Congenital Heart Diseases in Infants and Children

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching? a) "We need to avoid a tub bath for the next 3 days." b) "Strenuous activity should be limited for the next 3 days." c) "The feeling of the heart skipping a beat is common." d) "We need to watch for changes in skin color or difficulty breathing."

"The feeling of the heart skipping a beat is common."

The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? 1. Allow early ambulation to encourage activity participation. 2. Check pulses above the catheter insertion site for strength and quality. 3. Assess extremity distal to the insertion site for temperature and color. 4. Change the dressing to evaluate the site for infection.

3: assess extremity distal to the insertion site for temp and color Assess bandage for hemorrhage!!!

A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? 1. Gallop and rales. 2. Blood pressure discrepancies in the extremities. 3. Right ventricular hypertrophy on ECG. 4. Heart murmur.

4: Heart murmur

Which defect results in increased pulmonary blood flow?

ASD VSD Pulmonary stenosis PDA

Which action should the nurse include in the plan of care for a 2-month-old infant with heart failure?

Allow the infant to rest before feeding. Feed slowly while allowing time for adequate periods of rest.

A nurse is caring for a child who is experiencing heart failure. Which of the following assessment data was most likely seen when initially examined? a) Polyuria b) Tachycardia c) Bradycardia d) Splenomegaly

B: tachycardia, sweating while feeding while feeling cool

Surgical closure of the ductus arteriosus would:

Close the duct between the aorta and pulmonary artery

When caring for a child that has just had a cardiac catheterization, which of the following would indicate a sign of hypotension? a) Diaphoresis and tachycardia b) Cold clammy skin and increased heart rate c) Syncope and tachypnea d) Decreased heart rate and dizziness

Cold clammy skin and increased heart rate

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: a) bounding pulse. b) narrow pulse. c) hepatomegaly. d) femoral pulse weaker than brachial pulse.

Femoral pulse is weaker than brachial pulse

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:

In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

A nurse is reviewing blood work on a patient with a cyanotic heart defect. Which of the following results would most likely be seen in a patient experiencing polycythemia? a) Increased WBC b) Increased RBC c) Decreased RBC d) Decreased WBC

Inc. RBC

An infant with Tetralogy of Fallot becomes cyanotic and dyspneic after a crying episode. In what position should the nurse place the infant to relieve the cyanosis and dyspnea?

Squatting, knees-to-chest position

A newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis? a) Coarctation of aorta b) Pulmonary stenosis c) Aortic stenosis d) Tetralogy of Fallot

Tetralogy of fallot

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

Tetralogy of fallot Transposition of great arteries

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

The child and family should be exposed to the sights and sounds of the intensive care unit.

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

The disparity in pulses and blood pressures between the upper and lower extremities.

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?

These are signs of early congestive heart failure, and the physician should be notified.

A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education? a) Your child may need multiple surgeries to correct this defect. b) This is caused by an opening that usually closes by 1 week of age. c) This type of defect is caused by having a genetic predisposition for it. d) An IV for fluids will be started immediately.

This is caused by an opening that usually closes by 1 week of age.

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

When a CHD is suspected, the blood pressure should be measured in all four extremities while the child is quiet.

An 8-month-old has a ventricular septal defect. Which nursing diagnosis below would best apply? a) Impaired skin integrity related to poor peripheral circulation b) Impaired gas exchange related to a right-to-left shunt c) Ineffective airway clearance related to altered pulmonary status d) Ineffective tissue perfusion related to inefficiency of the heart as a pump

d) Ineffective tissue perfusion related to inefficiency of the heart as a pump

The nurse is providing preoperative teaching to the parents of a 9-month-old infant who is having surgery to repair a ventricular septal defect. Identify the area of the heart where the defect is located.

A ventricular septal defect is a hole in the septum between the ventricles. The defect can be anywhere along the septum but is most commonly located in the middle of the septum

The nurse is providing preoperative teaching to the parents of a 9-month-old infant who is having surgery to repair a ventricular septal defect. Identify the area of the heart where the defect is located.

A ventricular septal defect is a hole in the septum between the ventricles. The defect can be anywhere along the septum but is most commonly located in the middle of the septum.

When reviewing the record of a child with tetralogy of Fallot, which of the following would you expect to discover? a) Polycythemia b) Anemia c) Leukopenia d) Increased platelet level

A: polycythemia

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:

Apply pressure 1 inch above insertion site

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

Arrhythmia

Which of the following would be included in the care of an infant in heart failure? a) Begin formulas with increased calories. b) Encourage larger, less frequent feedings. c) Maintain child in the supine position. d) Administer digoxin even if the infant is vomiting

Begin formulas with increased calories to decrease the amount of formula the infant has to eat (Less work for baby)

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. Which of the following would most likely explain this assessment finding? a) The spleen increases due to increased destruction of red blood cells. b) The liver increases due to cardiac medications. c) The spleen increases due to frequent infection. d) The liver increases in right-sided heart failure.

D: hepatomegaly in right sided HF

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

Decreased urinary output Sweating (inappropriate) Fatigue

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child? a) Presacral region b) Lower extremities c) Hands d) Face

Lower extremities

A parent brings an infant in for poor feeding. Which of the following assessment data would most likely indicate a coarctation of the aorta? a) Pulses weaker in upper extremities compared to lower extremities b) Cyanosis with feeding c) Pulses weaker in lower extremities compared to upper extremities d) Cyanosis with crying

Pulses weaker in lower extremities compared to upper extremities

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

The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure.

A neonate was admitted to the pediatric unit with an unexpected congenital defect. What's the best way to involve the parents in the infant's care?

Offer the parents opportunities to be involved with the infant's care while they adjust to his unexpected condition.

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply. a) Shortness of breath when playing b) Bradycardia c) Crackles on lung auscultation d) Hypertension e) Tiring easily when eating

• Tiring easily when eating • Shortness of breath when playing • Crackles on lung auscultation

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?

Congestive heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body.

After a discussion with the health care provider, the parents of an infant with patent ductus arteriosus (PDA) ask the nurse to explain once again what PDA is. How should the nurse respond?

It is a duct that connects the aorta to the pulmonary artery. While the infant is in utero, this duct bypasses the lungs since mom is oxygenating the blood for baby.

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. Which of the following is the best response from the nurse? a) It will determine disturbances in heart conduction. b) It will show if blood is being shunted. c) This image will clarify the structures within the heart. d) It will determine if the heart is enlarged.

It will determine if the heart is enlarged

Tetralogy of Fallot consists of the following four anomalies: aortic stenosis, atrial septal defect, dextroposition (overriding) of the aorta, and hypertrophy of the left ventricle. a) False b) True

False: tetralogy of fallot consists of 1. PDA 2. Pulmonary stenosis 3. VSD 4. Overriding aorta (receives blood from both RV & LV)

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which of the following signs and symptoms would the infant most likely be exhibiting? a) Rapid weight gain b) Yellowish color c) Bradycardia d) Feeding problems

Feeding problems

A 3-month-old infant is admitted to the pediatric unit with a diagnosis of tetralogy of Fallot. The nurse's infant's weight has declined from the 25th percentile to the 5th. The nurse concludes that the most likely reason for this inadequate weight gain is:

Inadequate oxygen perfusion leading to activity intolerance, resulting in diminished energy to nurse

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

Organize nursing activities to allow for uninterrupted sleep.

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

PDA

Which of the following would be most important to implement for an infant who develops heart failure? a) Placing her in a semi-Fowler's position b) Keeping her supine and playing quiet games c) Planning ways to reduce salt intake d) Restricting milk intake daily

Placing her in semi-Fowler's

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:

The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace and regulate their activities. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence.

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

The incidence of congenital heart disease is approximately 50% in children with trisomy 21 (Down syndrome). A family history of congenital heart disease, not acquired heart disease, increases the risk of giving birth to a child with CHD. Infants born to mothers who are insulin dependent have an increased risk of CHD. Infants identified as having certain genetic defects, such as Turner's syndrome, have a higher incidence of CHD.

A parent asks why their infant with a cyanotic heart defect turns blue. What is the best response by the nurse? a) This is considered a medical emergency and needs immediate surgery. b) This is due to a decreased amount of oxygen to the peripheral tissue. c) This is due to the lack of oxygen to the brain. d) This is a sign of heart failure.

b) This is due to a decreased amount of oxygen to the peripheral tissue.

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?

To improve oxygenation

A nurse is interviewing a mother who is about to deliver her baby. Which of the following responses would alert the nurse for a higher potential for a heart defect in the infant? a) The mother has seizures, but did not take medication while pregnant. b) The mother states she slept all the time while pregnant. c) The mother states she took acetaminophen while pregnant. d) The mother states she has lupus.

Mother states she has lupus Also if mother has PKU, diabetes, rubella or is on drugs

Infants with congenital heart disease should not be allowed to become dehydrated because this makes them prone to a) cerebrovascular accident. b) jaundice. c) tachycardia. d) seizures.

cerebrovascular accident (can develop thrombi if they become dehydrated)