes vasodilation that decreases pulmonary and systemic vascular resistance, decreased blood pressure, reduced after load, and decreased right and left atrial pressures.

Angiotensin-converting enzyme (ACE) inhibitor

The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)? A. It decreases edema. B. It decreases cardiac output. C. It increases heart size. D. It increases venous pressure.

ANS: A Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size and venous pressure are decreased by digoxin.

A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. A. 60 B. 70 C. 90 to 110 D. 110 to 120

C. 90 to 110

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) A. Warm flushed extremities B. Weight loss C. Decreased urinary output D. Sweating (inappropriate) E. Fatigue

C. Decreased urinary output D. Sweating (inappropriate) E. Fatigue

Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? A. Pulmonary congestion B. Congenital heart defect C. Heart failure D. Systemic venous congestion

C. Heart failure

Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure? A. Tachypnea B. Tachycardia C. Peripheral edema D. Pale, cool extremities

C. Peripheral edema

The nurse is caring for a 9-month-old who was born with a congenital heart defect (CHD). Assessment reveals a HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.

Congestive heart failure or CHF.

The parents of a young child with heart failure tell the nurse that they are "nervous" about giving digoxin (Lanoxin). The nurse's response should be based on which statement? A. It is a safe, frequently used drug. B. It is difficult to either overmedicate or undermedicate with digoxin. C. Parents lack the expertise necessary to administer digoxin. D. Parents must learn specific, important guidelines for administration of digoxin.

D. Parents must learn specific, important guidelines for administration of digoxin.

Used because of its rapid onset and decreased risk for toxicity; increases the force of contraction (positive inotropic effect), decreases the heart rate (negative chronotropic effect), slows the conduction of impulses through the AV node (negative dromotropic effect), and indirectly enhances diuresis

Digoxin

A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has _____________________.

Kawasaki disease or KD

Patent ductus arteriosus causes what type of shunt? _____________________

Left to right. Blood flows from the higher pressure aorta to the lower pressure pulmonary artery, resulting in a left to right shunt.

A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow of blood through the heart is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood.

The flow of blood through the heart with an atrial septal defect (ASD) is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood.

A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

PDA (Patent ductus arteriosus)

A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called _____________________.

Tetralogy of Fallot or TOF.

which of the following defects has the worst prognosis? a) tetrology of fallot b) atrial ventricular canal defect c) transposition of the great vessels d) hypoplastic left heart syndrome

d) hypoplastic left heart syndrome

A clue in the mother's history that is important in the diagnosis of congenital heart disease is: a) rheumatoid arthritis b) rheumatic fever c) streptococcal infection d) rubella

d) rubella

Blocks reabsorption of sodium and water to produce diuresis

furosemide

ACE inhibitors that are frequently used in pediatrics

lisinopril, catopril, enalapril