Nurs 4 - Mod 13: Pediatric Heart Defects

The nurse is preparing a school-age child with a cardiac defect for heart surgery. What does the nurse include in the preoperative teaching? Select all that apply. 1 Show the child play areas in the facility 2 Describe new equipment that will be used 3 Teach how to manage pain after the surgery 4 Stay away from the intensive care unit (ICU) 5 Inform about what the child will see and feel

1 - Show the child play areas in the facility 2 - Describe new equipment that will be used 5 - Inform about what the child will see and feel The nurse informs the child about the play areas in the facility to alleviate the child's anxiety and focus on the pleasurable parts of the hospital stay. The nurse also describes the new equipment that is used for the procedure so that the child is not intimidated. The nurse also informs the child what the child will see and feel to diminish the child's fears. The nurse does not focus on the pain after the procedure, but distracts the child with imagery or storytelling. The nurse shows the ICU to the child before the procedure so that the child is not worried or anxious when transferred to that room.

The nurse is preparing to give digoxin to a 9-month-old infant. The nurse checks the dose and draws up 4 mL of the drug. What is the most appropriate nursing action? 1 To not give the dose; suspect dosage error 2 To mix the dose with juice to disguise its taste 3 To check heart rate; administer the dose by placing it to the back and side of the mouth 4 To check heart rate; administer the dose by letting the infant suck it through a nipple

1 - To not give the dose; suspect dosage error Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. Because it is a potentially dangerous drug, administration guidelines are very precise. Some institutions require that digoxin dosages be confirmed by another professional before administration. The nurse has drawn up too much medication. Checking heart rate, administering the dose by placing it to the back and side of the mouth, or by letting the infant suck it through a nipple are correct procedures, but too much medication has been prepared.

What does the nurse include in the teaching for a family of a child with a heart defect? Select all that apply. 1 Ask the parents to discuss any problems with parent groups 2 Advise the parents to read about the disease on the Internet 3 Show a simple drawing of the heart to teach about the defect 4 Explain the nature of the disease in easy to understand words 5 Provide written instructions for the family about the child's care

2 - Advise the parents to read about the disease on the Internet 3 - Show a simple drawing of the heart to teach about the defect 4 - Explain the nature of the disease in easy to understand words 5 - Provide written instructions for the family about the child's care The nurse explains the nature of the disease to the parents in simple language so that the parents can understand it. The nurse also shows a simple drawing or model of the heart to explain in detail about the disease. The nurse provides written instructions for the family about the child's condition and care in case the parents do not remember the verbal instructions. The nurse advises the parents to read about the disease on the Internet or any other source to obtain general information. Other parents may not have the correct information, so the nurse asks the parents to discuss any problems with the health care provider or other medical staff to obtain accurate information.

What is a priority nursing intervention when administering loop diuretics to a child with heart failure? 1 Ensure that the child gets adequate rest 2 Record the child's fluid intake and output 3 Change the child's position every 2 hours 4 Restrict salt and potassium in the child's diet

2 - Record the child's fluid intake and output Loop diuretics are designed to eliminate excess extracellular fluid. Therefore the nurse should record the child's fluid intake and output because of the risk of dehydration due to fluid loss. Salt is restricted by the health care provider because it promotes water retention. However, potassium is not restricted. A side effect of loop diuretics is hypokalemia, or potassium loss. The child will be asked to include high potassium foods in the diet and may even need potassium supplements. Ensuring that the child gets adequate rest will not help to prevent dehydration. The nurse changes the child's position every two hours to prevent skin breakdown and not to prevent dehydration.

The nurse is learning about circulatory disorders within the heart resulting from congenital heart defects. Which disorders cause cyanosis? Select all that apply. 1 There is an increase in the pulmonary blood flow within the heart. 2 There is a severe obstruction located on the right side of the heart. 3 Oxygenated and deoxygenated blood mixes in the heart chambers. 4 The blood is shunted from the right side to the left side of the heart. 5 The pressure on the right side of the heart is lower than the left side.

2 - There is a severe obstruction located on the right side of the heart. 3 - Oxygenated and deoxygenated blood mixes in the heart chambers. 4 - The blood is shunted from the right side to the left side of the heart. With many congenital heart defects, the blood is shunted from the right side of the heart to the left side of the heart due to increased pulmonary vascular resistance, or obstruction to blood flow through the pulmonic valve and artery. This results in cyanosis. Cyanosis also occurs if the oxygenated and deoxygenated blood mixes within the heart chambers. Cyanosis is also caused by severe obstruction on the right side of the heart. If the pressure on the right side of the heart is lower than that of the left side, it indicates a normal heart. An increased pulmonary blood flow within the heart indicates heart failure.

Which defect is present with tetralogy of Fallot? 1 Coarctation of the aorta 2 Patent ductus arteriosus 3 Hypertrophy of the right ventricle 4 Transportation of the great arteries

3 - Hypertrophy of the right ventricle Tetralogy of Fallot has four characteristics: ventricular septal defect, positioning of the aorta over the defect, pulmonary stenosis, and hypertrophy of the right ventricle. Patent ductus arteriosus is a result of the failure of the ductus arteriosus to close after birth. Blood flow is impeded, though this constricted area of the aorta is not a characteristic of tetralogy of Fallot. In transportation of the great arteries, the positions of the aorta and pulmonary artery are reversed.

A child with heart failure is prescribed digoxin (Lanoxin) to improve myocardial function. What precaution does the nurse take after administering the drug? 1 Takes apical pulse rate 2 Ensures complete bed rest 3 Observes for signs of toxicity 4 Provides sodium-restricted diet

3 - Observes for signs of toxicity Digoxin has narrow therapeutic range and so the patient who is administered digoxin is at risk for toxicity. The nurse takes apical pulse rate before administering the drug. Ensuring bed rest is a precaution taken for the general health promotion of the patient and not to counter digoxin toxicity. Sodium-restricted diet is provided to control heart failure.

What does nursing care of the infant or child with congestive heart failure include? 1 Forcing fluids appropriate to age 2 Monitoring respirations during active periods 3 Organizing activities to allow for uninterrupted sleep 4 Giving larger feedings less often to conserve energy

3 - Organizing activities to allow for uninterrupted sleep The nurse must organize care to facilitate a decrease in the child's energy expenditure. The child who has congestive heart failure has an excess of fluid. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The child often cannot tolerate larger feedings.

The nurse is providing care to a school-age child with heart failure. What does the nurse include in the child's plan of care? Select all that apply. 1 Teach the child how to take medications 2 Allow the child to go to the play area often 3 Provide the child with frequent rest periods 4 Prepare the child for prescribed procedures 5 Explain the disease process in simple terms

3 - Provide the child with frequent rest periods 4 - Prepare the child for prescribed procedures 5 - Explain the disease process in simple terms The nurse explains the disease to the child in simple terms so that the child understands the condition. The nurse prepares the child for prescribed procedures to relieve the child's anxiety about the treatment or procedures. The nurse ensures that the child takes adequate rest so that the child is not stressed out or fatigued. The nurse does not take the child to the play area but engages the child in quiet activities to prevent fatigue. The nurse does not teach the child to take medications, to prevent the risk of medication error.

A parent of a child with a heart defect tells the nurse, "I learned on a medical website that my child's heart condition will never improve." What is the nurse's best response? 1 "This information does not apply to your child." 2 "Discuss this information in your parent groups." 3 "You shouldn't read too much about the disease." 4 "As the validity of a website cannot be assumed, it would be better to clarify this information with your primary health care provider."

4 - "As the validity of a website cannot be assumed, it would be better to clarify this information with your primary health care provider." The nurse should be aware that all information obtained on a medical website may not be valid or reliable, therefore this information should be conveyed to the parents and then a further clarification discussion can be arranged with their primary health care provider. The nurse does not discourage the parent from learning about the child's disease from any sources. Saying that the information does not apply to the child is not adequate. The parent needs to be told in detail why it does not apply to the child. The nurse does not advise the parent to discuss it in the parent groups, but requests to discuss it with qualified personnel like the primary health care provider so that the parent receives accurate information. With regard to NCLEX, the test framework is based on the RN being able to handle clinical situations unless there is a medical emergency. This option negates the importance of that nursing role to be able to handle a situation by referring to the health care provider.

The doctor suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent what? 1 Pulmonary infection 2 Right-to-left shunt of blood 3 Decreased workload on left side of heart 4 Increased pulmonary vascular congestion

4 - Increased pulmonary vascular congestion Increased pulmonary vascular congestion is the primary complication. The shunt of blood is left to right. A PDA allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary congestion can occur. Pulmonary infection and decreased workload on left side of the heart are not the primary complication.

The parent of a child who is at risk for infective endocarditis (IE) asks the nurse how to prevent infection in the child. What instruction does the nurse provide to the parent? 1 "Take prophylactic antibiotics prior to dental work." 2 "Increase daily fluid intake to prevent dehydration." 3 "Read food labels to limit sodium intake in your diet." 4 "Take frequent rest periods and limit physical activity."

1 - "Take prophylactic antibiotics prior to dental work." The nurse instructs the parent to contact the dentist prior to dental appointments to obtain prophylactic antibiotics. This is because microorganisms may enter the bloodstream due to dental decay, which can cause IE. Increasing the fluid intake does not prevent any kind of infection, which is a priority in this case. Sodium is restricted in patients with heart failure, not as a preventative measure for IE. The amount of physical activity that a child engages in does not ensure that the infection will be prevented.

The nurse should explain to the parents that their child is receiving furosemide (Lasix) for severe congestive heart failure because it is what? 1 A diuretic 2 A β-blocker 3 An ACE inhibitor 4 A form of digitalis

1 - A diuretic Furosemide (Lasix) is a diuretic used to eliminate excess water and salt to prevent reaccumulation of the fluid. It is not a β-blocker, ACE inhibitor, or form of digitalis.

The nurse is caring for an infant with a cardiac defect. What signs in the infant will indicate heart failure? Select all that apply. 1 Cyanosis 2 Dyspnea 3 Orthopnea 4 Weight loss 5 Flaring nares

1 - Cyanosis 2 - Dyspnea 3 - Orthopnea 5 - Flaring nares Cyanosis, dyspnea, and orthopnea are due to a lack of oxygen that may lead to heart failure in newborns. Flaring nares indicate respiratory distress. Weight gain caused by fluid retention instead of weight loss is an indicator of heart failure.

The nurse is assessing a child before beginning the cardiac catheterization. What does the nurse include in the assessment? Select all that apply. 1 Marks the dorsalis pedis pulse 2 Evaluates the blood count result 3 Asks about any allergic reactions 4 Assesses for presence of any rashes 5 Assesses height and weight of the child

1 - Marks the dorsalis pedis pulse 3 - Asks about any allergic reactions 4 - Assesses for presence of any rashes 5 - Assesses height and weight of the child The nurse assesses the height and weight of the patient so that the correct catheter can be selected. The nurse asks about the history of allergic reactions to ensure that the child is not allergic to the iodine-based contrast agents used in the procedure. The nurse marks the dorsalis pedis pulse before the procedure for ease of assessing the pedal pulses after the procedure. The nurse also notes if there are any severe diaper rashes on the infant in case the femoral site is used. In that case the procedure is cancelled as it may raise the risk of catheterization procedure. The blood count result does not affect the cardiac catheterization procedure.

The nurse suspects that a child has cardiac disease. What does the nurse include in the assessment? Select all that apply. 1 Nutritional status 2 Chest deformities 3 Clubbing of fingers 4 Blood glucose levels 5 Heart rate and rhythm

1 - Nutritional status 2 - Chest deformities 3 - Clubbing of fingers 5 - Heart rate and rhythm The nurse needs to assess for chest deformities because an enlarged heart can cause chest disfiguration. The nurse assesses the child's nutritional status, as weight loss is associated with heart disease. The nurse listens to the rate and rhythm of the heart that may indicate any deformity. The nurse should listen for fast (tachycardia) or slow (bradycardia) heart rates. The nurse should also listen for any irregularities in the rhythm of the heartbeat. The nurse assesses if there is clubbing of fingers, which may indicate cyanosis. Blood glucose levels are evaluated in patients with diabetes mellitus.

The nurse is providing postoperative care to a child after cardiac surgery. What does the nurse include in the child's plan of care? Select all that apply. 1 Obtain vital signs frequently 2 Monitor the heart rate and rhythm 3 Auscultate lung sounds once a day 4 Report decreased body temperature 5 Assess fluid and electrolyte balance

1 - Obtain vital signs frequently 2 - Monitor the heart rate and rhythm 5 - Assess fluid and electrolyte balance The nurse records vital signs frequently until they are stable. The nurse records the heart rate and rhythm to assess for any irregularities. The nurse monitors fluid and electrolyte status to prevent dehydration or fluid volume overload. The nurse auscultates lung sounds every hour and is alert for any diminished or absent sounds. This may indicate an area of atelectasis, a pleural effusion, or a pneumothorax. The nurse does not need to report about hypothermia as it is expected to happen immediately after the surgery. Instead, the nurse keeps the child warm to prevent additional heat loss.

After administering digoxin (Lanoxin) to a child with heart failure, the nurse monitors for serum potassium levels in the child. What is the rationale for this action? 1 Decreased serum potassium levels can lead to dehydration. 2 Increased serum potassium levels can result in hypertension. 3 Decreased serum potassium levels can potentiate heart failure. 4 Increased serum potassium levels makes digoxin less effective.

4 - Increased serum potassium levels makes digoxin less effective. Increased serum potassium levels diminish the effect of digoxin and will not improve myocardial function in the child. Therefore it is important to monitor serum potassium levels. Low serum potassium levels result in hypertension. A decrease in serum potassium levels causes changes to the heart rhythm, but will not worsen heart failure. Dehydration may be caused by fluid restrictions instituted in the acute stages of heart failure.

Congenital heart defects traditionally have been divided into acyanotic or cyanotic defects. What should the nurse recognize about the system in clinical practice? 1 It is helpful because it explains the hemodynamics involved. 2 It is problematic because cyanosis is rarely present in children. 3 It is helpful because children with cyanotic defects are easily identified. 4 It is problematic because children with acyanotic heart defects may develop cyanosis.

4 - It is problematic because children with acyanotic heart defects may develop cyanosis. This classification is problematic. Children with traditionally named acyanotic defects may be cyanotic, and children with traditionally classified cyanotic defects may appear pink. The classification does not reflect the path of blood flow within the heart. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Cyanosis is present when children have defects in which oxygenated blood and unoxygenated blood are mixed.

The nurse is asked to administer captopril (Capoten) for afterload reduction in a child with heart failure. Which action does the nurse take before administering the drug? 1 Monitors temperature 2 Obtains blood glucose 3 Takes apical pulse rate 4 Monitors blood pressure

4 - Monitors blood pressure Captopril (Capoten) is an angiotensin-converting-enzyme (ACE) inhibitor that lowers the blood pressure. The nurse monitors blood pressure before administering captopril (Capoten) to assess for hypotension. The nurse takes the apical pulse rate before administering digoxin (Lanoxin) to assess for bradycardia as this is a side effect of the medication. The nurse would obtain a blood glucose reading for a child with diabetes mellitus. The nurse monitors temperature in a child who may be at risk for an infection.

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress what? 1 The need to be extremely concerned about cyanotic spells 2 The importance of relaxing discipline and limit-setting to prevent crying 3 The importance of reducing caloric intake to decrease cardiac demands 4 The desirability of promoting normalcy within the limits of the child's condition

4 - The desirability of promoting normalcy within the limits of the child's condition Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake. The child needs discipline and appropriate limits. Because cyanotic spells occur in children with some defects, the parents need to be taught how to manage these. The child needs to have social interactions, discipline, and appropriate limit-setting.

Which is considered a mixed cardiac defect? 1 Pulmonic stenosis 2 Atrial septal defect 3 Patent ductus arteriosus 4 Transposition of the great arteries

4 - Transposition of the great arteries Transposition of the great arteries allows the mixing of blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow.

Which condition leads to an increase in the pulmonary blood flow? 1 Aortic stenosis 2 Pulmonic stenosis 3 Coarctation of the aorta 4 Ventricular septal defect

4 - Ventricular septal defect A ventricular septal defect causes an increase in pulmonary blood flow. It is a congenital heart defect that is an abnormal opening between the right and left ventricles. It occurs because the blood flows from the higher-pressure left side of the heart to the lower-pressure right side. Coarctation of the aorta and aortic stenosis obstructs blood flow coming out of the heart. Pulmonic stenosis is a narrowing of the pulmonic artery and leads to right ventricular hypertrophy.