Pediatric Success Cardio

13. While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2. The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. Patent ductus arteriosus (PDA). 3. Ventricular septal defect (VSD). 4. Bronchopulmonary dysplasia.

2. Patent ductus arteriosus (PDA) 2. The main identifier in the stem is the machine-like murmur, which is the hallmark of a PDA.

27. While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left.

2. Polycythemia 2. Polycythemia is the result of the body attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood cells to carry the oxygen.

8. The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

4. Apply direct pressure 1 inch above the puncture site.

45. A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow of blood through the heart is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood.

11. For the child with hypoplastic left heart syndrome, which drug may be given to allow the patent ductus arteriosus (PDA) to remain open until surgery?

Prostaglandin E. HINT: Prostaglandin E maintains ductal patency to promote blood flow until the Norwood procedure is begun. Consider the opposite of wanting to close the PDA.

54. Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.

1. Polycythemia and clubbing. 54. 1. The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia.

58. During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.

3. Squatting The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow.

10. Indomethacin may be given to close which congenital heart defect (CHD) in newborns? _____________________

Patent ductus arteriosus or PDA. Prostaglandins allow the duct to remain open; thus, a prostaglandin inhibitor, such as Indocin or ibuprofen, can help close the duct.

20. A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called _____________________.

Tetralogy of Fallot or TOF.

33. A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

2. Pulses. 2. Checking for pulses, especially in the canulated extremity, would assure perfusion to that extremity and is the priority post procedure.

7. Which finding might delay a cardiac catheterization procedure on a 1-year-old? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

2. Severe diaper rash. 2. A child with severe diaper rash has potential for infection if the interventionist makes the standard groin approach.

40. The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness? 1. Kawasaki disease (KD). 2. Strep throat. 3. Malignant hypertension. 4. Atrial fibrillation.

2. Strep throat. 2. Chorea can be a manifestation of RF, with a higher incidence in females.

4. A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is

Rheumatic fever or RF. To make the diagnosis of RF, major and minor criteria are used. Major criteria include carditis, subcutaneous nodules, erythema marginatum, chorea, and arthritis. Minor criteria include fever and previous history of RF. It is an inflammatory disease caused by group A beta-hemolytic streptococcus.

41. The most common cardiac dysrhythmia in pediatrics is: 1. Ventricular tachycardia. 2. Sinus bradycardia. 3. Supraventricular tachycardia. 4. First-degree heart block.

Supraventricular tachycardia. 3. Supraventricular tachycardia is most common in children.

26. The _____________________ serves as the septal opening between the atria of the fetal heart.

Foramen ovale.

48. Patent ductus arteriosus causes what type of shunt? _____________________

Left to right. Blood flows from the higher pressure aorta to the lower pressure pulmonary artery, resulting in a left to right shunt.

2. A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

Patent ductus arteriosus or PDA. This is a defect with increased pulmonary flow. It should close in the first few weeks of life.

9. Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

1. Allow parents to hold and rock their child. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

36. A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy.

1. Congenital heart defect (CHD) 36. 1. CHD is found often in children with Down syndrome.

14. Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation.

46. The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse's best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for physicians to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

2. "Your baby's defect is small and will likely close on its own by 1 year of age."

49. A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has: 1. Ventricular septal defect (VSD). 2. Aortic stenosis (AS). 3. Mitral valve prolapse. 4. Tricuspid atresia.

2. Aortic stenosis (AS). 2. AS can progress, and the child can develop exercise intolerance that can be better when resting.

31. Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

3. Feeding in semi-Fowler position 3. The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so fluid in the lungs can go to the base of the lungs, allowing better expansion.

60. Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."

3. "I know she will be irritable for 2 months after her symptoms started. Children can be irritable for 2 months after the symptoms of the disease start.

34. Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him the aspirin that is ordered for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain."

3. "I will give him the aspirin that is ordered for pain and inflammation." 3. Aspirin is the drug of choice for treatment of RF.

18. During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.

4. Hold the child in knee-chest position to decrease venous blood return. 4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery.

28. The nurse is caring for a 9-month-old who was born with a congenital heart defect (CHD). Assessment reveals a HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.

Congestive heart failure or CHF. All of these are signs of pump failure. The infant is likely to have diaphoresis only on the scalp. The signs are not unlike those of an adult with this condition.

16. The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen.

1. Immunoglobulin G and aspirin. 1. High-dose immunoglobulin G and salicylate therapy for inflammation are the current treatment for KD. Richardson, Beth. Pediatric Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 106). F.A. Davis Company. Kindle Edition.

53. Which patient could require feeding by gavage? 1. Infant with congestive heart failure (CHF). 2. Toddler with repair of transposition of the great vessels. 3. Toddler with Kawasaki disease (KD) in the acute phase. 4. School-age child with rheumatic fever (RF) and chorea.

1. Infant with congestive heart failure (CHF). 1. The child may experience increased cardiac demand while feeding. Feedings by gavage eliminate that work and still provide high-calorie intake for growth.

3. Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 4. Pulmonic stenosis (PS). 6. Overriding aorta. Tetralogy of Fallot has four defects. Pulmonary stenosis causes decreased pulmonary flow.

51. Which medication should the nurse give to a child diagnosed with transposition of the great vessels? 1. Ibuprofen. 2. Betamethasone. 3. Prostaglandin E. 4. Indocin.

3. Prostaglandin E. 3. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery.

5. What should the nurse assess prior to administering digoxin? Select all that apply. 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

2. Apical pulse rate. 2. The apical pulse rate is assessed because digoxin decreases the HR, and if the HR is <60, digoxin should not be administered.

50. The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS).

2. Coarctation of the aorta (COA). 2. In the older child, COA causes dizziness, headache, fainting, elevated blood pressure, and bounding radial pulses.

32. In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).

3. Coarctation of the aorta (COA). With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lowerthan-expected BP and weak pulses in the lower extremities.

15. A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has

15. Kawasaki disease or KD. HINT: Classic signs of KD include red eyes with no discharge; dry, cracked lips; strawberry tongue; and red, swollen, and peeling palms and soles of the feet. Incidence of KD is higher in males. The strongest indicator for this disease is the hallmark strawberry tongue.

59. A heart transplant may be indicated for a child with severe heart failure and: 1. Patent ductus arteriosus (PDA). 2. Ventricular septal defect (VSD). 3. Hypoplastic left heart syndrome. 4. Pulmonic stenosis (PS).

3. Hypoplastic left heart syndrome. 3. Hypoplastic left heart syndrome is treated by the Norwood procedure, or heart transplant.

35. A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

4. Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life.

47. The flow of blood through the heart with an atrial septal defect (ASD) is _____________________.

47. Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood.