Wong: Chapter 27: The Child with Cardiovascular Dysfunction, Lewis Chapter 34: Heart Failure, Giddens Chapter 18 Perfusion

Which of the following is a sign of hypokalemia? 1. Apnea 2. Oliguria 3. Twitching 4. Muscle weakness

4. Muscle weakness

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? A. "You may need to increase the caloric density of your infant's formula." B. "You should feed your baby every 2 hours." C. "You may need to increase the amount of formula your infant eats with each feeding." D. "You should place a nasal oxygen cannula on your infant during and after each feeding."

A. "You may need to increase the caloric density of your infant's formula." The metabolic rate of infants with congestive heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue.

A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse be administering? A. Captopril (Capoten) B. Furosemide (Lasix) C. Spironolactone (Aldactone) D. Chlorothiazide (Diuril)

A. Captopril (Capoten)

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on which statement? A. Child needs opportunities to play with peers. B. Child needs to understand that peers' activities are too strenuous. C. Parents can meet all of the child's needs. D. Constant parental supervision is needed to avoid overexertion.

A. Child needs opportunities to play with peers.

What painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? 1. Osler nodes 2. Janeway lesions 3. Subcutaneous nodules 4. Aschoff nodes

ANS: 1 1. Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis.

Which of the following structural defects constitute tetralogy of Fallot? 1. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy 2. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy 3. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy 4. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

ANS: 1 1. Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.

Which of the following defects results in decreased pulmonary blood flow? 1. Atrial septal defect 2. Tetralogy of Fallot 3. Ventricular septal defect 4. Patent ductus arteriosus

ANS: 2 2. Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be which of the following? 1. Assess for neurologic defects. 2. Place the child in the knee-chest position 3. Begin cardiopulmonary resuscitation. 4. Prepare family for imminent death.

ANS: 2 2. The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated.

The primary nursing intervention to prevent bacterial endocarditis is which of the following? 1. Institute measures to prevent dental procedures. 2. Counsel parents of high-risk children about prophylactic antibiotics. 3. Observe children for complications, such as embolism and heart failure. 4. Encourage restricted mobility in susceptible children.

ANS: 2 2. The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition.

A chest radiograph film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" The nurse's response should be based on knowledge that the x-ray film will do which of the following? 1. Show bones of chest but not the heart 2. Measure electrical potential generated from heart muscle 3. Provide permanent record of heart size and configuration 4. Provide computerized image of heart vessels and tissues

ANS: 3 3. A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will be provide a baseline for future comparisons

Which of the following defects results in increased pulmonary blood flow? 1. Pulmonic stenosis 2. Tricuspid atresia 3. Atrial septal defect 4. Transposition of the great arteries

ANS: 3 3. The atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery.

After the child returns from cardiac catheterization, the nurse monitors the child's vital signs. The heart rate should be counted for how many seconds? 1. 10 2. 15 3. 30 4. 60

ANS: 4 4. After cardiac catheterization, the heart rate should be counted for a full minute to detect evidence of dysrhythmias or bradycardia.

Surgical closure of the ductus arteriosus would do which of the following? 1. Stop the loss of unoxygenated blood to the systemic circulation 2. Decrease the edema in legs and feet 3. Increase the oxygenation of blood 4. Prevent the return of oxygenated blood to the lungs

ANS: 4 4. The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary artery

What is the most common causative agent of bacterial endocarditis? 1. Staphylococcus albus 2. Streptococcus hemolyticus 3. Staphylococcus albicans 4. Streptococcus viridans

ANS: 4 Staphylococcus viridans is the most common causative agent in bacterial (infective) endocarditis

The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for? A. Cardiac arrhythmia B. Hypostatic pneumonia C. Heart failure D. Rapidly increasing blood pressure

ANS: A Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? a. Oxygen saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Heart rate of 106 beats/minute d. Urine output of 50 mL over 2 hours

ANS: A A decrease in oxygen saturation to less than 92% indicates hypoxemia. The nurse should administer supplemental oxygen immediately to the patient. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output also indicate worsening heart failure and require nursing actions, but the low oxygen saturation rate requires the most immediate nursing action

The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)? A. It decreases edema. B. It decreases cardiac output. C. It increases heart size. D. It increases venous pressure.

ANS: A Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size and venous pressure are decreased by digoxin.

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient. The nurse's priority action will be to a. give IV morphine sulfate 4 mg. b. give IV diazepam (Valium) 2.5 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

ANS: A Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea

Which action should the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? a. Monitor blood pressure frequently. b. Encourage patient to ambulate in room. c. Titrate nesiritide slowly before stopping. d. Teach patient about home use of the drug.

ANS: A Nesiritide is a potent arterial and venous dilator, and the major adverse effect is hypotension. Because the patient is likely to have orthostatic hypotension, the patient should not be encouraged to ambulate. Nesiritide does not require titration and is used for ADHF but not in a home setting

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. A patient who is cool and clammy, with new-onset confusion and restlessness b. A patient who has crackles bilaterally in the lung bases and is receiving oxygen. c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62

ANS: A The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management. The other patients also should be assessed as quickly as possible but do not have indications of severe decreases in tissue perfusion.

During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of "feeling too tired to get out of bed." Based on these data, the best nursing diagnosis for the patient is a. activity intolerance related to fatigue. b. disturbed body image related to weight gain. c. impaired skin integrity related to ankle edema. d. impaired gas exchange related to dyspnea on exertion.

ANS: A The patient's statement supports the diagnosis of activity intolerance. There are no data to support the other diagnoses, although the nurse will need to assess for other patient problems

Based on the Joint Commission Core Measures for patients with heart failure, which topics should the nurse include in the discharge teaching plan for a patient who has been hospitalized with chronic heart failure (select all that apply)? a. How to take and record daily weight b. Importance of limiting aerobic exercise c. Date and time of follow-up appointment d. Symptoms indicating worsening heart failure e. Actions and side effects of prescribed medications

ANS: A, C, D, E The Joint Commission Core Measures state that patients should be taught about prescribed medications, follow-up appointments, weight monitoring, and actions to take for worsening symptoms. Patients with heart failure are encouraged to begin or continue aerobic exercises such as walking, while self-monitoring to avoid excessive fatigue

The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching? A. "I should avoid tub baths but may shower." B. "I have to stay on strict bed rest for 3 days." C. "I should remove the pressure dressing the day after the procedure." D. "I may attend school but should avoid exercise for several days."

ANS: B The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.

A 53-year-old patient with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is most appropriate? a. "Because you have diabetes, you would not be a candidate for a heart transplant." b. "The choice of a patient for a heart transplant depends on many different factors." c. "Your heart failure has not reached the stage in which heart transplants are needed." d. "People who have heart transplants are at risk for multiple complications after surgery."

ANS: B Indications for a heart transplant include end-stage heart failure (Stage D), but other factors such as coping skills, family support, and patient motivation to follow the rigorous posttransplant regimen are also considered. Diabetic patients who have well-controlled blood glucose levels may be candidates for heart transplant. Although heart transplants can be associated with many complications, this response does not address the patient's question

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. Patient who is taking carvedilol (Coreg) and has a heart rate of 58 b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L c. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache d. Patient who is taking captopril (Capoten) and has a frequent nonproductive cough

ANS: B The patient's low potassium level increases the risk for digoxin toxicity and potentially fatal dysrhythmias. The nurse should assess the patient for other signs of digoxin toxicity and then notify the health care provider about the potassium level. The other patients also have side effects of their medications, but their symptoms do not indicate potentially life-threatening complications

A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Assess the IV insertion site for signs of extravasation. b. Teach the patient the reasons for remaining on bed rest. c. Monitor the patient's blood pressure and heart rate every hour. d. Titrate the rate to keep the systolic blood pressure >90 mm Hg.

ANS: C An experienced LPN/LVN would be able to monitor BP and heart rate and would know to report significant changes to the RN. Teaching patients, making adjustments to the drip rate for vasoactive medications, and monitoring for serious complications such as extravasation require RN level education and scope of practice

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

ANS: C B-type natriuretic peptide (BNP) is secreted when ventricular pressures increase, as they do with heart failure. Elevated BNP indicates a probable or very probable diagnosis of heart failure. A twelve-lead electrocardiogram, arterial blood gases, and troponin may also be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP

A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? a. "I will be sure to take the medication with food." b. "I will need to eat more potassium-rich foods in my diet." c. "I will call for help when I need to get up to use the bathroom." d. "I will expect to feel more short of breath for the next few days."

ANS: C Captopril can cause hypotension, especially after the initial dose, so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose. The angiotensin-converting enzyme (ACE) inhibitors are potassium sparing, and the nurse should not teach the patient to purposely increase sources of dietary potassium. Increased shortness of breath is expected with the initiation of b-adrenergic blocker therapy for heart failure, not for ACE inhibitor therapy. ACE inhibitors are best absorbed when taken an hour before eating

A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider? a. Presence of 1 to 2+ edema in the feet and ankles b. Palpable liver edge 2 cm below the ribs on the right side c. Serum potassium level 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days

ANS: C Hypokalemia can predispose the patient to life-threatening dysrhythmias (e.g., premature ventricular contractions), and potentiate the actions of digoxin and increase the risk for digoxin toxicity, which can also cause life-threatening dysrhythmias. The other data indicate that the patient's heart failure requires more effective therapies, but they do not require nursing action as rapidly as the low serum potassium level

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. limit dietary sources of potassium. b. take the hydrochlorothiazide before bedtime. c. notify the health care provider if nausea develops. d. skip the digoxin if the pulse is below 60 beats/minute.

ANS: C Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary. The patient will need to include potassium-containing foods in the diet to avoid hypokalemia. Patients should be taught to check their pulse daily before taking the digoxin and if the pulse is less than 60, to call their provider before taking the digoxin. Diuretics should be taken early in the day to avoid sleep disruption

A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment finding as a. orthopnea. b. pulsus alternans. c. paroxysmal nocturnal dyspnea. d. acute bilateral pleural effusion.

ANS: C Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period

IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops a. ventricular ectopy. b. a dry, hacking cough. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute.

ANS: C Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy

The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that a. she will take furosemide (Lasix) every day at bedtime. b. the nitroglycerin patch is applied when any chest pain develops. c. she will call the clinic if her weight goes from 124 to 128 pounds in a week. d. an additional pillow can help her sleep if she is feeling short of breath at night.

ANS: C Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 pounds in 2 days or 3 to 5 pounds in a week. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an "as needed" basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops, rather than just compensating by further elevating the head of the bed

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurse's priority action will be to a. have the patient recall the dietary intake for the last 3 days. b. ask the patient about the use of the prescribed medications. c. assess the patient for clinical manifestations of acute heart failure. d. teach the patient about the importance of restricting dietary sodium.

ANS: C The 5-pound weight gain over 3 days indicates that the patient's chronic heart failure may be worsening. It is important that the patient be assessed immediately for other clinical manifestations of decompensation, such as lung crackles. A dietary recall to detect hidden sodium in the diet, reinforcement of sodium restrictions, and assessment of medication compliance may be appropriate interventions but are not the first nursing actions indicated.

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%? a. Need to begin an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors d. Importance of making an annual appointment with the primary care provider

ANS: C The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction (EF) <40% receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are not usually recommended because of the risk of hyperkalemia, and the patient will need to see the primary care provider more frequently than annually

While admitting an 82-year-old with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." When planning for the patient's discharge the nurse will facilitate a a. consult with a psychologist. b. transfer to a long-term care facility. c. referral to a home health care agency. d. arrangements for around-the-clock care.

ANS: C The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed. A home health nurse will assess the patient's home situation and help the patient develop a method for taking the two medications as directed. There is no evidence that the patient requires services such as a psychologist consult, long-term care, or around-the-clock home care

While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. increased right atrial pressure. d. incompetent jugular vein valves.

ANS: C The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45-degree angle reflects increased right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis

An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? a. 2+ pedal edema b. Heart rate of 56 beats/minute c. Blood pressure (BP) of 88/42 mm Hg d. Complaints of fatigue

ANS: C The patient's BP indicates that the dose of metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect of b-adrenergic blockade, but the rate of 56 is not unusual with â-adrenergic blocker therapy. b-Adrenergic blockade initially will worsen symptoms of heart failure in many patients, and patients should be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs

A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse do first? a. Auscultate the abdomen. b. Check the capillary refill. c. Auscultate the breath sounds. d. Assess the level of orientation.

ANS: C This patient's severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) is occurring. ADHF usually manifests as pulmonary edema, which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest. The other assessments will provide useful data about the patient's volume status and also should be accomplished rapidly, but detection (and treatment) of pulmonary complications is the priority

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: A. directed at his parents because he is too young to understand. B. detailed in regard to the actual procedures so he will know what to expect. C. done several days before the procedure so that he will be prepared. D. adapted to his level of development so that he can understand.

ANS: D Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.

Following an acute myocardial infarction, a previously healthy 63-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. digitalis preparations. b. b-adrenergic blockers. c. calcium channel blockers. d. angiotensin-converting enzyme (ACE) inhibitors.

ANS: D ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure, and digoxin is added to the treatment protocol when therapy with other medications such as ACE-inhibitors, diuretics, and b-adrenergic blockers is insufficient. Calcium channel blockers are not generally used in the treatment of heart failure. The b-adrenergic blockers are not used as initial therapy for new onset heart failure

A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving? a. Furosemide (Lasix) 60 mg b. Captopril (Capoten) 25 mg c. Digoxin (Lanoxin) 0.125 mg d. Carvedilol (Coreg) 3.125 mg

ANS: D Although carvedilol is appropriate for the treatment of chronic heart failure, it is not used for patients with acute decompensated heart failure (ADHF) because of the risk of worsening the heart failure. The other medications are appropriate for the patient with ADHF

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a. Weight loss of 2 pounds in 24 hours b. Hourly urine output greater than 60 mL c. Reduction in patient complaints of chest pain d. Reduced dyspnea with the head of bed at 30 degrees

ANS: D Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in cardiac output has occurred, but are not as specific to evaluating this patient's response

The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to: A. notify physician. B. apply new bandage with more pressure. C. place the child in Trendelenburg position. D. apply direct pressure above catheterization site.

ANS: D If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.

When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. canned and frozen fruits. b. fresh or frozen vegetables. c. eggs and other high-protein foods. d. milk, yogurt, and other milk products.

ANS: D Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily. Other milk products, such as processed cheeses, have very high levels of sodium and are not appropriate for a 2000-mg sodium diet. The other foods listed have minimal levels of sodium and can be eaten without restriction

Which explanation regarding cardiac catheterization is appropriate for a preschool child? A. Postural drainage will be performed every 4 to 6 hours after the test. B. It is necessary to be completely "asleep" during the test. C. The test is short, usually taking less than 1 hour. D. When the procedure is done, you will have to keep your leg straight for at least 4 hours.

ANS: D The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.

Causes vasodilation that decreases pulmonary and systemic vascular resistance, decreased blood pressure, reduced after load, and decreased right and left atrial pressures.

Angiotensin-converting enzyme (ACE) inhibitor

A patient is questioning the nurse about circulation and perfusion. What is the nurse's best response? A) Perfusion assists the body by preventing clots and increasing stamina. B) Perfusion assists the cell by delivering oxygen and removing waste products. C) Perfusion assists the heart by increasing the cardiac output. D) Perfusion assists the brain by increasing mental alertness.

B

An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. A. 60 B. 70 C. 90 D. 100

B. 70

Which should the nurse consider when preparing a school-age child and the family for heart surgery? A. Unfamiliar equipment should not be shown. B. Let child hear the sounds of an ECG monitor. C. Avoid mentioning postoperative discomfort and interventions. D. Explain that an endotracheal tube will not be needed if the surgery goes well.

B. Let child hear the sounds of an ECG monitor.

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk? A. Minimize seizures. B. Prevent dehydration. C. Promote cardiac output. D. Reduce energy expenditure.

B. Prevent dehydration. In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes

Which is the leading cause of death after heart transplantation? A. Infection B. Rejection C. Cardiomyopathy D. Heart failure

B. Rejection

The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? A. Seizures B. Vomiting C. Bradypnea D. Tachycardia

B. Vomiting

As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: A. chlorides. B. potassium. C. sodium. D. vitamins.

B. potassium.

A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. A. 60 B. 70 C. 90 to 110 D. 110 to 120

C. 90 to 110

Which is an important nursing consideration when chest tubes will be removed from a child? A. Explain that it is not painful. B. Explain that only a Band-Aid will be needed. C. Administer analgesics before procedure. D. Expect bright red drainage for several hours after removal.

C. Administer analgesics before procedure.

Which is an important nursing consideration when suctioning a young child who has had heart surgery? A. Perform suctioning at least every hour. B. Suction for no longer than 30 seconds at a time. C. Administer supplemental oxygen before and after suctioning. D. Expect symptoms of respiratory distress when suctioning.

C. Administer supplemental oxygen before and after suctioning. If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia

Nursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.) A. Allow ambulation as tolerated. B. Monitor vital signs every 2 hours. C. Assess the affected extremity for temperature and color. D. Check pulses above the catheterization site for equality and symmetry. E. Remove pressure dressing after 4 hours. F. Maintain a patent peripheral intravenous catheter until discharge.

C. Assess the affected extremity for temperature and color. F. Maintain a patent peripheral intravenous catheter until discharge.

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.) A. Thirst and diminished urinary output B. Irritability and apprehension C. Cool extremities and decreased skin turgor D. Confusion and somnolence E. Normal blood pressure and narrowing pulse pressure F. Tachypnea and poor capillary refill time

C. Cool extremities and decreased skin turgor D. Confusion and somnolence F. Tachypnea and poor capillary refill time

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) A. Warm flushed extremities B. Weight loss C. Decreased urinary output D. Sweating (inappropriate) E. Fatigue

C. Decreased urinary output D. Sweating (inappropriate) E. Fatigue

Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? A. Pulmonary congestion B. Congenital heart defect C. Heart failure D. Systemic venous congestion

C. Heart failure

The nurse is caring for a child after heart surgery. Which should the nurse do if evidence is found of cardiac tamponade? A. Increase analgesia. B. Apply warming blankets. C. Immediately report this to physician. D. Encourage child to cough, turn, and breathe deeply.

C. Immediately report this to physician. If evidence is noted of cardiac tamponade, blood or fluid in the pericardial space constricting the heart, the physician is notified immediately of this life-threatening complication

Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure? A. Tachypnea B. Tachycardia C. Peripheral edema D. Pale, cool extremities

C. Peripheral edema

A beta blocker; blocks a and B-adrenergic receptors, causing decreased heart rate, decreased blood pressure and vasodilation; used selectively in children; improves symptoms and left ventricular function

Carvedilol

Acts directly on distal tubules and possibly proximal tubules to decrease sodium, water, potassium, chloride, and bicarbonate absorption; decreases urinary diluting capacity; may need to supplement potassium

Chlorothiazide

The parents of a young child with heart failure tell the nurse that they are "nervous" about giving digoxin (Lanoxin). The nurse's response should be based on which statement? A. It is a safe, frequently used drug. B. It is difficult to either overmedicate or undermedicate with digoxin. C. Parents lack the expertise necessary to administer digoxin. D. Parents must learn specific, important guidelines for administration of digoxin.

D. Parents must learn specific, important guidelines for administration of digoxin.

Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. Which action should the nurse take? A. Keep child warm with blankets. B. Apply a hypothermia blanket. C. Record temperature on nurses' notes. D. Report findings to physician.

D. Report findings to physician.

When discussing hyperlipidemia with a group of adolescents, the nurse should explain that cardiovascular disease can be prevented by high levels of: A. cholesterol. B. triglycerides. C. low-density lipoproteins (LDLs). D. high-density lipoproteins (HDLs).

D. high-density lipoproteins (HDLs).

Used because of its rapid onset and decreased risk for toxicity; increases the force of contraction (positive inotropic effect), decreases the heart rate (negative chronotropic effect), slows the conduction of impulses through the AV node (negative dromotropic effect), and indirectly enhances diuresis

Digoxin

Therapeutic management of the child with rheumatic fever includes: a) Administration of penicillin. b) Avoid salicylates (aspirin). c) Strict bed rest for 4 to 6 weeks. d) Administration of corticosteroids if chorea develops.

a) Administration of penicillin. The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice

Which of the following is a major clinical manifestation of rheumatic fever? a) Polyarthritis b) Osler nodes c) Janeway spots d) Splinter hemorrhages of distal third of nails

a) Polyarthritis Polyarthritis is swollen, hot, red, and painful joints. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. It is reversible.

tetrology of fallot consists of these defects (SATA): a) VSD b) ASD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aorta f) patent ductus arteriosus

a) VSD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aorta

air embolism may form in the venous system, traveling directly to the brain in the child with: a) a right to left shunt b) a left to right shunt c) dehydration and hypoxemia d) hypernatremia and hypokalemia

a) a right to left shunt

a common finding on physical examination of the child with acute rheumatic heart disease is: a) a systolic murmur b) a pleural friction rub c) an ejection click d) a split S2

a) a systolic murmur

The standard treatment for kawasaki disease is: a) aspirin and immune globulin b) aspirin and cryoprecipitate c) meperidine hydrochloride and immune globulin d) meperidine hydrochloride and cryoprecipitate

a) aspirin and immune globulin

In fetal circulation the majority of the oxygenated blood is pumped through the: a) foramen ovale b) lungs c) liver d) coronary sinus

a) foramen ovale

coarctation of the aorta should be suspected when: a) the blood pressure in the arms is different from the blood pressure in the legs b) the blood pressure in the right arm is different from the blood pressure in the left arm c) apical pulse is stronger than the radial pulse d) point of maximum impulse is shifted to the left

a) the blood pressure in the arms is different from the blood pressure in the legs

When obtaining a history from the parents of an infant suspected of having altered cardiac function, the nurse would expect: a) specific concerns related to palpitations the infant is having b) feeding difficulty, sweating with activity, and poor weight gain c) specific concerns about the infant's shortness of breath d) concerns related to the infant's lack of crying

b) feeding difficulty, sweating with activity, and poor weight gain

the process of the formation of the heart's atrial septum results in a temporary flap called the a) truncus arteriosus b) foramen ovale c) sinus venosus d) ductus venosus

b) foramen ovale

In children, the usual approach to the left ventricle of the heart in a cardiac catheterization is through the: a) left side of the heart b) right side of the heart

b) right side of the heart

of the following descriptions, the heart sound that would be considered normal in a young child is: a) splitting of S1 b) splitting of S2 c) splitting of S3 d) splitting of S4

b) splitting of S2

the peak age for the incidence of kawasaki disease is in the: a) infant age group b) toddler age group c) school age group d) adolescent age group

b) toddler age group

The standard pediatric ECG has: a) 6 leads b) 12 leads c) 15 leads d) 18 leads

c) 15 leads

Which of the following actions by the school nurse is important in the prevention of rheumatic fever? a) Encourage routine cholesterol screenings. b) Conduct routine blood pressure screenings. c) Refer children with sore throats for throat cultures. d) Recommend salicylates instead of acetaminophen for minor discomforts.

c) Refer children with sore throats for throat cultures. Nurses have a role in prevention; primarily in screening school-age children for sore throats caused by group A streptococci. This can be by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing.

which one of the following heart rates would be considered tachycardia in an infant? a) a resting hr of 120 bpm b) a crying hr of 200 bpm c) a resting hr of 170 bpm d) a crying hr of 180 bpm

c) a resting hr of 170 bpm

which one of the following defects has the best prognosis? a) tetrology of fallot b) ventricular septal defect c) atrial septal defect d) hypoplastic left heart syndrome

c) atrial septal defect

When children develop heart failure from a congenital heart defect, the failure is usually: a) right sided only b) left sided only c) both right and left sided

c) both right and left sided

The presence of poor ventricular function and atrial arrhythmia increases the risk for: a) infection b) CVA c) fever d) air embolism

c) fever

In fetal circulation, the umbilical vein divides and sends blood directly to the inferior vena cava by way of the ductus venosus. This division occurs at the: a) heart b) lungs c) liver d) placenta

c) liver

Because of the medication used for long term therapy, children with kawasaki disease are at increased risk for: a) chickenpox b) influenza c) reye syndrome d) myocardial infarction

c) reye syndrome

The diagnostic test that requires intravenous sedation and has been used increasingly in recent years to confirm the diagnosis of a congenital heart defect without a cardia catheterization is the: a) ECG b) echocardiogram c) transesophageal echocardiogram d) two-dimensional echocardiogram

c) transesophageal echocardiogram

Which of the following is a common, serious complication of rheumatic fever? a) Seizures b) Cardiac arrhythmias c) Pulmonary hypertension d) Cardiac valve damage

d) Cardiac valve damage

When caring for the child with Kawasaki disease, the nurse should know which of the following? a) Child's fever is usually responsive to antibiotics within 48 hours. b) Principal area of involvement is the joints. c) Aspirin is contraindicated. d) Therapeutic management includes administration of gamma globulin and aspirin.

d) Therapeutic management includes administration of gamma globulin and aspirin. High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness

which of the following defects has the worst prognosis? a) tetrology of fallot b) atrial ventricular canal defect c) transposition of the great vessels d) hypoplastic left heart syndrome

d) hypoplastic left heart syndrome

children who have been treated for rheumatic fever: a) do not need additional prophylaxis against BE b) are immune to rheumatic fever for the rest of their lives c) will have transitory manifestations of chorea for the rest of their lives d) may need antibiotic therapy for years

d) may need antibiotic therapy for years

A clue in the mother's history that is important in the diagnosis of congenital heart disease is: a) rheumatoid arthritis b) rheumatic fever c) streptococcal infection d) rubella

d) rubella

which of the following is not a major manifesto of rheumatic fever? a) carditis b) chorea c) erythema marginatum d) uveitis e) polyarthritis

e) polyarthritis

Blocks reabsorption of sodium and water to produce diuresis

furosemide

ACE inhibitors that are frequently used in pediatrics

lisinopril, catopril, enalapril

Blocks action of aldosterone to produce diuresis; allows retention of potassium

spironolactone