Chapter 42: Cardiovascular Dysfunction

The nurse is evaluating a child who is taking digoxin for her cardiac condition. The nurse is cognizant that a common sign of digoxin toxicity is:

Vomiting

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."

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement?

a. Administering penicillin

What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)?

a. Assess the parents' anxiety level and readiness to learn.

The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands?

a. Organize nursing activities to allow for uninterrupted sleep.

A major clinical manifestation of rheumatic fever is:

a. Polyarthritis.

Which structural defects constitute tetralogy of Fallot?

a. Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

A child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to the child and the child's parents (Select all that apply)?

a. Replace whole milk with 2% or 1% milk c. Increase servings of fish d. Avoid excessive intake of fruit juices

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 knowing that:

a. The child needs opportunities to play with peers.

In which situation is there the greatest risk that a newborn infant will have a congenital heart defect (CHD)? a. Trisomy 21 dete

a. Trisomy 21 detected on amniocentesis

Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?

a. Weigh the infant every day on the same scale at the same time.

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, what medication should the nurse prepare for immediate administration?

Epinephrine

The leading cause of death after heart transplantation is:

Rejection

The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?

b. "I have to stay on strict bed rest for 3 days."

As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. 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:

b. Potassium.

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents (strokes) exists. An important objective to decrease this risk is to:

b. Prevent dehydration.

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?

b. Tetralogy of Fallot

An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. The initial treatment of secondary hypertension initially involves:

b. Treating the underlying disease.

A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response?

c. "Your child must lie quietly; sometimes a mild sedative is administered before the procedure."

An important nursing consideration when chest tubes will be removed from a child is to:

c. Administer analgesics before the procedure.

An important nursing consideration when suctioning a young child who has had heart surgery is to:

c. Administer supplemental oxygen before and after suctioning.

When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure?

c. All four extremities

Which defect results in increased pulmonary blood flow?

c. Atrial septal defect

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

c. Congestive heart failure

Which clinical manifestations would the nurse expect to see as shock progresses in a child and becomes decompensated shock (Select all that apply)?

c. Cool extremities and decreased skin turgor d. Confusion and somnolence f. Tachypnea and poor capillary refill time

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)?

c. Decreased urinary output d. Sweating (inappropriate) e. Fatigue

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:

d. Apply direct pressure above the catheterization site.

A common, serious complication of rheumatic fever is:

d. Cardiac valve damage.

A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality?

Polycythemia

Which is the acceptable mg/dl level, or below this level, low-density lipoprotein (LDL) cholesterol level for a child from a family with heart disease? _____ Record your answer as a whole number.

ANS: 110

Nursing interventions for the child after a cardiac catheterization include which of the following (Select all that apply)?

ANS: C, F c. Assess the affected extremity for temperature and color. f. Maintain a patent peripheral intravenous catheter until discharge.

An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during a routine blood draw. Which interventions should the nurse implement? Place in order from the highest-priority intervention to the lowest-priority intervention. a. Administer 100% oxygen by blow-by. b. Place infant in knee-chest position. c. Remain calm. d. Give morphine subcutaneously or by an existing intravenous line. 59. First priority 60. Second priority 61. Third priority 62. Fourth priority

Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in infants with tetralogy of Fallot, may occur in any child whose heart defect includes obstruction to pulmonary blood flow and communication between the ventricles. The infant becomes acutely cyanotic and hyperpneic because sudden infundibular spasm decreases pulmonary blood flow and increases right-to-left shunting. Because profound hypoxemia causes cerebral hypoxia, hypercyanotic spells require prompt assessment and treatment to prevent brain damage or possibly death. The infant should first be placed in the knee-chest position to reduce blood returning to the heart. Next, 100% oxygen is given to alleviate the hypoxemia. Morphine is next administered to reduce infundibular spasms. Last, the nurse should remain calm.

Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?

Osler's nodes

Which drug is an angiotensin-converting enzyme (ACE) inhibitor?

a. Captopril (Capoten)

The nurse is assessing a child post-cardiac catheterization. Which complication might the nurse anticipate?

a. Cardiac arrhythmia

A beneficial effect of administering digoxin (Lanoxin) is that it:

a. Decreases edema.

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well?

b. Alert the physician.

One of the most frequent causes of hypovolemic shock in children is:

b. Blood loss.

The primary nursing intervention necessary to prevent bacterial endocarditis is to:

b. Counsel parents of high risk children about prophylactic antibiotics.

Which clinical changes occur as a result of septic shock?

b. Increased cardiac output

When preparing a school-age child and the family for heart surgery, the nurse should consider:

b. Letting child hear the sounds of an electrocardiograph monitor.

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect?

b. Patent ductus arteriosus

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to:

b. Place the child in the knee-chest position.

The nurse is caring for a child after heart surgery. What should she or he do if evidence is found of cardiac tamponade?

c. Immediately report this to the physician.

A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is:

c. Peripheral edema.

A nurse is teaching an adolescent about primary hypertension. The nurse knows that which of the following is correct?

c. Primary hypertension may be treated with weight reduction.

Which action by the school nurse is important in the prevention of rheumatic fever?

c. Refer children with sore throats for throat cultures.

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what conditions occur (Select all that apply)?

c. Temperature above 37.7° C (100° F) d. New, frequent coughing e. Turning blue or bluer than normal

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:

d. Adapted to his level of development so that he can understand.

What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?

d. Anaphylactic shock

What is an expected assessment finding in a child with coarctation of the aorta?

d. Disparity in blood pressure between the upper and lower extremities

When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what substance are thought to protect against cardiovascular disease?

d. High-density lipoproteins (HDLs).

Which postoperative intervention should be questioned for a child after a cardiac catheterization?

d. Keep the affected leg flexed and elevated.

The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on knowing that:

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

Surgical closure of the ductus arteriosus would:

d. Prevent the return of oxygenated blood to the lungs

Seventy-two hours after cardiac surgery, a young child has a temperature of 37.7° C (101° F). The nurse should:

d. Report findings to physician.

The most common causative agent of bacterial endocarditis is:

d. Streptococcus viridans.

When caring for the child with Kawasaki disease, the nurse should understand that:

d. Therapeutic management includes administration of gamma globulin and aspirin.

For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?

d. To improve oxygenation