Ricci - Chapter 41: Nursing Care of the Child With a Cardiovascular Disorder prepu
A child is having surgery for a congenital heart defect. The parent asks about their 1-year-old's growth and developmental delays and what they can expect after surgery. What is the best response by the nurse? a) "You can expect to continue to see delays." b) "This was caused by the lack of oxygen and it is usually permanent." c) "As long as you decrease external stimuli, the child should catch up." d) "After surgery, most children will catch up."
"After surgery, most children will catch up."
The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever? a) "The onset and progression of this disorder is rapid." b) "Children who have this diagnosis may have had strep throat." c) "This disorder is caused by genetic factors." d) "Being up to date on immunizations is the best way to prevent this disorder."
"Children who have this diagnosis may have had strep throat."
The nurse is assessing the past medical history of an infant with a suspected cardiovascular disorder. Which response by the mother warrants further investigation? a) "I was really nauseous throughout my whole pregnancy." b) "I am on a low dose of steroids." c) "His Apgar score was an 8." d) "I had the flu during my last trimester."
"I am on a low dose of steroids."
You take an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant? a) 150 beats per minute b) 60 beats per minute c) 80 beats per minute d) 100 beats per minute
100 beats per minute
The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy? a) 94 to 112/56 to 60 mm Hg b) 80 to 90/40 to 64 mm Hg c) 80 to 100/64 to 80 mm Hg d) 100 to 120/70 to 80 mm Hg
100 to 120/70 to 80 mm Hg
The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant's heart rate? a) 70 to 80 bpm b) 90 to 160 bpm c) 60 to 68 bpm d) 80 to 105 bpm
90 to 160 bpm
The nurse is conducting a physical examination of an infant with a suspected cardiovascular disorder. Which assessment finding is suggestive of sudden ventricular distention? a) Accentuated third heart sound b) Decreased blood pressure c) Heart murmur d) Cool, clammy, pale extremities
Accentuated third heart sound
A nurse is caring for an infant who is experiencing heart failure. Which of the following would be the most appropriate care for this infant? a) Administer oxygen. b) Restrict fluids. c) Provide large, less frequent feedings. d) Administer antidiuretic.
Administer oxygen.
A group of nurses is reviewing the cardiovascular system and its function. Which of the following statements is the most accurate regarding the cardiovascular system in the child? a) At birth the right and left ventricle are about the same size. b) Between the ages of 5 and 6 the left ventricle grows to about two times the size of the right. c) The heart rate of the child decreases if the child has a fever. d) The heart matures and functions like an adult's between 12 and 15 years of age.
At birth the right and left ventricle are about the same size.
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.
A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note? a) Appropriate mastery of developmental milestones b) Pitting periorbital edema c) Bounding pulse d) Preference to resting on the right side
Bounding pulse
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
The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed? a) Indomethacin b) Digoxin c) Furosemide d) Alprostadil
Digoxin
The nurse is administering medications to the child with congestive heart failure. Large doses of which of the following medications are used initially in the treatment of CHF to attain a therapeutic level? a) Ferrous sulfate b) Digoxin (Lanoxin) c) Furosemide (Lasix) d) Albuterol sulfate
Digoxin (Lanoxin)
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
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
The nurse performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a: a) Grade IV. b) Grade I. c) Grade III. d) Grade II.
Grade IV. A heart murmur characterized as loud with a precordial thrill is classified as Grade IV. Grade II is soft and easily heard. Grade I is soft and hard to hear. Grade III is loud without thrill.
On assessment immediately following cardiac surgery, which condition would the nurse expect to find in an infant? a) Hypertension b) Hypovolemia c) Hyperexcitability d) Hypothermia
Hypothermia
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
Increased RBC
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
Ineffective tissue perfusion related to inefficiency of the heart as a pump
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.
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 nurse is administering digoxin to a 3-year-old. Which of the following would be a reason to hold the dose of digoxin? a) Hypertension b) Fever and tinnitus c) Nausea and vomiting d) Ataxia
Nausea and vomiting
A nurse suspects a child is experiencing cardiac tamponade after heart surgery. Which of the following would be the priority nursing intervention? a) Observe vitals every two hours. b) Notify the doctor immediately. c) Administer epinephrine. d) Elevate the head of the bed.
Notify the doctor immediately.
The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess? 1. Obesity from overeating. 2. Clubbing of the nail beds. 3. Squatting during play activities. 4. Exercise intolerance.
Obesity from overeating.
A client's newborn is diagnosed with Tetralogy of Fallot. When explaining this condition to the client, which of the following defects would the nurse's description include? a) Atrial septal defect b) Overriding of the aorta c) Stenosis of the aorta d) Left ventricular hypertrophy
Overriding of the aorta
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
Polycythemia
Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? 1. Previous streptococcal throat infection. 2. History of open heart surgery at 5 years of age. 3. Playing too much soccer and not getting enough rest. 4. Exposure to a sibling with pneumonia.
Previous streptococcal throat infection.
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
A nurse is caring for a newborn with congenital heart disease (CHD). Which finding would the nurse interpret as indicating distress? a) Reduced respiratory rate during feeding b) Perspiration on body after feeding c) Feeding lasting for 15-20 minutes d) Subcostal retraction at the time of feeding
Subcostal retraction at the time of feeding
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
Tachycardia
When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure? a) Tachycardia b) Bradycardia c) Inability to sweat d) Splenomegaly
Tachycardia
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.
The liver increases in right-sided heart failure.
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.
The mother states she has lupus.
A parent asks if the reason her infant has a congenital heart defect is because of something she did while she was pregnant. What is the best response by the nurse? a) No, heart defects are mainly caused by genetic factors. b) The studies show it is impossible to know what causes heart defects. c) There are several reasons a baby can have a heart defect, let's talk about those causes. d) Yes, there is a chance you caused this defect.
There are several reasons a baby can have a heart defect, let's talk about those causes.
A parent asks about the risk of a congenital heart defect being passed on to another child since they already have one child that has it, but no one else in the family has one. What is the best response by the nurse? a) There is a less than 7% chance a sibling would inherit a heart defect. b) This was probably caused by environmental factors, not genetics. c) These occur related to medication the mother was taking while pregnant. d) There is no chance this will be passed to another child since we do not know what caused it.
There is a less than 7% chance a sibling would inherit a heart defect.
A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? a) This is a test that will check how blood is flowing through the heart. b) This is a test that will check the electrical impulses in the heart. c) This test can only determine the size of the heart. d) This test is an invasive test that will measure the blockage in the heart.
This is a test that will check how blood is flowing through the heart.
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.
The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy the process of digitalization is done for which of the following reasons? a) To decrease the pain to a tolerable level b) To build the blood levels to a therapeutic level c) To establish a maintenance dose of the drug d) To increase the heart rate
To build the blood levels to a therapeutic level
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)
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 weaker than brachial pulse.
The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? Select all that apply. a) 12-year-old child whose digoxin level was 0.9 ng/ mL on a blood draw this morning b) 4-month-old child with an apical heart rate of 102 beats per minute c) 16-year-old child with a heart rate of 54 beats per minute d) 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse e) 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning
• 16-year-old child with a heart rate of 54 beats per minute • 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning • 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse
The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatments would the nurse expect to administer if ordered? Select all that apply. a) Intravenous immunoglobulin b) Nonsteroidal anti-inflammatory drugs c) Digoxin d) Corticosteroids e) Penicillin
• Nonsteroidal anti-inflammatory drugs • Corticosteroids • Penicillin
Nursing students are reviewing information about the different types of congenital heart defects. They demonstrate understanding of the information when they identify which of these as disorders with increased pulmonary blood flow? Select all that apply. a) Ventricular septal defect b) Atrioventricular canal defect c) Patent ductus arteriosus d) Pulmonary stenosis e) Coarctation of the aorta
• Ventricular septal defect • Patent ductus arteriosus • Atrioventricular canal defect
A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can to reduce the risk of this type of condition occurring in her baby. Which of the following should the nurse mention to this patient? a) "There is really nothing you can do. b) "Make sure you are fully immunized." c) "Make sure that you encourage your child to exercise as he grows up." d) "Make sure you encourage a low-sodium diet in your child as he grows up."
"Make sure you are fully immunized."
The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure? a) "He does not seem short of breath." b) "He gets sweaty when he eats." c) "He does not seem sick." d) "He seems to have a normal appetite."
"He gets sweaty when he eats."
When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education? a) "Most infants do not need surgical repair for this." b) "Surgery is usually performed in the first two months of life for this." c) "The medication indomethacin is used to try to close the hole." d) "The medication prostaglandin E1 is used to try to close the hole."
"Most infants do not need surgical repair for this." Most infants do not need surgical repair for an ASD unless they are symptomatic. The hole will close spontaneously 87% of the time. The medication indomethacin is used to help close the opening of a PDA and the medication prostaglandin E1 is used to keep a patent ductus arteriosus (PDA) open. These medications are not used for ASDs.
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."
A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed? a) "She needs to take the drug for the full 14 days." b) "If she needs dental surgery, we might need additional medication." c) "We can stop the penicillin when her symptoms disappear." d) "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."
"We can stop the penicillin when her symptoms disappear."
A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which of the following should the nurse say to the girl's mother in response to these findings? a) "Your daughter has a functional heart murmur; I recommend that you limit her physical activity so that her heart rate is not elevated for long periods of time." b) "Your daughter has an organic heart murmur, which indicates that she has some degree of heart disease. The doctor will provide a referral to a good cardiologist." c) Not say anything, as the girl has an insignificant heart murmur and there is no reason to alarm the mother or her. d) "Your daughter has an innocent heart murmur, which is nothing to worry about."
"Your daughter has an innocent heart murmur, which is nothing to worry about."
The infant has been hospitalized and develops hypercyanosis. The physician has ordered the nurse to administer 0.1 mg of morphine sulfate per every kilogram of the infant's body weight. The infant weighs 15.2 lb (6.81 kg). Calculate the infant's morphine sulfate dose. Record your answer using one decimal place. ___________ mg
0.681 = 0.7mg
The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding? a) 80/40 mm Hg b) 110/60 mm Hg c) 100/60 mm Hg d) 90/64 mm Hg
90/64 mm Hg
Which of the following nursing diagnoses would best apply to a child with rheumatic fever? a) Risk for self-directed violence related to development of cerebral anoxia b) Activity intolerance related to inability of heart to sustain extra workload c) Ineffective breathing pattern related to cardiomegaly d) Disturbed sleep pattern related to hyperexcitability
Activity intolerance related to inability of heart to sustain extra workload
Which of the following would be included in discharge teaching by the nurse of a child that had a patch placed surgically for an ASD? a) Antibiotics should be administered before invasive procedures. b) Need for frequent rest periods at home c) Intake of 80 ounces of fluid daily d) Teaching about how to take daily blood pressures
Antibiotics should be administered before invasive procedures.
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.
Assess extremity distal to the insertion site for temperature and color.
Coarctation of the aorta demonstrates few symptoms in newborns. Which of the following is an important assessment to make on all newborns to help reveal this condition? a) Recording an upper extremity blood pressure b) Observing for excessive crying c) Auscultating for a cardiac murmur d) Assessing for the presence of femoral pulses
Assessing for the presence of femoral pulses
The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia? a) Child C with a total cholesterol level of 190 mg/dL and LDL of 125 mg/dL. b) Child D with a total cholesterol level of 220 mg/dL and LDL of 138 mg/dL. c) Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. d) Child B with a total cholesterol level of 175 mg/dL and LDL of 105 mg/dL.
Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL.
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 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.
Heart murmur.
The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. Which of the following should the nurse mention in explaining how this diagnostic test works? a) High-frequency sound waves are directed toward the heart b) A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy c) X-rays are directed toward the heart d) A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video
High-frequency sound waves are directed toward the heart
A nursing instructor is preparing for a class about the structural and functional differences in the cardiovascular system of infants and children as compared to adults. What would the instructor include in the class discussion? a) The heart is about four times the birth size between the ages of 6 and 12 years. b) Blood pressure is initially high at birth but gradually decreases to adult levels. c) The heart's apex is higher in the chest in children younger than the age of 7 years. d) Left ventricular function predominates immediately after birth.
The heart's apex is higher in the chest in children younger than the age of 7 years.
A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? a) Peeling hands and feet and fever b) Decreased heart rate and impalpable pulse c) Low blood pressure and decreased heart rate d) Irritability and dry mucous membranes
Peeling hands and feet and fever
A child is diagnosed with tetralogy of Fallot and during a temper tantrum turns blue. Which of the following would the nurse do first? a) Assess for an irregular heart rate. b) Assess for an increased respiratory rate. c) Place child in the knee-to-chest position. d) Explain to the child the need to calm down since it is affecting the heart.
Place child in the knee-to-chest position.
A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. What should the nurse instruct the parents to do in the event that the child becomes cyanotic? a) Administer prescribed amoxicillin b) Administer low-dose aspirin c) Perform hands-on CPR d) Place him in a knee-chest position
Place him in a knee-chest position
The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority? a) Use a calm, comforting approach. b) Administer propranolol (0.1 mg/kg IV). c) Provide supplemental oxygen. d) Place the child in a knee-to-chest position.
Place the child in a knee-to-chest position.
While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? 1. Provide supplemental oxygen by face mask. 2. Administer a dose of IV morphine sulfate. 3. Begin cardiopulmonary resuscitation. 4. Place the infant in a knee-to-chest position.
Place the infant in a knee-to-chest position.
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 a semi-Fowler's position
The nurse assesses a child for clubbing. What would the nurse identify as the initial sign? a) Shininess of the nail ends b) Softening of the nail beds c) Rounding of the fingers d) Thickening of the nail ends
Softening of the nail beds
The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding? a) Softening of the nail beds b) Intact rooting reflex c) Steady weight gain since birth d) Appropriate mastery of developmental milestones
Softening of the nail beds
At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important? a) Allowing the child to talk about the procedure b) Allowing the child to adapt to the light room gradually c) Taking pedal pulses for the first 4 hours d) Assuring the child that the procedure is now over
Taking pedal pulses for the first 4 hours
The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. Which of the following would be included in the intervention strategies? a) Blood pressures should be measured daily. b) The child should not be allowed to participate in sports. c) Beta blocker education should be given to the parents. d) The nurse would review the child's 24-hour diet recall.
The nurse would review the child's 24-hour diet recall.
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.
This is due to a decreased amount of oxygen to the peripheral tissue.
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