Chapter 42: Cardiovascular Dysfunction
What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? Congestive heart failure
congestive heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body
The nurse is evaluating a child who is taking digoxin for her cardiac condition. The nurse is cognizant that a common sign of digoxin toxicity is: Vomiting.
The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on knowing that:
When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure All four extremities
What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)?Assess the parents' anxiety level and readiness to learn.
The most appropriate initial nursing action is to:Apply direct pressure above the catheterization site.
Which defect results in increased pulmonary blood flow? Atrial septal defect Blood flows from the left atrium higher pressure into the right atrium lower pressure and then to the lungs via the pulmonary artery
Digoxin has a rapid onset and is useful in increasing cardiac output, decreasing venous pressure, and as a result decreasing edema. Heart size is decreased by digoxin.
Which drug is an angiotensin-converting enzyme ACE inhibitor? Captopril Capoten Lasix is a loop diuretic. Aldactone blocks the action of aldosterone. Diuril works on the distal tubules.
Parents must learn specific, important guidelines for administration of digoxin.
Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium.
When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what substance are thought to protect against cardiovascular disease? HDL
HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high levels of proteins It is thought that HDLs protect against cardiovascular disease.
A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality?Polycythemia
Polycythemia is a compensatory response to chronic hypoxiaThe body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood.
For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?To improve oxygenation
Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation and increase pulmonary blood flow.
When preparing a school-age child and the family for heart surgery, the nurse should consider: Letting child hear the sounds of an electrocardiograph monitor.
Seventy-two hours after cardiac surgery, a young child has a temperature of 37.7 C (101 F). The nurse should: Report findings to physician.
The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?I have to stay on strict bed rest for 3 days."
Surgical closure of the ductus arteriosus would:Prevent the return of oxygenated blood to the lungs.
Which structural defects constitute tetralogy of Fallot? Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.
"Your child must lie quietly; sometimes a mild sedative is administered before the procedure."Although an echocardiogram is noninvasive, painless, and associated with no known side effects, it can be stressful for children.
The child must lie quietly in the standard echocardiographic positions; crying, nursing, being held, or sitting up often leads to diagnostic errors or omissions
Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on knowing that:
The child needs opportunities to play with peers.
Which postoperative intervention should be questioned for a child after a cardiac catheterization? Keep the affected leg flexed and elevated.
The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure.
In which situation is there the greatest risk that a newborn infant will have a congenital heart defect (CHD)? Trisomy 21 detected on amniocentesis
The incidence of congenital heart disease is approximately 50% in children with trisomy 21 Down syndrome.
An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality.
The initial treatment of secondary hypertension initially involves:Treating the underlying disease.
An important nursing consideration when chest tubes will be removed from a child is to: Administer analgesics before the procedure.
The most common causative agent of bacterial endocarditis is: Streptococcus viridans. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis.
Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?Weigh the infant every day on the same scale at the same time.
The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect?Patent ductus arteriosus
The metabolic rate of infants with heart failure is greater because of poor cardiac function and increased heart and respiratory rates
The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? Administering penicillin
An important nursing consideration when suctioning a young child who has had heart surgery is to: Administer supplemental oxygen before and after suctioning.
The nurse is caring for a child after heart surgery. What should she or he do if evidence is found of cardiac tamponade? Immediately report this to the physician.
José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: Adapted to his level of development so that he can understand.
The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood.
Temperature above 37.7° C (100° F) New, frequent coughing Turning blue or bluer than normal
The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include
A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? Tetralogy of Fallot results in decreased blood flow to the lungs.
The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? You may need to increase the caloric density of your infant's formula."
Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? Osler's nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis.
primary nursing intervention necessary to prevent bacterial endocarditis is to: Counsel parents of high risk children about prophylactic antibiotics.prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health
Which action by the school nurse is important in the prevention of rheumatic fever? Refer children with sore throats for throat cultures.
A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response?
What is an expected assessment finding in a child with coarctation of the aorta?Disparity in blood pressure between the upper and lower extremities
The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities.
One of the most frequent causes of hypovolemic shock in children is: Blood loss
What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy? Anaphylactic shock
The leading cause of death after heart transplantation is:Rejection.
When caring for the child with Kawasaki disease, the nurse should understand that: Therapeutic management includes administration of gamma globulin and aspirin.
An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to:Place the child in the knee-chest position.
nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. nurse recognizes that a risk of cerebrovascular accidents strokes exists. An important objective to decrease this risk is to:Prevent dehydration.
The nurse is assessing a child post-cardiac catheterization. Which complication might the nurse anticipate? Cardiac arrhythmia
Because a catheter is introduced into the heart, a risk exists of catheter-induced arrhythmias occurring during the procedure.
A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is:Peripheral edema.
A beneficial effect of administering digoxin is that it:Decreases edema.
Which clinical changes occur as a result of septic shock? Increased cardiac output
A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, what med should the nurse prepare for administration?Epinephrine
A common, serious complication of rheumatic fever is Cardiac valve damage.
A major clinical manifestation of rheumatic fever is: Polyarthritis. is swollen, hot, red, and painful joints. The affected joints will change every 1 to 2 days. Primarily the large joints are affected
child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to child's parents Replace whole milk with 2% or 1% milkIncrease servings of fish Avoid excessive intake of fruit juices
A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what conditions occur
What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well? Alert the physician.
A nurse is teaching an adolescent about primary hypertension. The nurse knows that which of the following is correct? Primary hypertension may be treated with weight reduction and exercise programs.
Decreased urinary output Sweating inappropriate Fatigue
An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during a routine blood draw. Which interventions should the nurse implement
Which clinical manifestations would the nurse expect to see as shock progresses in a child and becomes decompensated shock
Cool extremities and decreased skin turgor Confusion and somnolence Tachypnea and poor capillary refill time
The infant should first be placed in the knee-chest position to reduce blood returning to the heart. Next, 100% oxygen is given to alleviate the hypoxemia.
Morphine is next administered to reduce infundibular spasms. Last, the nurse should remain calm.
The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands?Organize nursing activities to allow for uninterrupted sleep.
Nursing interventions for the child after a cardiac catheterization include which of the following Assess the affected extremity for temperature and color Maintain a patent peripheral intravenous catheter until discharge.
