Davis Pediatric Success Chapter 5 Cardiovascular Disorders

Which finding might delay a cardiac catheterization procedure on a 1-year-old? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

2 A child with severe diaper rash has potential for infection if the interventionist makes the standard groin approach.

A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should fi rst assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

2 Checking for pulses, especially in the canulated extremity, would assure perfusion to that extremity and is the priority post procedure.

A 16-year-old being treated for hypertension has a history of asthma. Which drug class should be avoided in treating this client ' s hypertension? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

1 Beta blockers are not generally used in clients with asthma and hypertension because of concern the beta agonist will cause severe asthma attacks.

Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fl uid 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 that fl uid in the lungs can go to the base of the lungs, allowing better expansion.

The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse ' s fi rst action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

4 Applying direct pressure 1 inch above the puncture site will localize pressure over the vessel site.

The most common cardiac dysrhythmia in the pediatric population is: 1. Ventricular tachycardia. 2. Sinus bradycardia. 3. Supraventricular tachycardia. 4. First-degree heart block.

3 Supraventricular tachycardia is most common in children.

A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin (Lanoxin) and furosemide (Lasix). 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 (Lanoxin) toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide (Lasix) can increase the risk for digoxin toxicity.

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

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 fi sts. 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 fi sts could indicate hunger. 6. Change bed linens only when necessary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the child.

Which assessments indicate that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? Select all that apply. 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. 5. Playing basketball with other children his age.

3, 5 3. The 50th percentile height and weight for age shows good growth, indicating good nutrition and perfusion. 5. Playing basketball with children his age indicates he is following the prescribed treatment and responding well to it.

A toddler who has been hospitalized for vomiting because of gastroenteritis is sleeping and diffi cult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refi ll of 3 seconds. Which dysrhythmia does the nurse suspect in this child? 1. Rapid pulmonary fl utter. 2. Sinus bradycardia. 3. Rapid atrial fi brillation. 4. Supraventricular tachycardia.

4 SVT is often above 200 and a result of dehydration, which a vomiting child could have. The rapid rate causes a low CO, resulting in low BP and prolonged capillary refi ll.

Which vaccines must be delayed for 11 months after the administration of gamma globulin? Select all that apply. 1. Diphtheria, tetanus, and pertussis. 2. Hepatitis B. 3. Inactivated polio virus. 4. Measles, mumps, and rubella. 5. Varicella.

4, 5 4. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months. 5. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months.

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1. Cracked lips 2. Normal appearance 3. Conjunctival hyperemia 4. Desquamation of the skin

Answer: 3 Rationale: Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an acute systemic inflammatory illness. In the acute stage, the child has a fever, conjunctival hyper- emia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocy- tosis occur. In the convalescent stage, the child appears nor- mal, but signs of inflammation may be present.

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 refi ll of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.

Congestive heart failure (CHF).

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 (KD).

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 _____________________.

Patent ductus arteriosus (PDA).

Indomethacin (Indocin) may be given to close which congenital heart defect (CHD) in newborns? _____________________

Patent ductus arteriosus (PDA).

For the child with hypoplastic left heart syndrome, which drug may be given to allow the patent ductus arteriosus (PDA) to remain open until surgery? _____________________

Prostaglandin E.

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. Candida or Streptococcus A. 4. Streptococcus A or staphylococcus.

1 Both chickenpox and infl uenza 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 fi rm 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 (Motrin).

1 High-dose immunoglobulin G and salicylate (aspirin) 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 fi ngers is a result of the polycythemia and hypoxemia.

An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff? 1. Soy. 2. Latex. 3. Penicillin. 4. Dairy.

2 Children with spina bifida (myelomeningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy.

Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin (Lanoxin) and furosemide (Lasix). The child no longer has retractions, lungs are clear, and HR is 96 beats per minute while the child sleeps. The nurse is confi dent 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.

What should the nurse assess prior to administering digoxin (Lanoxin)? 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

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

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 infl ammation."

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

Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin (Lanoxin) 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 dose will be inadequate.

The nurse is closely monitoring the intake and output of an infant with heart failure who is re- ceiving diuretic therapy. The nurse would use which most appropriate method to assess the urine output? 1 Weighing the diapers 2 Inserting a urinary catheter 3 Comparing intake with output 4 Measuring the amount of water added to formula

Answer: 1 Rationale: Heart failure is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. The most appropriate method for assess- ing urine output in an infant receiving diuretic therapy is to weigh the diapers. Comparing intake with output would not provide an accurate measure of urine output. Measuring the amount of water added to formula is unrelated to the amount of output. Although urinary catheter drainage is most accurate in determining output, it is not the most appropriate method in an infant and places the infant at risk for infection.

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse would assess the infant for which early sign of HF? 1. Pallor 2. Cough 3. Tachycardia 4. Slow and shallow breathing

Answer: 3 Rationale: HF is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. The early signs of HF include tachycardia, tachy- pnea, profuse scalp sweating, fatigue and irritability, sudden weight gain, and respiratory distress. A cough may occur in HF as a result of mucosal swelling and irritation, but it is not an early sign. Pallor may be noted in an infant with HF, but it is not an early sign.

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? 1 "I will not mix the medication with food." 2 "If more than one dose is missed, I will call the pediatrician." 3 "I will take my child's pulse before administering the medication." 4 "If my child vomits after medication administra- tion, I will repeat the dose."

Answer: 4 Rationale: Digoxin is a cardiac glycoside. The parents need to be instructed that if the child vomits after digoxin is admin-istered, they are not to repeat the dose. Options 1, 2, and 3 are accurate instructions regarding the administration of this medication. In addition, the parents need to be instructed that if a dose is missed and the missed dose is not identified until 4 hours later, the dose would not be administered.

The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in conrming the diagnosis? 1. Immunoglobulin 2. Red blood cell count 3. White blood cell count 4. Anti-streptolysin O titer

Answer: 4 Rationale: Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and central ner- vous system. A diagnosis of rheumatic fever is confirmed by the presence of two major manifestations or one major and two minor manifestations from the Jones criteria. In addition, evidence of a recent streptococcal infection is confirmed by a positive anti-streptolysin O titer, Streptozyme assay, or anti- DNase B assay. Options 1, 2, and 3 would not help confirm the diagnosis of rheumatic fever.

A child with rheumatic fever will be arriving at the nursing unit for admission. On admission assess- ment, the nurse would ask the parents which question to elicit assessment information specic to the development of rheumatic fever? 1. "Has the child complained of back pain?" 2. "Has the child complained of headaches?" 3. "Has the child had any nausea or vomiting?" 4. "Did the child have a sore throat or fever within the last 2 months?"

Answer: 4 Rationale: Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and central ner- vous system. Rheumatic fever characteristically manifests 2 to 6 weeks after an untreated or partially treated group A beta- hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child had a sore throat or an unexplained fever within the past 2 months. Options 1, 2, and 3 are unrelated to rheumatic fever.

A pediatrician has prescribed oxygen as needed for an infant with heart failure. Which situation would likely increase the oxygen demand, requiring the nurse to administer oxygen to the infant? 1. During sleep 2. When changing the infant's diapers 3. When a parent is holding the infant 4. When drawing blood for electrolyte level testing

Answer: 4 Rationale: Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood to meet the oxygenand metabolic needs of the body. Crying exhausts the lim- ited energy supply, increases the workload of the heart, and increases the oxygen demands. Oxygen administration may be prescribed for stressful periods, especially during bouts of cry- ing or invasive procedures. Options 1, 2, and 3 are unlikely to produce crying in the infant.