Ch. 27 Cardiac Evolve Quiz

What is a priority patient outcome for a child with congestive heart failure?

The child will not have distended neck veins. A lack of distended neck veins is an appropriate patient outcome for a child with congestive heart failure. The child should have a heart rate that is acceptable for age rather than rapid. The skin should be warm to touch rather than cool. The child should sleep with the head elevated rather than with the head down and the feet elevated.

Which is considered a mixed cardiac defect?

Transposition of the great arteries Transposition of the great arteries permits mixing of oxygenated and unoxygenated blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow.

Surgical repair for patent ductus arteriosus (PDA) is performed to prevent which complication?

A worsening of pulmonary vascular congestion A patent ductus arteriosus (PDA) allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary vascular congestion may occur. Increased pulmonary vascular congestion is the primary complication; pulmonary infection may occur, but it is not the priority complication. Patent ductus arteriosus involves left-to-right shunting of blood. The decreased workload on the left side of the heart is not a priority complication of a PDA.

Which heart defect causes narrowing of the aortic valve?

Aortic stenosis Aortic stenosis causes narrowing of the aortic valve, which in turn results in resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Atrial septal defect is an abnormal opening between the atria that allows blood from the higher-pressure left atrium to flow into the lower-pressure right atrium. Coarctation of the aorta is an obstructive defect in which there is narrowing near the insertion of the ductus arteriosus. Patent ductus arteriosus is the failure of the fetal ductus arteriosus to close during the first few weeks of life.

Which congenital heart defect is described as the incomplete fusion of the endocardial cushions?

Atrioventricular canal defect Atrioventricular canal defect is the incomplete fusion of the endocardial cushions. Atrial septal defect is abnormal opening between the atria. Ventricular septal defect is an abnormal opening between right and left ventricles. Patent ductus arteriosus is the failure of the fetal ductus arteriosus to close within the first weeks of life.

In which procedure for cardiac diagnosis are radiopaque catheters placed in a peripheral blood vessel and advanced into the heart?

Cardiac catheterization In cardiac catheterization, radiopaque catheters are placed in a peripheral blood vessel and advanced into the heart as a means of measuring pressures and oxygen levels in heart chambers and visualizing heart structures and blood flow patterns. Electrocardiography involves leads placed on the patient's chest do detect how electrical signals pass through the heart. Echocardiography uses high-frequency sound waves to create a picture of the structures of the heart. Electrophysiology uses catheters within the heart to diagnose dysrhythmias.

What clinical manifestation does the nurse expect to find during the assessment of an infant with coarctation of the aorta?

Cooler lower extremities An infant with coarctation of the aorta, an obstructive defect of the heart, has cooler lower extremities due to localized narrowing near the insertion of the ductus arteriosus. This leads to decreased pressure in the lower extremities and weak or absent femoral pulses. The narrowing also causes increased pressure in the head and upper extremities and bounding pulses in the arms.

In what procedure are high-frequency sound waves directed through a transducer to produce an image of cardiac structures?

Echocardiography Echocardiography involves the use of high-frequency sound waves. The child undergoing this procedure must lie completely still. With improvements in technology a diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is an electrical tracing of the depolarization of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart, a contrast medium is injected, and the heart and its vessels are visualized. Electrophysiology is an invasive procedure in which catheters with electrodes record the impulses of the heart directly from the conduction system.

The nurse is caring for a child with a bedside cardiac monitor for electrocardiogram (ECG). Which intervention by the nurse is appropriate?

Ensure that the white electrode is on the right of the chest. Electrodes for cardiac monitoring are often color coded. White electrodes are placed on the right side of the chest, above the level of the heart. The black electrode is placed on the left chest above the level of the heart, not the right leg. Electrodes should be changed every 1 or 2 days because they irritate the skin. Bedside monitors assist in patient care. However, the nurse should assess the patient and not the cardiac monitor for auscultation of heart sounds. The ground electrode is green or red and is placed on the abdomen.

Which medications are diuretics used in the management of heart failure? Select all that apply.

Furosemide Chlorothiazide Spironolactone Diuretics used in the management of heart failure include furosemide (Lasix), chlorothiazide (Diuril), and spironolactone (Aldactone). Digoxin (Lanoxin) is not a diuretic. Potassium supplements are not diuretics; instead, they replace potassium lost as a result of taking potassium-depleting diuretics.

What does the nurse teach the parents of a child who has a history of bacterial infective endocarditis (IE)?

Institute prophylactic antibiotic therapy. The parents must take adequate measures to prevent infection. The child must be administered prophylactic antibiotic therapy 1 hour before certain procedures, such as dental work. Treatment of IE requires long-term parenteral drug therapy. Intravenous antibiotics may be administered at home with nursing supervision. Any unexplained fever, weight loss, lethargy, malaise, or anorexia must be reported to the health care provider. Such symptoms should not be self-diagnosed as a cold or flu, nor should they be treated with over-the-counter drugs. Early diagnosis and treatment are important in preventing further cardiac damage, embolic complications, and growth of resistant organisms. Blood cultures must be taken periodically to evaluate the response to antibiotic therapy.

What position does the nurse caring for a young child with tetralogy of Fallot see the child assuming in an attempt to compensate for the congenital heart defect?

Knee-chest The squatting position, otherwise known as the knee-chest position, decreases the amount of blood returning to the heart and allows the child time to compensate. The prone and supine positions do not offer any advantages to the child with cardiac compromise. The low Fowler position would assist with respiratory issues but not with cardiac compensation.

The nurse is planning care for an infant with heart failure. Which intervention does the nurse include?

Organizing activities to permit uninterrupted sleep The child needs to be well-rested before feeding. The child's needs should be met to minimize crying. The nurse must organize care to decrease energy expenditure. The child in congestive heart failure has an excess of fluid, so forcing fluids is contraindicated. Monitoring of vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings; small, frequent feedings should be given to the child in congestive heart failure.

Congenital heart defects have traditionally been divided into acyanotic and cyanotic defects. What does the nurse know about this system in clinical practice?

Problematic because children with acyanotic heart defects may experience cyanosis This classification is problematic. Children with traditionally named acyanotic defects may become cyanotic, and children with traditionally classified cyanotic defects may be pink at times. The classification does not reflect the blood flow within the heart. Cardiac defects are best described by their actual pathophysiologic processes and mechanisms. Children with cyanosis may be easily identified, but that does not aid diagnosis. Cyanosis is present when children have defects in which there is mixing of oxygenated and unoxygenated blood.

The patient with heart failure receives furosemide intravenously. Which intervention is appropriate?

Record output as soon as the drug is given Furosemide is a diuretic used in heart failure. It blocks the reabsorption of sodium and water in the proximal renal tubule. Output should be recorded as soon as the medication is administered, and the child must be monitored for dehydration. Furosemide causes excretion of chloride and potassium. Therefore, the child must be encouraged to have foods high in potassium or given potassium supplements. One of the side effects of furosemide is postural hypotension. Skin rash and drowsiness are side effects seen in children who receive spironolactone.

Which clinical manifestations result from pulmonary congestion in children with congestive heart failure?

Tachypnea, exercise intolerance, cyanosis Tachypnea, exercise intolerance, and cyanosis, along with orthopnea, wheezing, and cough, are clinical manifestations of pulmonary congestion in children with congestive heart failure. Fatigue and restlessness are the result of impaired myocardial function, and weight gain is caused by systemic venous congestion.