Pediatrics Quiz 5 Alterations in Cardiovascular Function in Children

A 7-year-old client is diagnosed with rheumatic fever. The physician orders throat cultures of all family members. The nurse explains that:

"Family members can carry streptococcus and be asymptomatic."

A nurse is caring for a 14 year-old child who has been diagnosed with Congestive Heart Failure (CHF). Treatment began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear and equal bilaterally, and heart rate is 70 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes that the child's urine output is:

1 ml/kg/hr

A toddler has been started on digoxin (Lanoxin) for cardiac failure. If the child develops digoxin (Lanoxin) toxicity, the first sign the nurse notes should be

A change in heart rhythm

A school-age child is admitted with a suspected acyanotic heart disease. After learning that the heart defect is a congenital disorder, the parents ask the nurse how they could have missed the problem all these years. The nurse's response should include the information that

Acyanotic heart disease may be asymptomatic Older children with acyanotic congenital heart disease may be asymptomatic, or manifest exercise intolerance, chest pain, arrhythmias, syncope, or sudden death.

A 2-year-old child is being discharged home and will have palliative surgery for tetralogy of Fallot at a later date. The mother wants to know about how much physical activity she can allow for the child. The nurse's best answer is:

Allow the child to regulate her activity

A 5 year old child has been transferred to the pediatric unit after a cardiac catheterization. The nurse has checked the sheath insertion site for bleeding, oozing, or hematoma. In order of priority, which of the following interventions should the nurse do next?

Assess the strength and presence of the distal pulses

The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities. The next assessment the nurse should perform is to check

Blood pressure of the four extremities. Coarctation of the aorta can present with stronger pulses in the upper extremities than in the lower extremities and higher blood pressure readings in the arms than in the legs because of obstruction of circulation to the lower extremities. Blood pressure values of the four limbs should be the next assessment data collected

Which evaluation would indicate a toxic dose of digoxin?

Bradycardia, nausea, and vomiting

Which assessment data is most indicative of a potential complication of Kawasaki's disease?

Change in blood pressure, pulse, and skin color; complaints of pain in the chest Cardiac involvement is the most serious complication of Kawasaki disease. It is the main cause of heart disease acquired in childhood in the United States and Japan. Death can occur due either to myocardial infarction secondary to blood clot formation in a coronary artery aneurysm or to rupture of a large coronary artery aneurysm. Death is most common two to 12 weeks after the onset of illness. The other signs and symptoms are diagnostic indicators of Kawasaki's disease. Early diagnosis is critical to prevent cardiovascular complications. Patients should be hospitalized during the acute phase to monitor for complications. The primary treatment is aspirin 100mg/kg/day until the fever has passed, after which the dose is reduced to 5-10 mg/kg/day until all lab tests return to normal. High dose intravenous gamma globulin (IVIG) has been used to reduce the risk of coronary aneurysms and myocardial infarction.

The mother of a child with a heart defect is questioning the nurse about the child's medication. When discussing the diuretic the child is on, the nurse should place an emphasis on teaching about:

Close monitoring of output

The pediatric nurse understands that captopril (Capoten), an ACE-inhibitor:

Decreases afterload Has side effects of hyperkalemia and hypotension Promotes vascular relaxation and reduced peripheral vascular resistance

The pediatric nurse understands that spironolactone (aldactone):

Decreases preload Has side effects of hyperkalemia and hypotension Is a potassium-sparing maintenance diuretic

The pediatric nurse understands that furosemide (Lasix):

Decreases preload Has side effects of hypokalemia, metabolic alkalosis, and hypotension Promotes rapid diuresis by blocking reabsorption of sodium and water in the renal tubules.

On initial exam of a child with newly diagnosed Kawasaki disease, the nurse should expect to document

Dry, swollen, fissured lips. Dry, swollen, fissured lips are symptoms of Kawasaki disease. Lymph nodes can be palpable, conjunctivitis is present but without exudates, and hands and feet are typically erythematous.

Signs and symptoms of congenital heart disease in infants include

Dyspnea with crying or eating Pallor Poor feeding Sweating Murmur Cyanosis with crying or eating Fatigue No weight gain Irritable

The laboratory finding that would be seen in the cyanotic heart disease client but not in the acyanotic heart disease client would be a(an):

Elevated red blood cell count Polycythemia is increased red blood cell production in the bone marrow. Chronic hypoxemia leads to polycythemia. The polycythemia is a compensatory mechanism to provide increased oxygen transport in the presence of cyanotic heart disease

A client is admitted with a diagnosis of "rule out rheumatic fever." Based on Jones criteria, the nurse assesses for

Erythema, polyarthritis, and elevated antistreptolysin-O (ASO) titer. Jones criteria is a protocol to assist in identifying rheumatic fever. It consists of major symptoms, minor symptoms, and supporting evidence. Erythema, polyarthritis, and elevated ASO titer are among the major and minor symptoms and supporting evidence.

An athletic activity the nurse should recommend for a school-age child with pulmonary-artery hypertension is:

Golf A child with pulmonary-artery hypertension should have exercise tailored to avoid dyspnea. Golf would require less exertion than soccer, basketball, or cross-country running.

The nurse has admitted a child with a ventricular septal defect (VSD) to the unit. An appropriate nursing diagnosis for this child is

Impaired Gas Exchange Related to Pulmonary Congestion Secondary to the Increased Pulmonary Blood Flow. Because of the increased pulmonary congestion, impaired gas exchange would be an appropriate nursing diagnosis. Ventricular septal defects do not cause pain, fever, or deficient fluid volume.

The pediatric nurse understands that lanoxin (digoxin):

Increases contractility of the heart Has side effects of nausea, vomiting, anorexia, and bradycardia Can interact with over-the-counter medications, herbal preparations, and antibiotics. Digoxin helps make the heart beat stronger and with a more regular rhythm.

The pediatric nurse understands that aspirin:

Is used to prevent blood clots from forming in the coronary arteries during the acute phase of Kawasaki disease Is used to treat joint pain and inflammation in rheumatic fever Can be associated with Reye's syndrome, a serious and potentially deadly condition in children and teenagers Decreases platelet aggregation and inhibits thrombus formation

The nurse is checking peripheral perfusion to a child's extremity following a cardiac catheterization. If there is adequate peripheral circulation, the nurse should find that the extremity

Is warm, with a capillary refill of two seconds or less.

After a pediatric client has a cardiac catheterization, which intervention should have the highest priority in the immediate postoperative period?

Observe cath insertion site for bleeding. If bleeding is found, the nurse should immediately glove, and apply direct manual pressure to the site (without leaving the patient's bedside) until hemostasis is obtained.

Truncus Arteriosus

One large blood vessel with a single valve leaves the heart.

Tetrology of Fallot is characterized by which cardiac defects?

Overriding aorta Right ventricular hypertrophy Ventricular septal defect Pulmonary stenosis

A baby is observed at birth to be noncyanotic. On physical examination the patient is found to have a continuous "machinery-type" murmur that is present in both systole and diastole. A nonsteroidal anti-inflammatory drug is prescribed, and on follow-up the murmur has disappeared. Which of the following is the most likely congenital lesion?

Patent ductus arteriosus

An infant with tetralogy of Fallot is having a hypercyanotic episode ("tet" spell). Appropriate management of a tet spell in these children include:

Place the child in knee-chest position. Administer oxygen. Administer morphine and propranolol intravenously as ordered.

A newborn with possible hypoplastic left heart disease is to be admitted to the nursing unit. Which drug should be available for use?

Prostaglandin E1 (Prostin VR). Hypoplastic left heart syndrome is a rare heart defect. In a normal heart, the blood flows in from the body to the right atrium. It then goes into the right ventricle. Next, the blood travels to the lungs through the pulmonary valve. Here, it picks up fresh oxygen. The blood returns to the left atrium and goes into the left ventricle. The blood then moves out to the rest of the body. With this syndrome, structures on the left side of the heart (aorta, aortic valve, left ventricle, and mitral valve) may be: Too small Absent Abnormally developed Since the heart cannot function properly, oxygen-rich blood flow to the body is limited. Prostaglandin E1 is given by intravenous infusion immediately after birth. Prostaglandin E1 prevents closure of ductus arteriosus and thereby allows for mixing of oxygenated and unoxygenated blood until the initial palliative surgery can be done. This helps to keep blood flowing through the ductus arteriosus. The ductus arteriosus is a connection between the pulmonary artery and aorta (largest artery in the body). It usually closes within a few days after birth. Keeping this passage open is a temporary treatment. Other medicines may be used, as well. The initial palliative surgery, the Norwood Procedure, is performed as soon as possible during the first week after birth. With this procedure, a connection is created between the aorta and the right ventricle. This is done so that the right ventricle pushes blood to both the lungs and the rest of the body. As the child ages, more surgeries will be needed to create other connections with the heart, lungs, and body.

The pediatric nurse understands that sildenafil (Revatio, Viagra) is prescribed to

Relax and widen the blood vessels in the lungs.

The nurse is teaching the parents of a group of cardiac patients. The nurse includes in the information that a child who has undergone cardiac surgery:

Should be evaluated to determine if prophylactic antibiotics for dental, oral, or upper-respiratory-tract procedures are necessary. Parents should be taught that the child may need prophylactic antibiotics for some dental procedures, according to the American Heart Association, to prevent endocarditis. The child should live a normal and active life following repair of a cardiac defect. Immunizations should be provided according to the schedule, and any unexplained fever should be reported.

Which of the following should the nurse expect to note as a frequent complication for a child with congenital heart disease?

Susceptibility to respiratory infection

A child has been admitted to the hospital unit in congestive heart failure (CHF). Symptoms related to this admission diagnosis should include

Tachycardia Tachycardia is a sign of congestive heart failure because the heart attempts to improve cardiac output by beating faster. Other signs include poor feeding and diaphoresis especially during feeding. Bradycardia is a serious sign and can indicate impending cardiac arrest. Blood pressure does not increase in CHF, and the weight, instead of decreasing, increases because of retention of fluids.

The nurse is developing a discharge teaching plan for the family of a child with Kawasaki's disease. Which of the following is the first priority

Teaching parents to administer aspirin and watch for side effects.

In assessing children with congenital heart defects, the nurse would expect to see clubbing of the fingers and toes in the child diagnosed with:

Tetralogy of Fallot. Central cyanosis and clubbing in a child is mostly due to congenital cyanotic heart disease or chronic pulmonary disease. Clubbing of the fingers and toes occurs in cyanotic heart defects, such as tetralogy of Fallot. Clubbing can occur in the fingers and/or toes. It is a sign of long-term oxygen deprivation.

The pediatric nurse understands that characteristics of pulmonary hypertension include

The causes are lung disease and some congenital heart diseases. Caused by narrowing of the pulmonary arterioles within the lung; the narrowing of the arteries creates resistance and an increased work load for the heart. Symptoms include chest pain, weakness, shortness of breath, and fatigue. Must treat this condition early while still reversible to prevent permanent destructive pulmonary vascular remodeling. Treatments include sildenafil, calcium channel blockers, diuretics, nitric oxide, and lung transplantation.

Transposition of the Great Arteries

The pulmonary artery and the aorta are in opposite position of where they should be. Two noncommunicating circulatory systems—a condition incompatible with life.

Atrioventricular Septal Defect

There is a hole between the top two chambers and the bottom two chambers of the heart. Common with Down syndrome.

Atrial Septal Defect

There is a hole between the top two chambers of the heart.

Coarctation of the Aorta

There is a narrowing of the major artery from the heart to the body (Aorta)

Patent Ductus Arteriosus

There is an open connection between the aorta and the pulmonary artery

Hypoplastic left heart syndrome consists of hypoplasia (i.e., underdevelopment or incomplete development) of the left ventricle and ascending aorta, maldevelopment and hypoplasia of the aortic and mitral valves (frequently aortic atresia is present), an atrial septal defect, and a large patent ductus arteriosus. Unless normal closure of the patent ductus arteriosus is prevented with prostaglandin infusion, cardiogenic shock and death ensue. The only cure is heart transplantation. This condition can be palliated through three-stage open-heart surgical procedures. This is not a cure, as the child's circulation is made to work with only two of the heart's four chambers. True or false?

True

With acyanotic heart defects, there is a left-to-right shunt. There is increased pulmonary blood flow and the blood is oxygenated. True or false?

True Acyanotic heart disease is a broad term for any congenital heart defect in which all of the blood returning to the right side of the heart passes through the lungs and pulmonary vasculature. The common forms of acyanotic congenital heart defects are those where there is a defect in one of the walls separating the chambers of the heart, or patent ductus arteriosus (abnormal blood flow occurs between two of the major arteries connected to the heart, the aorta and pulmonary artery).

With cyanotic heart defects, there is a right-to-left shunt: blood is shunted from the right side of the heart (pulmonary) to the left (systemic) side. Pulmonary circulation is bypassed. True or false?

True Cyanotic and acyanotic heart diseases are defined based on how blood moves through the heart and occur due to abnormal openings or defects in the heart. In cyanotic heart disease, de-oxygenated blood moves from the right side of the heart to the left side through abnormal openings or defects. It mixes there with oxygenated blood and is then distributed to the body through the aorta. It is caused by structural defects of the heart (i.e.:right-to-left, bidirectional shunting, malposition of the great arteries), or any condition which increases pulmonary vascular resistance. In acyanotic heart disease, oxygenated blood moves from the left side of the heart to the right side and then to the lungs. This occurs as a result of a hole or abnormal shunt between the left and right sides of the heart.

In a normal heart, the blood follows this cycle: body-heart-lungs-heart-body. When a child has this congenital heart defect, the blood leaving the heart does not follow this path. It has only one vessel, instead of two separate ones for the lungs and body. With only one artery, there is no specific path to the lungs for oxygen before returning to the heart to deliver oxygen to the body. In addition, there is usually a hole between the two lower chambers of the heart known as a ventricular septal defect. As a result of this heart defect, oxygen-poor blood that should go to the lungs and oxygen-rich blood that should go to the rest of the body are mixed together. This creates severe circulatory problems. What is the name of this congenital heart defect?

Truncus arteriosus

A child is being seen in the ambulatory clinic for a sore throat diagnosed as caused by group A beta hemolytic streptococcus. The nurse provides care with the understanding that the risk of developing rheumatic fever is greatest:

Two weeks later

Nursing interventions to promote a balanced dietary intake of food and fluids in an infant with congestive heart failure include

Weigh the child daily. Use high-calorie concentrated formula. Space feedings 3 hours apart. Use supplemental tube feedings if the infant is too fatigued to ingest a sufficient amount by mouth. Limit bottle feedings to 20-30 minutes. Provide small, frequent feedings

Tetralogy of Fallot

a congenital malformation of the heart involving four distinct Aorta is lined up just over the hole between the bottom two chambers of the heart.

A 16 month old child diagnosed with Kawasaki Disease (KD) is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. Which of the following should the nurse interpret as the priority?

placing the toddler in a quiet environment One of the characteristics of children with KD is irritability. They are often inconsolable. Placing the child in a quiet environment may help quiet the child and reduce the workload of the heart. The child's irritability takes priority over peeling of the skin.