Cardiac Peds 2

The parents of a child with heart failure ask the nurse, "How will the digoxin he is getting help?" Which response by the nurse would be most appropriate? "Digoxin helps to improve the heart's ability to contract ." "The drug will help to remove the extra fluid in his body." "The drug will lower his blood pressure so the heart won't work so hard." "Digoxin helps to open up the blood vessels to improve blood flow."

"Digoxin helps to improve the heart's ability to contract ." Explanation: Digoxin is used to improve myocardial contractility. Diuretics are used to remove fluid build-up. Digoxin does not decrease blood pressure or dilate blood vessels.

The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which statement by the mother indicates a need for further teaching? "The baby may need as much as 150 calories/kg/day." "Small, frequent feedings are best if tolerated." "I need to feed him every hour to make sure he eats enough." "Gavage feedings may be required for now."

"I need to feed him every hour to make sure he eats enough." Explanation: Although offering small, frequent feedings are appropriate if the infant tolerates them, feeding every hour is not necessary. During the acute phase, continuous or intermittent gavage feedings may be needed to help the infant maintain or gain weight. Due to the increased metabolic demands, the infant may require as much as 150 calories/kg/day.

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was: 140 beats per minute. 120 beats per minute. 100 beats per minute. 80 beats per minute.

80 beats per minute. Explanation: In an infant, if the apical pulse rate is less than 90 beats per minute, the dose is held and the physician should be notified.

The nurse is educating an adolescent female at risk for hypertension. Which interventions will the nurse recommend? Select all that apply. Begin a beta-blocker. Increase hours of sleep. Avoid any smoking. Exercise on a daily basis. Maintain a healthy weight.

Increase hours of sleep. Avoid any smoking. Exercise on a daily basis. Maintain a healthy weight. Explanation: Increasing the hours of sleep, daily exercise, avoiding smoking, and maintaining a healthy weight are all recommended interventions to prevent hypertension in the adolescent. An adolescent at risk for hypertension would not need a beta-blocker. Medication would be used for an adolescent with hypertension that did not improve after less invasive interventions.

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding? Janeway lesions Jerky movements of the face and upper extremities Black lines Osler nodes

Jerky movements of the face and upper extremities Explanation: Sydenham chorea is a movement disorder of the face and upper extremities associated with acute rheumatic fever. Janeway lesions, black lines, and Osler nodes are associated with infective endocarditis.

A newborn has been diagnosed with congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis? coarctation of the aorta Tetralogy of Fallot pulmonary stenosis aortic stenosis

Tetralogy of Fallot Explanation: Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of the aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.

The nurse is providing care to a child with a congenital heart defect. Which of the following would lead the nurse to suspect that the child is developing heart failure? Select all that apply. A. Tachycardia B. Sacral edema C. Bradypnea D. Inability to sweat E. Splenomegaly

ANS: A, B Rationale: Signs of heart failure include tachycardia, dependent edema such as in the sacral area, tachypnea, and hepatomegaly. In addition, diaphoresis, fatigue and exercise intolerance may be noted.

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? Place the child on a soft diet. Initiate intravenous access. Administer acetaminophen. Assess cervical lymph nodes.

Initiate intravenous access. Explanation: 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. Placing the child on a soft diet will be done after ensuring IV access. Pain is not a priority, and children with Kawasaki disease are given aspirin because of the anti-inflammatory properties of aspirin, instead of acetaminophen. Because the child already has the required four signs of Kawasaki disease, assessing cervical lymph nodes is minimally helpful and could be performed later.

The nurse is preparing to administer furosemide to an 8-year-old child with heart failure. What consideration(s) will the nurse take into account for this medication? Select all that apply. Monitor urinary output. Monitor potassium. Perform daily weights. Monitor for orthostatic hypotension. Monitor the apical pulse for 1 minute. Avoid giving with meals.

Monitor urinary output. Monitor potassium. Perform daily weights. Monitor for orthostatic hypotension. Explanation: The nurse will monitor urinary output, monitor the potassium level, perform daily weights, and monitor for orthostatic hypotension for the child with heart failure on furosemide therapy. Monitoring the apical pulse for 1 minute prior to administration and avoiding giving the medication with meals are considerations for digoxin therapy, not furosemide.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? Peeling hands and feet; fever Decreased heart rate and impalpable pulse Irritability and dry mucous membranes Low blood pressure and decreased heart rate

Peeling hands and feet; fever Explanation: Kawasaki disease is an acute systemic vasculitis. Symptoms begin with very high fevers. One of the signs of Kawasaki disease is the peeling hands and feet and in perineal region. The child is usually tachycardic and laboratory values would indicate increased platelets and decreased hemoglobin. Another classic sign of Kawasaki is the strawberry tongue. The other symptoms are not necessarily characteristic of Kawasaki disease. The child should be evaluated if there are impalpable pulses because this could indicate a heart defect or some other serious illness.

When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover? Leukopenia Polycythemia Increased platelet level Anemia

Polycythemia Explanation: Tetralogy of Fallot is a congenital heart defect causing decreased pulmonary blood flow. This causes mild to severe oxygen desaturation. To compensate for the low blood oxygenation the kidneys produce erythropoietin to stimulate the bone marrow to make more red blood cells (RBCs). The increased amount of RBCs is known as polycythemia. This increased blood volume causes more workload on the heart. It also does not increase the amount of blood reaching the lungs so the child remains desaturated. Leukopenia, increased platelets, and anemia are not associated with tetralogy of Fallot.

An infant with congenital heart disease is not growing and developing adequately. The nurse will institute what feeding strategy? Suggest that the infant should receive commercial formula rather than breast milk. Feed the infant at a minimum of every 2 hours. Increase the length of the feeding sessions to 45 to 50 minutes. Raise the caloric density of the feeding beyond 20 calories per ounce.

Raise the caloric density of the feeding beyond 20 calories per ounce. Explanation: 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. Using commercial formula could be necessary if a special formula is needed. However, breast milk is usually the infant's best source of nutrition. Feeding the infant every 2 hours and increasing the length of the feeding beyond 30 minutes will fatigue the child and allow for little rest between feedings.

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure? Tachycardia Bradycardia Inability to sweat Splenomegaly

Tachycardia Explanation: Heart failure occurs when the heart has the inability to pump effectively to provide adequate blood, oxygen, and nutrients to the body's organs and tissues. Symptoms occur because of three factors. The neurohormonal influences cause symptoms of tachycardia, pallor, decreased urine output, sweating, hypertension, weight gain and edema. The symptoms seen from systolic dysfunction are dyspnea on exertion, increased work of breathing, and feeding difficulties. Diastolic influences produce hepatomegaly, jugular vein distention and periorbital edema.

The nurse is conducting a physical examination of an infant with a suspected cardiovascular disorder. Which assessment finding is suggestive of sudden ventricular distention? decreased blood pressure heart murmur cool, clammy, pale extremities accentuated third heart sound

accentuated third heart sound Explanation: An accentuated third heart sound is suggestive of sudden ventricular distention. Decreased blood pressure; cool, clammy, and pale extremities; and a heart murmur are all associated with cardiovascular disorders. However, these findings do not specifically indicate sudden ventricular distention.

A 9-year-old child has undergone a cardiac catheterization and is being prepared for discharge. The nurse is instructing the parents and child about postprocedure care. Which statement by the parents indicates that the teaching was successful? "This pressure dressing needs to stay on for 5 days from now." "He can't eat but he can drink fluids for the next 24 hours." "He should avoid taking a bath for about 3 days but he can shower." "It's normal if he says he feels like his heart skipped a beat."

"He should avoid taking a bath for about 3 days but he can shower." Explanation: After a cardiac catheterization, the child should avoid tub baths for about 3 days but he can shower or use sponge baths. The pressure dressing should be removed the day after the procedure and a dry sterile dressing or adhesive bandage is applied for the next several days. After the procedure, the child can resume his usual diet. Any reports of fluttering or the heart skipping a beat should be reported.

After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow? Tetralogy of Fallot Atrial septal defect Hypoplastic left heart syndrome Transposition of the great vessels

Atrial septal defect Explanation: Atrial septal defect is an example of a disorder involving increased pulmonary blood flow. Tetralogy of Fallot is a defect involving decreased pulmonary blood flow. Transposition of the great vessels and hypoplastic left heart syndrome are examples of mixed disorders.

What information would be included in the care plan of an infant in heart failure? Encourage larger, less frequent feedings. Begin formulas with increased calories. Maintain child in the supine position. Administer digoxin even if the infant is vomiting.

Begin formulas with increased calories. Explanation: Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering

The nurse is caring for an infant with suspected patent ductus arteriosus. Which assessment finding would the nurse identify as helping to confirm this suspicion? Thrill at the base of the heart Harsh, continuous, machine-like murmur under the left clavicle Faint pulses Systolic murmur best heard along the left sternal border

Harsh, continuous, machine-like murmur under the left clavicle Explanation: With patent ductus arteriosus, a harsh, continuous, machine-like murmur (usually loudest under the left clavicle) is heard at the first and second intercostal spaces. A thrill at the base, faint pulses, and systolic murmur heard best along the left sternal border point to aortic stenosis.

The nurse is caring for a newborn in the hospital. Which assessment finding is most concerning? a fixed split-S2 heart sound cool and bluish tint to hands high-pitched systolic murmur respiratory rate 62 breaths per minute

a fixed split-S2 heart sound Explanation: A fixed split-S2 can be indicative of right heart volume overload and is seen with an atrial septal defect. Acrocyanosis (bluish tint to the hands and/or feet) is a normal finding in the newborn; although the hands should not feel cool, this finding is not as concerning as a fixed split-S2. Although an abnormal finding, a high-pitched systolic murmur is a common innocent murmur of infancy related to the turbulent flow of blood through the pulmonary arteries. A respiratory rate of 62 breaths per minute is also abnormal, but it may be related to the newborn's transition to extrauterine life, and it is not as concerning as a fixed split-S2.

The nurse takes 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? 60 beats per minute 80 beats per minute 100 beats per minute 150 beats per minute

100 beats per minute Explanation: Digoxin is a cardiac glycoside that works by increasing the contractility of the heart muscle. It decreases conduction and increases the force of the heart beat. The result is a slowing of the heart rate. An 8-month-old infant has a normal range of heart rate of 80 to 150 beats per minute while awake and resting, and 80 to 130 beats per minute while sleeping. The accepted practice for this age child is to withhold the digoxin if the heart rate is 90 beats per minute or less. It would be safe to administer the drug if the heart rate is 100 beats per minute. If the child has a heart rate of 150 beats per minute, further assessment should be made prior to administering the drug.

The nurse is caring for a child with aortic stenosis. Which health care provider prescription(s) will the nurse question? Select all that apply. Obtain echocardiogram. Apply a cardiac monitor. Administer indomethacin. Prepare for balloon dilation. Give prostaglandin E1 (PGE1).

Administer indomethacin. Give prostaglandin E1 (PGE1). Explanation: Interventions for a child with aortic stenosis include applying a cardiac monitor, obtaining an echocardiogram, and preparing for balloon dilation to relieve the stenosis. Indomethacin is an nonsteroidal anti-inflammatory drug (NSAID) given to cause closure of a patent ductus arteriosus. A child should already have closure of the ductus arteriosus; therefore, the nurse should question this prescription. Prostaglandin E1 (PGE1) is given to maintain patency of the ductus arteriosus. A PGE1 infusion could keep the ductus arteriosus open to allow blood to get to the body in a newborn with severe aortic stenosis. A child should already have closure of the ductus arteriosus; therefore, the nurse should question this prescription.

An infant has been diagnosed with a small ventricular septal defect following detection of a murmur during a routine assessment. What anticipatory guidance should the nurse provide the infant's family? The infant's growth and development are unlikely to be affected. The infant will likely be prepared for emergency surgery. The infant's growth and development will be hindered unless there is prompt treatment. The infant may be a candidate for a heart transplant.

The infant's growth and development are unlikely to be affected. Explanation: Small, isolated defects are usually asymptomatic. Growth and development are usually unaffected and this is not a cardiac emergency needing immediate surgery or transplant.

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note? appropriate mastery of developmental milestones bounding pulse preference to resting on the right side pitting periorbital edema

bounding pulse Explanation: A bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. Narrow or thready pulses may occur in children with heart failure or severe aortic stenosis. A normal pulse would not be expected with aortic regurgitation.

The nurse is conducting a physical examination of a child with a ventricular septal defect. Which finding would the nurse expect to assess? right ventricular heave holosystolic harsh murmur along the left sternal border fixed split-second heart sound systolic ejection murmur

holosystolic harsh murmur along the left sternal border Explanation: With ventricular septal defects, there is often a characteristic holosystolic harsh murmur along the left sternal border. Right ventricular heave, fixed split-second heart sound, and systolic ejection murmur are typically found with atrial septal defects.

An infant is prescribed digoxin. What should the nurse explain to the parents regarding the action of this medication? increases the heart rate slows and strengthens the heartbeat thickens the walls of the myocardium prevents subacute bacterial endocarditis

slows and strengthens the heartbeat Explanation: Digoxin, a cardiac glycoside made from digitalis, acts directly on the heart to increase the contractility of the myocardium and the force of contraction to slow the heart rate. Digoxin does not increase the heart rate, thicken the walls of the myocardium, or prevent subacute bacterial endocarditis.

4. Which assessment findings should the nurse expect to see in the infant diagnosed with pulmonary stenosis and heart failure? Select all that apply. A. Crackles (rales) B. Cyanosis C. Left ventricular hypertrophy D. Murmur E. Right ventricular hypertrophy

ANS: B, D, E Rationale: Patients with pulmonary stenosis have a narrowing in their pulmonary arteries, causing a decrease in blood flow to the lungs, which can cause cyanosis and the inability of the right ventricle to empty, leading to right ventricular hypertrophy. Crackles (rales) and left ventricular hypertrophy are signs of left-sided heart failure, which this patient does not have.

In developing a plan of care for the child diagnosed with rheumatic fever, the nursing intervention that takes highest priority for this child is to: A. position the child to relieve joint pain. B. monitor the C-reactive protein and ESR levels. C. provide age-appropriate diversional activities. D. promote rest periods and bed rest.

ANS: D Rationale: As long as the rheumatic process is active, progressive heart damage is possible. To prevent heart damage, bed rest is essential to reduce the heart's workload. Laboratory tests for ESR and C-reactive protein can be used to evaluate disease activity and guide treatment, but they do not improve the child's health itself. The child's comfort is important, so it is essential to relieve joint pain and prevent injury with padded bed rails. But these measures are less important than rest when it comes to preventing long-term complications such as residual heart disease.

A 6-year-old girl had a cardiac catheterization at 9 a.m. At 11 a.m. the nurse notes hypotension as compared to baseline. Based on this assessment finding, which of the following would the nurse do first? Check the insertion site. Recheck the blood pressure every 15 minutes. Assess the child's temperature. Check the toes' capillary refill.

Check the insertion site. Explanation: Hypotension may signify hemorrhage due to perforation of the heart muscle or bleeding from the insertion site. Rechecking the blood pressure every 15 minutes is done during the first hour and then every 30 minutes for the next hour. Rechecking the blood pressure would be appropriate after the nurse checks the insertion site and determines that bleeding is not present. Pain or fever would be more likely with infection or thrombus formation. Pallor, diminished temperature, and altered capillary refill time in the affected extremity could signal compromised neurovascular status

The nurse is preparing to take a blood pressure reading for a 5-year-old child with coarctation of the aorta. How will the nurse proceed with the assessment? Take a blood pressure reading on all four extremities. Take a blood pressure reading on the right arm. Ensure the child is calm for at least 60 seconds prior to taking a blood pressure reading. Have the child lie supine during the assessment.

Take a blood pressure reading on all four extremities. Explanation: The nurse will take a blood pressure reading on all four extremities on a child with coarctation of the aorta. Taking the blood pressure on the right arm is recommended in children with other conditions. The child should sit quietly for 5 minutes, not 60 seconds, prior to the blood pressure reading. The child does not need to lie supine during the assessment.

The nurse is evaluating the plan of care for a 2-year-old child with heart failure. Which outcome(s) demonstrates that the plan of care has been effective for the child? Select all that apply. adequate calorie intake balanced intake and output symptoms controlled with amoxicillin therapy free of complications of coronary aneurysms adhering to a low-fat diet

adequate calorie intake balanced intake and output Explanation: The outcomes of adequate calorie intake and balanced intake and output demonstrate that the plan of care has been effective for the child with heart failure. Amoxicillin therapy may be used to treat infective endocarditis, not heart failure. Being free of complications of coronary aneurysms is an outcome applicable to Kawasaki disease. Adherence to a low-fat diet is a successful outcome for a child with hypertension.

The nurse is caring for a 5-year-old child with acute rheumatic fever. What intervention(s) will the nurse include in the plan of care? Select all that apply. antibiotic therapy anti-inflammatory therapy promoting rest pain relief measures digoxin therapy

antibiotic therapy anti-inflammatory therapy promoting rest Explanation: The nurse will include administering antibiotic therapy and anti-inflammatory therapy as prescribed, promoting rest, and performing pain relief measures for the child with acute rheumatic fever. Digoxin therapy is indicated for heart failure, not for acute rheumatic fever.

The nurse will administer what medication to children with Kawasaki disease both in the acute and later stages of the illness? penicillin aspirin intravenous immune globulin iron

aspirin Explanation: Aspirin is important in reducing the inflammation of Kawasaki disease as well as helping to limit platelet aggregation. Larger doses are given during the acute process and smaller doses during the convalescent period. Intravenous immune globulin (IVIG) is a medication given immediately on diagnosis. The other medications are not appropriate.

The nurse is assessing a child with aortic stenosis. Which findings would the nurse most likely assess? Select all that apply. chest pain with activity dizziness with prolonged standing thrill palpated at base of heart moderately loud systolic murmur at the base of the heart blood pressure in arms significantly higher than in legs

chest pain with activity dizziness with prolonged standing thrill palpated at base of heart Explanation: Assessment findings associated with aortic stenosis include angina or chest pain with activity, dizziness with prolonged standing, and a thrill palpated at the base of the heart. A moderately loud systolic murmur at the base of the heart suggests coarctation of the aorta. Blood pressure that is significantly higher in the arms than in the legs, possibly 20 mm Hg or higher, also suggests coarctation of the aorta.

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? "He gets sweaty when he eats." "He does not seem short of breath." "He does not seem sick." "He seems to have a normal appetite."

"He gets sweaty when he eats." Explanation: Diaphoresis with nipple feeding indicates heart failure. Shortness of breath would suggest heart failure. Children with heart failure experience subtle signs that suggest that something is wrong. Children with heart failure often display subtle signs such as difficulty feeding.

A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate? 118 beats/min 102 beats/min 94 beats/min 80 beats/min

80 beats/min Explanation: Prior to administering each dose of digoxin, the nurse would count the apical pulse for 1 full minute, noting rate, rhythm, and quality. The nurse would withhold the dose and notify the health care provider if the apical pulse is less than 60 in an adolescent, less than 90 in an infant.

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? A. It will determine if the heart is enlarged. B. It will determine disturbances in heart conduction. C. It will show if blood is being shunted. D. This image will clarify the structures within the heart

ANS: A Rationale: Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI.

A nurse is providing care to a child with Kawasaki disease. Which medication(s) would the nurse expect the health care provider to prescribe? Select all that apply. aspirin ibuprofen abciximab IV immunoglobulin corticosteroids

aspirin IV immunoglobulin Explanation: Management of the child with Kawasaki disease includes a high dose of IV immunoglobulin therapy to relieve the symptoms and prevent coronary artery abnormalities, along with aspirin to control inflammation and fever. Aspirin may be continued for as long as 1 year in lower doses as an antiplatelet.

A child with heart failure is receiving supplemental oxygen. The nurse understands that in addition to improving oxygen saturation, this intervention also has what effect? causes vasodilation increases pulmonary vascular resistance promotes diuresis mobilizes secretions

causes vasodilation Explanation: Oxygen improves oxygen saturation and also functions as a vasodilator and decreases pulmonary vascular resistance. Diuretics promote diuresis. Chest physiotherapy helps to mobilize secretions.

The nurse sees a school-aged child in an ambulatory setting because of rheumatic fever. Which of the following would the nurse expect to find revealed by the health history? knee pain, abdominal rash, subcutaneous nodules an elevated temperature, back pain, loss of hair fatigue, slow pulse, frequent urination loss of weight, abdominal pain, chest pain

knee pain, abdominal rash, subcutaneous nodules Explanation: Classic signs of rheumatic fever are joint pain, a rash on the trunk, and subcutaneous nodules near major joints.

The nurse is preparing a teaching plan for the parents of a child who has been diagnosed with a congenital heart defect. What would the nurse be least likely to include? Daily weight assessment Maintenance of strict bed rest Prevention of infection Signs of complications

Maintenance of strict bed rest Explanation: A child with congenital heart disease should be allowed to engage in activity as tolerated, with rest periods frequently throughout the day to prevent overexertion. Daily weights, infection prevention measures, and signs of complications are all appropriate to include when teaching parents of a child with a congenital heart defect.

The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond? "Are you sure you are making nutrient-dense foods?" "Maybe your child doesn't really like the foods your making. This could lead to not gaining sufficient weight." "It's great you are providing nutritious meals, but small, frequent meals will tire your child less and promote weight gain." "It's hard to get your child to eat enough at this age to maintain their weight since they are expending so much energy with the heart condition."

"It's great you are providing nutritious meals, but small, frequent meals will tire your child less and promote weight gain." Explanation: Small, frequent feedings will reduce the amount of energy required to feed or eat and prevents overtiring the child. Questioning the parents as to whether they are making nutritious foods or foods preferred by the child does not address the issue of energy expenditure when eating 3 larger meals per day. Just stating that it is "hard to get your child to eat enough" also does not address the situation.

A nurse is taking the history of a 4-year-old child who will undergo a cardiac catheterization. Which statement by the parent may necessitate rescheduling of the procedure? "My child seems listless and slightly warm." "My child is allergic to iodine and shellfish." "My child tells me about headaches because of being scared and nervous about the procedure." "My child kept scratching the chest, so I applied hydrocortisone cream to stop the itching."

"My child seems listless and slightly warm." Explanation: Fever and other signs and symptoms of infection may necessitate rescheduling the procedure. Although information about allergies is important, not all contrast media contain iodine as a base. The nurse should assess the head pain and the child's fears in a developmentally appropriate way, but fear of the procedure does not warrant rescheduling. The report of itching on the child's chest should be evaluated and reported to the health care provider but does not necessarily warrant cancellation of the procedure unless determined that it is a sign of a viral infection.

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant? Administer antidiuretic. Provide large, less frequent feedings. Restrict fluids. Administer oxygen.

Administer oxygen. Explanation: If a child is experiencing heart failure, the infant will need oxygen. One of the medications the infant would be on is a diuretic. An infant with heart failure will need smaller, more frequent feedings to conserve energy for feeding. Infants are not usually put on fluid restriction.

After assessing a child's blood pressure, the nurse determines the pulse pressure and finds that it is narrowed. What would the nurse identify as associated with this finding? Aortic stenosis Patent ductus arteriosus Aortic insufficiency Complete heart block

Aortic stenosis Explanation: A narrowed pulse pressure is associated with aortic stenosis. A widened pulse pressure is associated with patent ductus arteriosus, aortic insufficiency, fever, anemia, or complete heart block.

A nurse is providing care to a toddler after surgery for a partial atrioventricular (AV) canal defect. The nurse has set a client care goal of maintaining adequate respiratory function. Which nursing intervention is most applicable to this goal? Administer analgesics as prescribed. Auscultate lungs for adventitious sounds. Provide activities such as blowing bubbles. Show the toddler how to splint the incision with a pillow.

Provide activities such as blowing bubbles. Explanation: Interventions focused on maintaining adequate respiratory function after surgery would include activities that promote full lung expansion, such as coughing and deep breathing. For a toddler or school-age child, that would be activities like blowing bubbles or pinwheels. Administering prescribed analgesics or demonstrating how to splint the incision would make the toddler more comfortable and able to perform coughing and deep-breathing exercises. However, performing the exercises is directly related to maintaining adequate respiratory function. Auscultating the lungs for adventitious sounds is an appropriate intervention, but activities to promote lung expansion are directly related to maintaining adequate respiratory function.

A nurse is caring for a child who is experiencing heart failure. Which assessment data was most likely seen when initially examined? bradycardia tachycardia splenomegaly polyuria

tachycardia Explanation: If a child were experiencing heart failure, the most likely sign of this would be tachycardia, not bradycardia. The child may also experience hepatomegaly or oliguria, not splenomegaly or polyuria.

Which problem-based nursing care plan will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot? surgical site infection risk acute parental anxiety fluid overload risk altered cardiopulmonary tissue perfusion risk

altered cardiopulmonary tissue perfusion risk Explanation: Nursing priority following cardiac surgery will focus on assessing for ineffective cardiopulmonary tissue perfusion. Monitoring for excess fluid volume, infection, and parental anxiety will be performed after ensuring cardiopulmonary tissue perfusion is adequate

When caring for a child with Kawasaki disease, the nurse would know that: management includes administration of aspirin and IVIG. joint pain is a permanent problem. antibiotics should be administered every 8 hours by IV. steroid creams are used for the hand peeling.

management includes administration of aspirin and IVIG. Explanation: Kawasaki disease is an acute systemic vasculitis. It is the most common form of acquired heart disease in children. The treatment is directed to reduce the inflammation in the walls of the coronary arteries and prevent thrombosis. Children are given high-dose aspirin therapy four times a day and they receive an infusion of IV immunoglobulins (IVIG) to prevent cardiac complications. Joint pain is common but not necessarily a permanent problem associated with Kawasaki disease. Antibiotics and steroid creams are not used to treat this disorder.

What would be the most important measure to implement for an infant who develops heart failure? restricting milk intake daily planning ways to reduce salt intake placing the infant in a semi-Fowler position keeping the infant supine and playing quiet games

placing the infant in a semi-Fowler position Explanation: Placing an infant with heart failure in a semi-Fowler position reduces the pressure of the abdominal contents against the chest and allows for better lung expansion. Keeping the infant supine would cause more pressure on the heart and lungs and increase the work of the heart and lungs. Infants with heart disease need calories to grow. They are given formula or breast milk which is fortified with extra nutrients. Thus the infant can have an intake of the same amount of fluid but receive extra nutrients.

A nurse is caring for a newborn with congenital heart disease (CHD). Which finding would the nurse interpret as indicating distress? reduced respiratory rate during feeding subcostal retraction at the time of feeding perspiration on body after feeding feeding lasting for 15-20 minutes

subcostal retraction at the time of feeding Explanation: Subcostal retraction during feeding is indicative of distress associated with feeding in newborn infants with CHD. Feeding can be a stress to newborns with CHD who are seriously compromised. Additional features indicating distress in infants with CHD include increased respiratory rate, perspiration along the hairline during feeding, and feeding time longer than 30 minutes.

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education? "Surgery is usually performed in the first two months of life for this." "Most infants do not need surgical repair for this." "The medication indomethacin is used to try to close the hole." "The medication prostaglandin E1 is used to try to close the hole."

"Most infants do not need surgical repair for this." Explanation: 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 caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation? "My baby does not make any grunting noises." "The baby seems more comfortable over my shoulder." "The baby usually drinks all of her bottle." "I don't notice any rapid breathing patterns."

"The baby seems more comfortable over my shoulder." Explanation: The nurse should be alert to statements indicating that the baby seems to be more comfortable when she is sitting up or over her mother's shoulder than when she is lying flat. Grunting or rapid breathing would be a cause for concern. Drinking all of the bottle would be considered normal.

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? "We can stop the penicillin when her symptoms disappear." "If she needs dental surgery, we might need additional medication." "She needs to take the drug for the full 14 days." "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."

"We can stop the penicillin when her symptoms disappear." Explanation: For a child with rheumatic fever, drug therapy must be given for the full 10 to 14 days to ensure complete eradication of the infection. The drug must not be stopped when the signs and symptoms disappear. To prevent recurrent attacks, prophylactic antibiotic therapy is prescribed for at least 5 years or until the child is 18 years old. Additional prophylactic therapy should be instituted when dental or tonsillar surgery is planned.

The nurse is caring for a 10-year-old boy following a cardiac catheterization. Four hours after the procedure, the nurse notes some minor bleeding at the site. Which action would be most appropriate? Apply pressure 1 inch above the site. Contact the physician. Ensure that the child's leg is kept straight. Change the dressing.

Apply pressure 1 inch above the site. Explanation: If bleeding occurs after a cardiac catheterization, apply pressure 1 inch above the site to create pressure over the vessel, thereby reducing the blood flow to the area. The nurse should first apply pressure and then notify the physician if this measure is ineffective or the bleeding increases. The child should maintain the leg in a straight position for about 4 to 8 hours. However, this would not address the bleeding assessed at the site. Changing the dressing would not be effective.

A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia? Increased WBC Decreased RBC Decreased WBC Increased RBC

Increased RBC Explanation: Polycythemia can occur in clients with a cyanotic heart defect. The body tries to compensate for having low oxygen levels and produces more red blood cells (RBCs). This would cause an increased result on the lab tests. This problem does not affect the white blood cells (WBCs).

The primary health care provider has prescribed intravenous furosemide for a child diagnosed with congestive heart failure (CHF). Which action will the nurse take when administering this medication? Administer with 10% dextrose solution. Infuse no more than 4 mg per minute. Monitor respirations during administration. Assess glucose levels.

Infuse no more than 4 mg per minute. Explanation: Diuretics such as furosemide, along with fluid restriction in the acute stages of CHF, help to eliminate excess fluids in the child with congestive heart failure. The nurse would administer no more than 4 mg of IV furosemide per minute to prevent ototoxicity. Furosemide should be diluted in D5W, NS, or LR solutions. Respirations should be monitored frequently in this client, but it is not necessary to monitor while administering the medication. Glucose levels should be monitored in clients with diabetes only.

The nurse is assessing a newborn for a patent ductus arteriosus. What will the nurse include in the assessment? Select all that apply. Monitor breathing for intercostal retractions. Assess for full, bounding pulses. Monitor for tiring easily. Examine skin during feeding for sweating. Monitor for lack of appetite.

Monitor breathing for intercostal retractions. Assess for full, bounding pulses. Explanation: The nurse will monitor breathing for intercostal retractions; and assess for full, bounding pulses when assessing a newborn for a patent ductus arteriosus. Tiring easily is an assessment finding consistent with atrial septal defect, and should be part of the assessment for that disorder. Similarly, sweating is a finding consistent with a ventricular septal defect. Monitoring for lack of appetite is part of the assessment for an atrioventricular canal.

What is an appropriate nursing intervention for the child diagnosed with Kawasaki disease who is receiving high-dose aspirin therapy and reports joint pain? Administer ibuprofen to ease the joint pain. Call the healthcare provider and request a higher dose of aspirin. Disregard the complaints because the child is just irritable. Provide age-appropriate bed rest activities.

Provide age-appropriate bed rest activities. Explanation: 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 client with Kawasaki disease is administered for its antiplatelet effects, not to decrease joint pain. Therefore, requesting an increase in the aspirin dose would be inappropriate nursing care. Finally, the child's reports should not be disregarded.

Which health teaching concept should the nurse emphasize when instructing the parents of a child with polycythemia caused by a congenital heart disorder? Prepare for seizures. Prevent dehydration. Expect the skin to turn yellow. Encourage progressive activity.

Prevent dehydration. Explanation: In children with polycythemia, hydration must be monitored so that dehydration does not occur. Otherwise, the polycythemia could become so severe that clotting or thrombophlebitis results. Seizures are not a threat with polycythemia. Jaundice is not associated with polycythemia. Encourage parents to observe the infant carefully when new activities are introduced so they can recognize the first signs of respiratory distress or the point at which the child is beginning to exceed exercise tolerance.

A 5-year-old is getting a cardiac catheterization. When describing this procedure to the parents, which of the following would the nurse most likely include? The child's temperature will be monitored continuously through the procedure by a rectal probe. Acetaminophen will be administered prior to the procedure if the child has a fever. After the procedure, vitals will be monitored closely every hour. The child will be encouraged to become mobile after the procedure.

The child's temperature will be monitored continuously through the procedure by a rectal probe. Explanation: The room where catheterization is performed is kept cool so monitoring the temperature is important. Vitals will be monitored, but not every hour. The child will need to lie still for several hours after the procedure.

Parents are told that their infant has a heart defect with a left-to-right shunt. What is the best way for the nurse to explain this type of shunting to the parents? This type of shunting causes an increase of blood to the lungs. This type of shunting causes an increase of blood to the systemic circulation. This type of shunting causes a decrease of blood to the lungs. This type of shunting causes a decrease of blood to the brain.

This type of shunting causes an increase of blood to the lungs. Explanation: This type of shunting causes an increase of blood to the lungs. A right-to-left shunt causes an increase in blood to the systemic circulation that is mixed with deoxygenated blood.

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? hydralazine digoxin furosemide nifedipine

digoxin Explanation: The most common drug used to increase myocardial contractility is digoxin. Hydralazine or nifedipine may be used to decrease afterload. Furosemide is used to decrease preload.

A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers? nonsterioidal anti-inflammatory drugs (NSAIDs) antiviral insulin phenytoin

nonsterioidal anti-inflammatory drugs (NSAIDs) Explanation: Medications used in the treatment of rheumatic fever include penicillin, NSAIDs, and corticosteroids. Insulin would be given for diabetes and phenytoin for seizure disorders. Antivirals are not relevant to the treatment of a bacterial infection.

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction? wheezing stomach upset nausea with diarrhea abdominal distress

wheezing Explanation: The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset, nausea, and abdominal distress are common with oral antibiotics and do not need to be reported immediately.

The nurse is caring for a newborn diagnosed with patent ductus arteriosus. Which finding will the nurse assess that is consistent with this diagnosis? slow heart rate expiratory grunt wide pulse pressure absent femoral pulses

wide pulse pressure Explanation: On physical examination, the child with patent ductus arteriosus usually has a wide pulse pressure. The diastolic pressure is low because of the shunt or runoff of blood, which reduces resistance. Manifestations of patent ductus arteriosus do not include a slow heart rate, expiratory grunt, or absent femoral pulses.

The nurse is caring for a pediatric client diagnosed with tetralogy of Fallot. After speaking with the physician, the parents state to the nurse, "The doctor said something about our child having too many red blood cells. We don't understand how that could happen?" What is the best response by the nurse? "The doctor was talking about polycythemia. It's common with this type of heart disorder." "It is a very complicated process. Since your child has tetralogy of Fallot, their body is overtaxed with everything it does. The amount of red blood cells being produced is just one more thing the heart has to deal with." "Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder." "I'm not really sure what red blood cells have to do with the heart defect your child has. We should ask your doctor."

"Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder." Explanation: To compensate for low blood oxygen levels, the kidneys produce the hormone erythropoietin to stimulate the bone marrow to produce more red blood cells (RBCs). This increase in RBCs is called polycythemia. Polycythemia can lead to an increase in blood volume and possibly blood viscosity, further taxing the workload of the heart. The correct response is the clearest and easiest description for the parents to understand. Telling the parents the doctor was discussing polycythemia with them doesn't answer their question.

The nurse is caring for a child diagnosed with rheumatic fever. When addressing the child's pain, the nurse should perform which intervention(s)? Select all that apply. A. Carefully handle the child's knees, ankles, elbows and wrists when moving the child. B. Administer salicylates after meals or with milk. C. Teach the child how to use a patient-controlled analgesia system. D. Administer intravenous morphine as prescribed. E. Prioritize nonpharmacologic interventions over pharmacologic interventions.

ANS: A, B Rationale: Pain control and relief are the highest priorities for the child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever but primarily to relieve joint inflammation and pain. They are also used as a heart protective. They are prescribed in high dosages. These are more commonly administered instead of opioids. Patient-controlled anesthesia is not typically used. Nonpharmacologic interventions can be used as an adjunct to pain medications.

A nurse is assessing the history of a 7-year-old boy who is suspected of having a cardiovascular disorder. Which of the following findings would tend to indicate a cardiovascular disorder in this child? Select all that apply. A. Fatigues easily after a short walk home from school B. A tendency to squat C. Periorbital edema D. A lack of perspiration E. Frequent voiding F. Bouts of hyperactivity

ANS: A, B, C Rationale: A mark of older children with heart disease is that they notice easy fatigue. They often voluntarily squat, as this position traps blood in the lower extremities because of the sharp bend at the knee and hip, allowing the child to oxygenate the blood remaining in the upper body more fully and easily. Ask about perspiration as children with left-to-right cardiac shunts may perspire excessively because of sympathetic nerve stimulation. They are able to effectively produce urine only when cardiac function is adequate to perfuse kidneys. To assess kidney output, evaluate how often the child voids. Infrequent voiding could indicate lack of perfusion of the kidneys, and thus decreased heart function. Edema from retained fluid that cannot be voided is a late sign of heart disease in children. If it does occur, periorbital edema (swelling around the eyes) generally occurs first. Bouts of hyperactivity are not associated with cardiovascular disorders.

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. Tiring easily when eating B. Shortness of breath when playing C. Crackles on lung auscultation D. Bradycardia E. Hypertension

ANS: A, B, C Rationale: Manifestations of heart failure include difficulty feeding or eating or becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension

. A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series of laboratory tests have been ordered. Which findings are consistent with this disease? Select all that apply. A. Reduced hemoglobin levels B. Reduced white blood cell count C. Elevated erythrocyte sedimentation rate (ESR) D. Negative C reactive protein levels E. Reduced platelet levels

ANS: A, C Rationale: Kawasaki disease is an acute systemic vasculitis occurring mostly in children 6 months to 5 years of age. It is the leading cause of acquired heart disease among children. The CBC count may reveal mild to moderate anemia, an elevated white blood cell count during the acute phase, and significant thrombocytosis (elevated platelet count [500,000 to 1 million]) in the later phase. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level are elevated.

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe? Select all that apply. A. Intravenous immunoglobulin B. Ibuprofen C. Acetaminophen D. Aspirin E. Alprostadil

ANS: A, C, D Rationale: In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever. Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent in infants with ductal-dependent congenital heart defects.

The nurse receives the shift report of multiple pediatric clients. Which pediatric client will the nurse see first? A. an infant whose parents report difficulty feeding with a temperature of 100.1°F (38°C) B. a toddler with tetralogy of Fallot squatting quietly in the corner of the room C. a child with history of hypertension and a current blood pressure of 130/90 mm Hg D. an adolescent with coarctation of the aorta with reports of coughing and coryza

ANS: B Rationale: The first child the nurse will see is the child showing signs and symptoms of decreased pulmonary blood flow and possible hypercyanotic (tet) spell, which includes a toddler with tetralogy of Fallot squatting. Squatting increases systemic vascular resistance and forces blood to flow through the narrow pulmonary valve to improve oxygenation. An infant with difficult feeding and an elevated temperature may have an infection but could be seen after addressing a potential respiratory/circulatory issue. The child with history of hypertension who has an elevated blood pressure can be seen later because this is an expected finding and not life-threatening. The adolescent with coarctation of the aorta being seen for coughing and coryza without any other signs of distress can also be seen later.

The nurse is assessing a child with suspected rheumatic fever. What assessment findings are consistent with the disease process? Select all that apply. A. Diastolic murmur B. Involuntary limb movement C. Macular rash on trunk D. Tender swollen joints E. Nonpalpable subcutaneous nodules ANS: B, C, D Rationale: Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.

ANS: B, C, D Rationale: Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.

The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive heart failure. Which clinical manifestation observed during the physical assessment would be consistent with this diagnosis? A. Jerking movements of the arms and legs B. Scissoring of the legs with toes pointed down C. Failure to gain weight D. Spooning of the finger nails

ANS: C Rationale: In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and spooning of the finger nails is seen in iron deficiency anemia

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? A. Contact the physician. B. Offer a snack and administer another dose. C. Immediately administer another dose. D. Administer next dose as ordered in 12 hours.

ANS: D Rationale: Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose. It is not necessary to contact the physician.

The nurse is caring for a 7-year-old child with Kawasaki disease. Which outcome(s) indicates that the plan of care has been effective for the client? Select all that apply. remains comfortable during acute phase takes adequate periods of rest to promote recovery free from complications of coronary aneurysms free from complications of aspirin therapy receives prophylactic antibiotics

remains comfortable during acute phase takes adequate periods of rest to promote recovery free from complications of coronary aneurysms free from complications of aspirin therapy Explanation: Remaining comfortable during the acute phase, adequate periods of rest to promote recovery, being free from complications of coronary aneurysms, and being free from complications of aspirin therapy are outcomes that indicate that the plan of care has been effective for the child with Kawasaki disease. The child receiving prophylactic antibiotics is an outcome applicable to infective endocarditis, not Kawasaki disease.

A nurse is reading a journal article about congenital heart conditions that are associated with decreased pulmonary blood flow. The nurse demonstrates understanding of the information when she identifies which anomalies as being associated with tetralogy of Fallot? Select all that apply. pulmonary stenosis atrial septal defect overriding aorta right ventricular hypertrophy patent ductus arteriosus

pulmonary stenosis overriding aorta right ventricular hypertrophy Explanation: Tetralogy of Fallot is a congenital heart defect composed of four heart defects: pulmonary stenosis (a narrowing of the pulmonary valve and outflow tract, creating an obstruction of blood flow from the right ventricle to the pulmonary artery); ventricular septal defect; overriding aorta (enlargement of the aortic valve to the extent that it appears to arise from the right and left ventricles rather than the anatomically correct left ventricle); and right ventricular hypertrophy (the muscle walls of the right ventricle increase in size due to continued overuse as the right ventricle attempts to overcome a high-pressure gradient).

The nurse is preparing the parents and the child with Kawasaki disease for discharge from the hospital. What will the nurse teach the family about home care? Select all that apply. "Aspirin therapy should be given daily for several months as prescribed." "The child should not receive any live vaccines for 6 months." "Schedule the prescribed cardiac evaluations." "Allow the child to be active daily to increase joint range of motion." "Take the child's temperature twice daily."

"Aspirin therapy should be given daily for several months as prescribed." "The child should not receive any live vaccines for 6 months." "Schedule the prescribed cardiac evaluations." Explanation: Kawasaki disease is an acute febrile disease. It usually occurs in boys under the age of 5 years. The child runs high fevers for approximately 3 weeks before the other symptoms of strawberry tongue, cervical lymphadenopathy, edema of the hands and feet, and rash on the trunk develop. The child is very ill. The largest complication is cardiac involvement. Treatment is the administration of high-dose aspirin and the administration of intravenous immunoglobulin (IVIG). Aspirin is given up to 1 year after the acute illness. The parents will be taught to administer aspirin regularly and to be aware of any bleeding issues. Because the child has received IVIG, no live vaccines should be administrated for 3 to 6 months. The child should have regular echocardiograms and other cardiac evaluations regularly following discharge. The child should rest and not be active. Joint care should be passive. It is not necessary to take the child's temperature regularly.

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? "The feeling of the heart skipping a beat is common." "We need to avoid a tub bath for the next 3 days." "Strenuous activity should be limited for the next 3 days." "We need to watch for changes in skin color or difficulty breathing."

"The feeling of the heart skipping a beat is common." Explanation: Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. The tub bath statement is appropriate because tub baths should be avoided for about 3 days. The strenuous activity statement is appropriate because 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 would best apply to a child during the acute phase of rheumatic fever? Disturbed sleep pattern related to hyperexcitability Ineffective breathing pattern related to cardiomegaly Risk for self-directed violence related to development of cerebral anoxia Activity intolerance related to inability of heart to sustain extra workload

Activity intolerance related to inability of heart to sustain extra workload Explanation: The course of rheumatic fever is about 6 to 8 weeks. Children are maintained on bed rest only during the acute phase of illness until the pulse rate returns to normal. Because pulse rate is a valuable sign of improvement, monitoring vital signs is essential during and following the acute phase. Obtain an apical pulse for a full minute for best results. Taking it while the child is asleep as well as when the child is awake helps to measure the effect of activity on the pulse rate; this is another way to judge that inflammation is decreasing and the child's heart action is improving. Chorea occurs in some children with rheumatic fever; however, it is not known if this manifestation will disturb the child's sleep. Children with rheumatic fever may develop congestive heart failure; however, cardiomegaly is not a long-term effect of the disease. The child is not at risk for self-directed violence because cerebral anoxia is not a manifestation of the disease

Which of the following would be included in discharge teaching by the nurse of a child that had a patch placed surgically for an atrial septal defect? Antibiotics should be administered before invasive procedures. intake of 80 ounces of fluid daily need for frequent rest periods at home teaching about how to take daily blood pressures

Antibiotics should be administered before invasive procedures. Explanation: Antibiotics should be administered to prevent the risk of endocarditis. Consuming 80 ounces of fluid daily is too large of an amount. The need for frequent rest periods and daily blood pressures should not be necessary since the defect is repaired.

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition? Observing for excessive crying Assessing for the presence of femoral pulses Recording an upper extremity blood pressure Auscultating for a cardiac murmur

Assessing for the presence of femoral pulses Explanation: Coarctation of the aorta is a defect where there is narrowing of the aorta, which is the largest vessel carrying oxygenated blood to the body. As a result of this narrowing, blood flow is impeded causing pressure to increase in the area proximal to the defect and decrease distal to the defect. As a result, the blood pressure will be higher in the upper part of the body and decreased in the lower part of the body. The pulses will be full or bounding in the upper part of the body and weak or absent in the lower part of the body. When assessing an infant with coarctation there may be weak or absent femoral pulses. There will also be differences in the blood pressure readings. These infants may or may not have a murmur and will be no more fussy than other babies.

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 Keep the child NPO for 2 to 4 hours before the procedure Record pedal pulses Apply EMLA cream to the catheter insertion site

Avoid drawing a blood specimen from the right femoral vein before the procedure Explanation: 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). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine

While assessing a neonate with a ventricular septal defect (VSD), the nurse notes crackles and retractions. The nurse obtains the following vital signs: temp 100.2°F (38°C), pulse 134 bpm, respirations 64 breaths/minute, oxygen saturation 97% on room air. What will the nurse do first? Advise the mother to bottle feed. Give furosemide intravenously. Administer acetaminophen rectally. Apply oxygen 10 liters/min (LPM) via oxyhood.

Give furosemide intravenously. Explanation: The nurse's first action when a neonate with a cardiac disorder is experiencing signs of fluid overload but has a normal oxygen saturation is to administer a diuretic such as furosemide. Oxygen could be applied if the furosemide was not effective in reducing fluid overload or if the oxygen saturation was low. This will remove fluid from the lungs, allowing the infant to breathe more easily. Although the neonate has an elevated temperature, administration of acetaminophen does not take priority over breathing. If the neonate continues to show signs of pulmonary overload, the nurse could advise the mother to give expressed breast milk through a bottle or nasogastric tube.

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

Indomethacin Explanation: Indomethacin is the drug typically ordered to close a patent ductus arteriosus. Alprostadil would be indicated to maintain the ductus arteriosus temporarily in infants with ductal-dependent congenital heart defects. Heparin would be used for prophylaxis and treatment of thromboembolic disorders, especially after surgery. Spironolactone would be used to manage edema due to heart failure and to treat hypertension.

The nurse is planning care for an 8-month-old infant with a ventricular septal defect. Which nursing diagnosis should the nurse use to help guide the care for this client? Impaired gas exchange related to a right-to-left shunt Impaired skin integrity related to poor peripheral circulation Ineffective airway clearance related to altered pulmonary status Ineffective tissue perfusion related to inefficiency of the heart as a pump

Ineffective tissue perfusion related to inefficiency of the heart as a pump Explanation: Ventricular septal defect is the most common type of congenital cardiac disorder. With this disorder, an opening is present in the septum between the two ventricles. Blood shunts from left to right across the septum, impairing the efficiency of the heart because the blood that should be forced into the aorta and out to the body from contraction of the left ventricle shunts back into the pulmonary circulation, resulting in right ventricular hypertrophy and increased pressure in the pulmonary artery. This disorder does not impair gas exchange, cause impaired skin integrity, or cause ineffective airway clearance.

The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder? heart failure infective endocarditis cardiomyopathy Kawasaki Disease

Infective endocarditis would present with intermittent, unexplained low-grade fever, fatigue, anorexia, weight loss, or flu-like symptoms. Characteristics of cardiomyopathy include respiratory distress, fatigue, poor growth (dilated), chest pain, dizziness, and syncope. Abdominal pain, joint pain, fever, and irritability are signs of Kawasaki disease.

A nurse is administering digoxin to a 3-year-old child. What would be a reason to hold the dose of digoxin? Nausea and vomiting Ataxia Hypertension Fever and tinnitus

Nausea and vomiting Explanation: Digoxin is a cardiac glycoside and antiarrhythmic. It can cause toxicity if the dosages increase due to poor absorption, dehydration, etc. Signs of digoxin toxicity are nausea and vomiting, lethargy, and bradycardia. The apical pulse should be taken for one full minute prior to administering digoxin. The dosage should be held if the pulse rate is less than 60 beats/min in an adolescent or less than 90 beats/min in an infant. The other symptoms listed do not relate to digoxin toxicity and could occur for numerous reasons.

When educating the family of an ill infant with an atrioventricular canal defect/septal defect, what information would be included in the education if the doctor is planning on performing palliative care until the infant is healthier? Palliative pulmonary artery banding should help the infant grow. Most infants do not need surgical repair for this if palliative procedures are performed. The medication indomethacin is used to try to close the hole. VSD patching surgery should be performed immediately.

Palliative pulmonary artery banding should help the infant grow. Explanation: Palliative pulmonary artery banding should help the infant grow enough so that the atrioventricular canal defect can be repaired. The pulmonary artery banding will help, but the defect will still need to be fixed. Most infants will need surgery for a large, symptomatic VSD. The medication indomethacin is used for a PDA.

A 1-year-old with tetralogy of Fallot turns blue during a temper tantrum. What will the nurse do first? Place child in the knee-to-chest position. Assess for an irregular heart rate. Listen for an increased respiratory rate. Explain to the child the need to calm down.

Place child in the knee-to-chest position. Explanation: Tetralogy of Fallot is a cyanotic heart defect. Hypercyanosis can develop suddenly. The symptoms are increased cyanosis, hypoxemia, dyspnea, and agitation. The nurse should use a calm, comforting approach with the child and place child in the knee-to-chest position. This position is the first priority of the child with tetralogy of Fallot. This position increases pulmonary blood flow by increasing systemic vascular resistance. The additional interventions for a hypercyanotic spell are to administer oxygen and give morphine, IV fluids, and propranolol. A child will not understand to calm down and cannot be expected to listen during a temper tantrum. Assessing the child's heart rate and respirations are not priority. Perfusion is priority for this client at this time.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority? Place the infant in the knee-chest position. Start an IV for fluids. Prepare the infant for surgery. Raise the head of the bed.

Place the infant in the knee-chest position. Explanation: Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position.

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta? Pulses weaker in lower extremities compared to upper extremities Pulses weaker in upper extremities compared to lower extremities Cyanosis with crying Cyanosis with feeding

Pulses weaker in lower extremities compared to upper extremities Explanation: With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased systemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot.

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess? Hirsutism or striae Strawberry tongue Malar rash Café au lait spots

Strawberry tongue Explanation: Dry, fissured lips and a strawberry tongue are common findings with Kawasaki disease. Acne, hirsutism, and striae are associated with anabolic steroid use. Malar rash is associated with lupus. Café au lait spots are associated with neurofibromatosis.

The nurse instructs the parents of a child with a congenital heart disorder on the administration of digoxin at home. Which observation indicates that teaching has been effective? The father provides a dose of the medication after the baby spits it up. The father provides a dose of the medication at the conclusion of a feeding. The mother feels for a radial pulse before giving the baby the next scheduled dose. The mother provides a dose of the medication 1 hour before the next scheduled feeding.

The mother provides a dose of the medication 1 hour before the next scheduled feeding. Explanation: Guidelines to ensure safe digoxin administration at home include providing a dose of the medication 1 hour before the next scheduled feeding. If a dose is vomited, do not repeat the dose. The medication should be given 2 hours after a feeding and not immediately after. The apical heart rate and not the radial pulse should be assessed before providing a dose of the medication.

A nurse is obtaining the history from a woman who is in labor. Which of the following if reported by the mother would alert the nurse to the possibility that the newborn has an increased risk for a congenital heart defect? The mother states she has lupus. The mother states she took acetaminophen while pregnant. The mother has a history of seizures. The mother states she slept all the time while pregnant.

The mother states she has lupus. Explanation: Having lupus while pregnant could contribute to a congenital heart defect. Acetaminophen, history of seizures and excessive sleeping during pregnancy are not associated with an increased risk for congenital heart defects.

The nurse is caring for a 6-year-old child with blood pressure readings consistently between 130/60 and 139/89 mm Hg. For which condition does the nurse anticipate treatment? stage 1 hypertension stage 2 hypertension elevated blood pressure none; this is an expected finding

The nurse anticipates treatment for stage 1 hypertension, defined as systolic and diastolic blood pressure greater than or equal to the 95th percentile to less than the 95th percentile plus 12 mm Hg, or between 130/80 to 139/89 mm Hg, whichever is lower. This applies to children aged 1 to 12 years. Stage 2 hypertension for children aged 1 to 12 years is defined as systolic and diastolic blood pressure less than or equal to the 95th percentile plus 12 mm Hg, or greater than or equal to 140/90 mm Hg, whichever is lower. Elevated blood pressure for children aged 1 to 12 years is defined as systolic and diastolic blood pressure between the 90th and 95th percentile, or between 120/80 mm Hg and greater than the 95th percentile, whichever is lower. Normal blood pressure for children aged 1 to 12 years is defined as systolic and diastolic blood pressure less than the 90th percentile.

A parent asks about the risk of a congenital heart defect (CHD) 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? There is less than a 7% chance a sibling would inherit a heart defect. This was probably caused by environmental factors, not genetics. These occur related to medication the mother was taking while pregnant. There is no chance this will be passed to another child since we do not know what caused it.

There is less than a 7% chance a sibling would inherit a heart defect. Explanation: The risk to subsequent siblings of a child with CHD is approximately 2% to 6%, so genetics can play a role in the child having a cardiac defect.

Parents are told their infant has a hypoplastic left heart. How would the nurse explain this condition to the family? This is a problem where the right side of the heart did not develop properly. This is a problem where the left side of the heart did not develop properly. There are no surgeries that can help the child live with this heart defect. The infant will have immediate surgery to completely correct the heart defect.

This is a problem where the left side of the heart did not develop properly. Explanation: This is a problem where the left side of the heart did not develop properly. There is a three-step palliative surgery that can be implemented or the child will need a heart transplant.

A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education? Your child may need multiple surgeries to correct this defect. An IV for fluids will be started immediately. This is caused by an opening that usually closes by 1 week of age. This type of defect is caused by having a genetic predisposition for it.

This is caused by an opening that usually closes by 1 week of age. Explanation: A PDA is caused by an opening called the ductus arteriosus. A PDA usually closes by 1 week of age. If it does not close, the defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

A 10-week-old infant continues to have a small ventricular septal defect (VSD) and is prescribed digoxin. When evaluating the infant's response to drug therapy, which assessment finding is related to the therapeutic action of the medication? a reduced fluid accumulation in the lungs a resolving infection of the heart the dilation of the coronary vessels the closing of the septal defect

a reduced fluid accumulation in the lungs Explanation: Because up to 85% of VSDs are so small they close spontaneously, many children are managed only by close observation during the first years of life, perhaps with administration of a diuretic or digoxin to help prevent fluid from accumulating in the lungs. Placement of a septal occlude device during cardiac catheterization is done to prevent chronic pulmonary artery hypertension from developing or the heart from becoming infected (endocarditis) because of the recirculating and stagnant blood flow. Digoxin does not dilate arteries nor prevent infection or arrhythmia. The therapeutic effect is not to facilitate the closing of the defect.

A newborn is diagnosed with coarctation of the aorta. Which assessment should the nurse make when caring for this infant? observing for excessive crying auscultating for a cardiac murmur assessing for the presence of femoral pulses recording an upper extremity blood pressure

assessing for the presence of femoral pulses Explanation: If the coarctation is slight, absence of palpable femoral pulses from the decreased blood pressure in the lower body may be the only symptom seen. To help detect this, the nurse should always include evaluation of femoral pulses in all initial newborn assessments and admission inspections to newborn nurseries. Excessive crying, cardiac murmur, and blood pressure changes are not manifestations of coarctation of the aorta.

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks the child seems to have lack of coordination, facial grimaces and repetitive involuntary movements. Based on these symptoms the nurse would suspect what condition? chorea carditis arthralgia polyarthritis

chorea Explanation: Rheumatic fever affects the heart, the central nervous system, skin and subcutaneous tissue. It causes carditis, arthritis, and chorea. Chorea is a disorder characterized by emotional instability, purposeless movements, and muscular weakness. The onset of chorea is gradual, with increasing incoordination, facial grimaces, and repetitive involuntary movements. Polyarthritis means there is arthritis in multiple joints which is common in rheumatic fever, but this is not a symptom of chorea. Arthralgia is a very common symptom of rheumatic fever. It is pain in the joints but again not a symptom of chorea. The heart muscle is affected in rheumatic fever as are the valves but not included in the symptoms of chorea.

After teaching a group of nursing students about congenital heart defects, the instructor determines a need for additional teaching when the students identify which of the following as a defect of the great vessels? coarctation of the aorta total anomalous pulmonary venous return truncus arteriosus transposition of the great arteries

coarctation of the aorta Explanation: Coarctation of the aorta is classified as an obstructive defect. Total anomalous pulmonary venous return, truncus arteriosus, and transposition of the great vessels are classified as defects of the great vessels.

When assessing an infant born at 32 weeks' gestation, which finding would lead the nurse to suspect that the newborn has a patent ductus arteriosus (PDA)? weak, thready pulse decreased pulse rate high diastolic arterial pressure continuous murmur on auscultation

continuous murmur on auscultation Explanation: Presence of a continuous murmur on auscultation of the heart is indicative of patent ductus arteriosus (PDA) in preterm infants. Preterm infants are at an increased risk of developing PDA. Other assessment findings that indicate PDA include bounding pulse, increased pulse rate and low diastolic arterial pressure.

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 electrolyte values within acceptable parameters. demonstrate stable vital signs, capillary refill less than 3 seconds, and a urine output of 1-2 ml/kg/hr. exhibit clear breath sounds and no weight gain. have stable ABGs, decreased pulmonary secretions, and clear breath sounds. TAKE ANOTHER QUIZ

demonstrate stable vital signs, capillary refill less than 3 seconds, and a urine output of 1-2 ml/kg/hr. Explanation: The most appropriate outcome for a nursing diagnosis of decreased cardiac output would be one that illustrates that the client has improved cardiac output. This can be illustrated by the client who has stable vital signs, capillary refill less than 3 seconds, and good urine output of at least 1-2 ml/kg/hr. Stable electrolyte values, clear breath sounds, and no weight gain illustrate that the child does not have an imbalanced fluid volume. Stable ABGs, decreased pulmonary secretions, and clear breath sounds are indicative of the child who has improved gas exchange.

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: femoral pulse weaker than brachial pulse. bounding pulse. narrow pulse. hepatomegaly.

femoral pulse weaker than brachial pulse. Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure.

What evaluation best illustrates the effectiveness of furosemide therapy in a child diagnosed with congestive heart failure (CHF)? The child: does not become overly tired when awake. has a heart rate within acceptable limits for age. has appropriate weight gain for age. has clear breath sounds.

has clear breath sounds. Explanation: Furosemide is used to eliminate excess fluids from the body of the client with CHF. An evaluation of clear breath sounds would be an indicator that the client does not have pulmonary edema associated with CHF. An evaluation of activity level would be more reflective of activities that are provided for the client and whether enough rest is provided. A normal heart rate would be more specific to the effects of digoxin. An appropriate weight gain is more apt to reflect nutritional status.

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 increased pulmonary blood flow narrowing of the major vessel mixing of well-oxygenated and poorly-oxygenated blood

obstruction of blood flow to the lungs Explanation: 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. Defects with connections involving the left and right sides, such as atrial or ventricular septal defects, will shunt blood from the higher-pressure left side to the lower-pressure right side and subsequently more blood will go to the lungs. A narrowed major vessel leads to an obstructive defect, interfering with the ability of the blood to flow freely through the vessel. Mixed defects such as transposition of the great vessels involve the mixing of well-oxygenated with poorly-oxygenated blood, leading to a systemic blood flow that contains a lower oxygen content.

A newborn is diagnosed with tetralogy of Fallot. When explaining this condition to the mother, which defect would the nurse's description include? atrial septal defect stenosis of the aorta overriding of the aorta left ventricular hypertrophy

overriding of the aorta Explanation: One of the components in the tetralogy of Fallot is the overriding of the aorta. Tetralogy of Fallot is a congenital heart disease with four components. The defects in the tetralogy of Fallot include ventricular septal defect, overriding of the aorta, pulmonary stenosis, and right ventricular hypertrophy. Atrial septal defect, stenosis of the aorta, and left ventricular hypertrophy are not components of tetralogy of Fallot.

Which finding(s) is a major criterion used to help the health care provider diagnose acute rheumatic fever in a child? Select all that apply. elevated erythrocyte sedimentation rate temperature of 101.2°F (38.4°C) painless nodules located on the wrists pericarditis with the presence of a new heart murmur heart block with a prolonged PR interval

painless nodules located on the wrists pericarditis with the presence of a new heart murmur Explanation: Subcutaneous nodules and carditis are considered major criteria used in the diagnosing of acute rheumatic fever. The other options are minor criteria.

The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatment(s) would the nurse expect to administer if prescribed? Select all that apply. penicillin corticosteroids nonsteroidal anti-inflammatory drugs digoxin intravenous immunoglobulin

penicillin corticosteroids nonsteroidal anti-inflammatory drugs Explanation: A full 10-day course of an antibiotic, such as penicillin or equivalent, is used. Anti-inflammatory agents, such as corticosteroids and nonsteroidal anti-inflammatory drugs, are also used in the treatment of acute rheumatic fever. Digoxin, an antiarrhythmic agent, a is used to treat heart failure, atrial fibrillation, atrial flutter, and supraventricular tachycardia. Intravenous immunoglobulin, an immunoglobulin therapy, is used to treat Kawasaki disease.

An infant is hospitalized with heart failure. The health care provider has prescribed furosemide, enalapril, and carvedilol as part of the plan of care. Based on these medications, when reviewing the infant's laboratory results, which value is most important for the nurse to consider? blood urea nitrogen (BUN) calcium potassium glucose

potassium Explanation: Potassium plays a major role in the heart's rhythm and muscle contractility. Furosemide and enalapril both affect potassium levels; furosemide depletes potassium and enalapril increases potassium levels. It is appropriate for the nurse to monitor calcium and glucose levels, but the potassium level has stronger implications related to the prescribed medications. Nurses should also monitor BUN levels for signs related to renal failure in children with heart failure but not necessarily as it relates to the prescribed medications.

A nursing instructor is teaching about the development of congestive heart failure in children. The instructor determines that teaching was successful when the students place the development of signs and symptoms in the order in which they would most likely occur with right heart failure. Place the signs and symptoms in the sequence that demonstrates student understanding. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. lower extremity edema tachycardia tachypnea hepatomegaly

tachycardia tachypnea hepatomegaly lower extremity edema Explanation: One of the first signs of congestive heart failure is tachycardia, followed by tachypnea. Next hepatomegaly occurs, causing the child to feel irritable and restless from the abdominal pain from liver distention. Lower extremity edema, usually a primary sign in adults, is often a late sign.