Test 3: Ch 41 Cardiovascular Disorders PrepU

A group of nurses is reviewing the cardiovascular system and its function. Which statement by one of the nurses demonstrates an understanding of a child's cardiovascular system?

"At birth, the infant's right and left ventricle are about the same size."

The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?

"He likes to stop and squat wherever he walks." The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance.

A 7-year-old child with a family history of cardiovascular disease is being screened for hyperlipidemia. When reviewing the child's laboratory test results, which total cholesterol level would be of significant concern?

210 mg/dL A total cholesterol level greater than 200 mg/dL is considered high and would be of the greatest concern. Levels of 120 mg/dL and 150 mg/dL are considered within the normal range.

A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the physician will most likely order which medication?

Indomethacin Indomethacin is the drug typically ordered to close a patent ductus arteriosus

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?

Tachycardia

A newborn has been diagnosed with a congenital heart disease. Which congenital heart diseases is associated with cyanosis?

Tetralogy of Fallot Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Tetralogy of Fallot defects cause oxygen-poor blood to flow out of the heart and into the rest of the body. Risk factors include a viral illness such as rubella (German measles) during pregnancy, maternal alcoholism, or a family history of the condition. Symptoms include blue-tinged skin and shortness of breath. Surgery is typically performed the first year of life, followed by ongoing care.

When administering corticosteroids to the child with rheumatic fever, what should the nurse recognize as an important aspect of giving this classification of medications for this diagnosis?

The drug should be stopped gradually by giving decreasing dosages.

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. What would most likely explain this assessment finding?

The liver size increases in right-sided heart failure.

A shunt is being placed on a child with pulmonary atresia. What is the best explanation of this procedure to the parents?

The surgery will increase the blood flow to the lungs.

The nurse is assessing an infant and notes brachial pulses of 2+ and femoral pulses of 1+. Which action will the nurse perform first?

Assess blood pressure in all extremities.

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection?

Avoid drawing a blood specimen from the right femoral vein before the procedure Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein).

To prevent infective endocarditis in the child with an artificial heart valve, the nurse teaches parents to:

Administer prophylactic antibiotics before dental work.

Medication education on which drug should the nurse provide to the caregivers of a child diagnosed with rheumatic fever?

Aspirin

What information would be included in the care plan of an infant in heart failure?

Begin formulas with increased calories.

When assessing a infant born at 32 weeks' gestation, which finding would lead the nurse to suspect to suspect that the newborn has a patent ductus arteriosus (PDA)?

Continuous murmur on auscultation

The nurse is performing an ECG on a 12-year-old boy. On completion, she notices that boy's P-R interval is lengthened. Which of the following does this finding indicate?

Difficulty with coordination between the SA and AV nodes (first-degree heart block) On an ECG tracing, a longer-than-usual P wave suggests the atria are hypertrophied making it take longer than usual for the electrical conduction to spread over the atria. A lengthened P-R interval suggests there is a difficulty with coordination between the SA and AV nodes (first-degree heart block). A heightened R wave indicates ventricular hypertrophy is present. An R wave which is decreased in height suggests the ventricles are not contracting fully, as happens if they are surrounded by fluid (pericarditis). Elongation of the T wave occurs in hyperkalemia; depression of the T wave is associated with anoxia; depression of the ST segment is associated with abnormal calcium levels.

A nursing student is reviewing information about medications used to treat congestive heart failure in children. The student demonstrates understanding of the information by identifying which drug as prescribed to increase myocardial contractility?

Digoxin

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?

Digoxin Digoxin is indicated for atrial fibrillation. It increases the contractility of the heart muscle by decreasing conduction and increasing force.

The nurse is administering medications to the child with congestive heart failure. Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?

Digoxin The use of large doses of digoxin at the beginning of therapy to build up the blood levels of the drug to a therapeutic level is known as digitalization.

The nurse is caring for child who present to the emergency department with reports of a fever for 5 days. The nurse notes a diffuse maculopapular rash, reddened cracked lips, erythema of hands, and bilateral conjunctivitis and suspects Kawasaki disease. Which nursing action is priority?

Initiate intravenous access. A child with signs of Kawasaki disease is at risk for dehydration due to a prolonged fever and oral pain. The priority for the nurse is to establish intravenous access to begin IV fluids

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother?

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions

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. What is the best response from the nurse?

It will determine if the heart is enlarged.

A nurse is administering digoxin to a 3-year-old. What would be a reason to hold the dose of digoxin?

Nausea and vomiting *sign on digoxin toxicity

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?

Notify the doctor immediately.

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of which of the following as the major mechanism involved?

Obstruction of blood flow to the lungs Tricuspid atresia is a congenital heart defect in which the valve between the right atrium and right ventricle fails to develop, resulting in no opening to allow blood to flow from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs. It is classified as a disorder of decreased pulmonary blood flow due to obstruction of blood flow to the lungs

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess?

Strawberry tongue Dry, fissured lips and a strawberry tongue are common findings with Kawasaki disease.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?

Peeling hands and feet and fever

The nurse is caring for a 6-year-old with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?

Place the child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered

What is an appropriate nursing intervention for the child diagnosed with Kawasaki disease who is receiving high-dose aspirin therapy and complains of joint pain?

Provide age-appropriate bed rest activities. Providing age-appropriate bed rest activities can act as a diversion to the joint pain that the child is having, and the bed rest serves as a comfort measure. Ibuprofen should not be administered to the child on aspirin therapy because it antagonizes the irreversible platelet inhibition that is induced by aspirin. The aspirin administered to a patient with Kawasaki disease is administered for its antiplatelet effects, not to decrease joint pain.

A parent brings an infant in for poor feeding. Which assessment data would most likely indicate a coarctation of the aorta?

Pulses weaker in lower extremities compared to upper extremities

An infant with congenital heart disease is not growing and developing adequately. The nurse will institute what feeding strategy?

Raise the caloric density of the feeding beyond 20 calories per ounce. Increasing the caloric density of the feeding allows the infant to ingest more calories without increased volume and in a shorter period of time. This conserves energy. Calories per ounce can be increased by adding supplements to pumped breast milk.

A 10-week-old infant continues to have a small ventricular septal defect and is prescribed Digoxin? When evaluating the infat's response to drug therapy, which therapeutic action of the medication is identified?

Reduced fluid accumulation in the lungs

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 statements are true?

Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. Tub baths should be avoided for about 3 days. Strenuous activity is limited for about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported.

Which nursing diagnosis will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot?

Risk for ineffective cardiopulmonary tissue perfusion

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

Serum potassium level Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug.

A nurse is caring for a child that just had open-heart surgery and the parents are asking why there are wires coming out of the chest of the infant. What is the best response by the nurse?

These wires are connected to the heart and will detect if your child's heart gets out of rhythm.

Kawasaki disease is the most likely cause of acquired heart disease in children.

True

The nurse is planning care for an infant with a nursing diagnosis of decreased cardiac output related to a cardiac defect. What is the most appropriate outcome for this nursing diagnosis? The child will:

demonstrate stable vital signs, capillary refill less than 3 seconds, and a urine output of 1-2 mL/kg/hr.

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:

femoral pulse weaker than brachial pulse.