Chapter 26: The Child with a Cardiovascular Disorder

The nurse explains that a ventricular septal defect will allow: a. blood to shunt left to right, causing increased pulmonary flow and no cyanosis. b. blood to shunt right to left, causing decreased pulmonary flow and cyanosis. c. no shunting because of high pressure in the left ventricle. d. increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume.

ANS: A blood to shunt left to right, causing increased pulmonary flow and no cyanosis.

The assessment that would lead the nurse to suspect that a newborn infant has a ventricular septal defect is: a. a loud, harsh murmur with a systolic tremor. b. cyanosis when crying. c. blood pressure higher in the arms than in the legs. d. a machinery-like murmur.

ANS: A a loud, harsh murmur with a systolic tremor.

An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). The nurse understands dyspnea occurs because blood is: a. circulated through the lungs again, causing pulmonary circulatory congestion. b. shunted past the pulmonary circulation, causing pulmonary hypoxia. c. shunted past cardiac arteries, causing myocardial hypoxia. d. circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.

ANS: A circulated through the lungs again, causing pulmonary circulatory congestion.

The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. The nurse can determine the father understood the instructions when he states "If the baby turns blue, I will: a. hold him against my shoulder with his knees bent up toward his chest." b. lay him down on a firm surface with his head lower than the rest of his body." c. immediately put the baby upright in an infant seat." d. put the baby in supine position with his head elevated."

ANS: A hold him against my shoulder with his knees bent up toward his chest."

When a father asks why his child with tetralogy of Fallot seems to favor a squatting position, the nurse would explain that squatting: a. increases the return of venous blood back to the heart. b. decreases arterial blood flow away from the heart. c. is a common resting position when a child is tachycardic. d. increases the workload of the heart.

ANS: A increases the return of venous blood back to the heart.

The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, "How does Kawasaki disease affect my child's heart and blood vessels?" The nurse's response is based on the understanding that: a. inflammation weakens blood vessels, leading to aneurysm. b. increased lipid levels lead to the development of atherosclerosis. c. untreated disease causes mitral valve stenosis. d. altered blood flow increases cardiac workload with resulting heart failure.

ANS: A inflammation weakens blood vessels, leading to aneurysm.

How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? Select all that apply. a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding d. Substituting glucose water for formula e. Offering high-caloric formula

ANS: A, B, C, E a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding e. Offering high-caloric formula

What assessment(s) in a child with tetralogy of Fallot would indicate the child is experiencing a paroxysmal hypercyanotic episode? Select all that apply. a. Spontaneous cyanosis b. Dyspnea c. Weakness d. Dry cough e. Syncope

ANS: A, B, C, E a. Spontaneous cyanosis b. Dyspnea c. Weakness e. Syncope

The nurse uses a diagram to illustrate what four structural heart anomalies that comprise tetralogy of Fallot? Select the four that apply. a. Hypertrophied right ventricle b. Patent ductus arteriosus c. Ventral septal defect d. Narrowing of pulmonary artery e. Dextroposition of aorta

ANS: A, B, D, E a. Hypertrophied right ventricle b. Patent ductus arteriosus d. Narrowing of pulmonary artery e. Dextroposition of aorta

The nurse explains that which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? Select all that apply. a. Atrial septal defects (ASDs) b. Tetralogy of Fallot c. Dextroposition of aorta d. Patent ductus arteriosus e. Ventricular septal defects (VSDs)

ANS: A, D, E a. Atrial septal defects (ASDs) d. Patent ductus arteriosus e. Ventricular septal defects (VSDs)

The comment made by a parent of a 1-month-old that would alert the nurse about the presence of a congenital heart defect is: a. "He is always hungry." b. "He tires out during feedings." c. "He is fussy for several hours every day." d. "He sleeps all the time."

ANS: B "He tires out during feedings."

A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever? a. Subcutaneous nodules and fever b. Painful, tender joints and carditis c. Erythema marginatum and arthralgia d. Chorea and elevated sedimentation rate

ANS: B Painful, tender joints and carditis

A child develops carditis from rheumatic fever. The nurse knows that the areas of the heart affected by carditis are the: a. coronary arteries. b. heart muscle and the mitral valve. c. aortic and pulmonic valves. d. contractility of the ventricles.

ANS: B heart muscle and the mitral valve.

An appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant would be: a. counting the apical rate for 30 seconds before administering the medication. b. withholding a dose if the apical heart rate is less than 100 beats/min. c. repeating a dose if the child vomits within 30 minutes of the previous dose. d. checking respiratory rate and blood pressure before each dose.

ANS: B withholding a dose if the apical heart rate is less than 100 beats/min.

The nurse clarifies to the parents of a 4-year-old child recovering from rheumatic fever that the child will need to receive monthly injections of penicillin G for a minimum of _____ year(s). a. 1 b. 2 c. 5 d. 10

ANS: C 5 years

When the child with rheumatic fever begins involuntary, purposeless movements of her limbs, the nurse recognizes that this is an indication of: a. seizure activity. b. hypoxia. c. Sydenham's chorea. d. decreasing level of consciousness.

ANS: C Sydenham's chorea.

The nurse is aware that the characteristics of high-density lipoproteins (HDLs) are that they: a. have high amounts of triglycerides. b. have only small amounts of protein. c. have little cholesterol. d. aid in steroid production.

ANS: C have little cholesterol.

The school nurse recommends a heart healthy diet that limits fats to no more than ____% of the total dietary intake. a. 10 b. 15 c. 20 d. 30

ANS: D 30%

The nurse is aware that the infant born with hypoplastic left heart syndrome must acquire his or her oxygenated blood through: a. the patent ductus arteriosus. b. a ventricular septal defect. c. the closure of the foramen ovale. d. an atrial septal defect.

ANS: D an atrial septal defect.

The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, "Why do my child's fingertips look like that?" The nurse bases a response on the understanding that clubbing occurs as a result of: a. untreated congestive heart failure. b. a left-to-right shunting of blood. c. decreased cardiac output. d. chronic hypoxia.

ANS: D chronic hypoxia.

The finding the nurse would expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta is blood pressure that is: a. higher on the right side. b. higher on the left side. c. lower in the arms than in the legs. d. lower in the legs than in the arms.

ANS: D lower in the legs than in the arms.

An infant with congestive heart failure is receiving digoxin (Lanoxin). The nurse recognizes a sign of digoxin toxicity, which is: a. restlessness. b. decreased respiratory rate. c. increased urinary output. d. vomiting.

ANS: D vomiting.