Pediatric Success: Cardiovascular Questions

Which drug should not be used to control secondary hypertension in a sexually active adolescent female who uses intermittent birth control?

ACE inhibitors.

Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)?

Chickenpox or influenza.

A heart transplant may be indicated for a child with severe heart failure and:

Hypoplastic left heart syndrome.

Which finding might delay a cardiac catheterization procedure on a 1-year-old?

Severe diaper rash.

The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimaces, 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.

Strep throat.

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

Left to right

The Norwood procedure is used to correct:

Hypoplastic left heart syndrome.

The mother of a toddler reports that the child's father has just had a myocardial infarction (MI). Because of this information, the nurse recommends the child have a(n):

Lipid profile.

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

Which medication should the nurse give to a child diagnosed with transposition of the great vessels?

Prostaglandin E.

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.

In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs?

Coarctation of the aorta (COA).

A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is:

Feeding formula that is supplemented with additional calories.

Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant?

Feeding in semi-Fowler position.

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:

Coarctation of the aorta (COA).

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:

Immunoglobulin G and aspirin.

An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff?

Latex

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

Left to right 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.

A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess:

Pulses

A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding?

Hypokalemia.

Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin indicates the need for further education?

I will mix the digoxin in some formula to make it taste better.

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:

Hold the child in knee-chest position to decrease venous blood return.

A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of which drug?

Beta blocker.

1. What can an electrocardiogram (ECG) detect? Select all that apply. 1)Ischemia. 2) Injury. 3)Cardiac output (CO). 4) Dysrhythmias. 5) Systemic vascular resistance (SVR). 6) Occlusion pressure. 7) Conduction delay.

1)Ischemia 2) Injury. 4) Dysrhythmias. 7) Conduction delay

Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states:

"I know she will be irritable for 2 months after her symptoms started."

Which statement by the mother of a child with rheumatic fever (RF) shows she has a good understanding of the care of her child? SAT

"I will give him the aspirin that is ordered for pain and inflammation." "I will take my child every month to the health care provider's office for his penicillin shot"

Which statement by the mother of a child with rheumatic fever (RF) shows she has an understanding of prevention for her other children?

"If their culture is positive for group A streptococcus, I will give them their antibiotic."

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:

"She will need to take the antibiotics for the rest of her life."

On examination, a nurse hears a murmur at the left sternal border (LSB) in a child with diarrhea and fever. The parent asks why the pediatrician never said anything about the murmur. The nurse explains:

"The fever increased the intensity of the murmur."

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:

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

Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is:

1 cc/kg/hr.

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 children. 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 children. 4) Make frequent position changes. 5) Feed the child when sucking the fists. 6) Change bed linens only when necessary. 7) Organize nursing activities.

Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1 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.

Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Select all that apply. 1) Polycythemia. 2) Blood clots. 3) Cerebrovascular accident. 4) Developmental delays. 5) Viral pericarditis. 6) Brain damage. 7) Alkalosis.

1) Polycythemia. 2) Blood clots. 3) Cerebrovascular accident. 4) Developmental delays. 6) Brain damage.

The following are examples of acquired heart disease. Select all that apply. Infective endocarditis. 1) Hypoplastic left heart syndrome. 2) Rheumatic fever (RF). 3) Cardiomyopathy. 4) Kawasaki disease (KD). 5) Transposition of the great vessels.

1,3,4,5 1) Hypoplastic left heart syndrome. 3) Cardiomyopathy. 4) Kawasaki disease (KD). 5) Transposition of the great vessels.

Congenital heart defects (CHDs) are classified by which of the following? Select all that apply. 1) Cyanotic defect. 2) Acyanotic defect. 3) Defects with increased pulmonary blood flow. 4) Defects with decreased pulmonary blood flow. 5) Mixed defects. 6) Obstructive defects. 7) Pansystolic murmurs.

3) Defects with increased pulmonary blood flow. 4) Defects with decreased pulmonary blood flow. 5) Mixed defects. 6) Obstructive defects.

Which vaccines must be delayed for 11 months after the administration of gamma globulin? Select all that apply. 1. Diphtheria, tetanus, and pertussis. 2. Hepatitis B. 3. Inactivated polio virus. 4. Measles, mumps, and rubella. 5. Varicella.

4,5

Which assessment indicates that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr. 5. playing baseball with other children his age.

3. 50th percentile height and weight for age. 5. playing baseball with other children his age.

BP screenings to detect end-organ damage should be done routinely beginning at what age?

3years.

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:

Aortic stenosis (AS).

What should the nurse assess prior to administering digoxin? Select all that apply.

Apical pulse rate.

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 of4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.

CHF

A child born with Down syndrome should be evaluated for which associated cardiac manifestation?

Congenital heart defect (CHD).

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

Foramen Ovale

Which patient could require feeding by gavage?

Infant with congestive heart failure (CHF). infant with signifant PS

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 _____________________.

Kawasaki Disease

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

PDA

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:

Patent ductus arteriosus (PDA).

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?

Polycythemia

Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)?

Polycythemia and clubbing.

Aspirin has been ordered for the child with rheumatic fever (RF) in order to:

Reduce joint inflammation.

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

During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position?

Squatting.

A toddler who has been hospitalized for vomiting due to gastroenteritis is sleeping and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child?

Supraventricular tachycardia.

The most common cardiac dysrhythmia in pediatrics is:

Supraventricular tachycardia.

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

Tetrology of Fallot

A 16-year-old is being treated for hypertension and asthma. Which drug does the nurse suspect the patient takes based on her hypertension?

beta blockers

What cardiac murmurs are usually pathologic?

diastolic & continuous type

A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal 10. 11. that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

patent ductus arteriosis PDA

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:

Apply direct pressure 1 inch above the puncture site.

What associated manifestation might the nurse occasionally find in a child diagnosed with Wilms tumor?

HTN

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. Overriding aorta. 6) Patent ductus arteriosus (PDA).

1) Ventricular septal defect (VSD). 2) Right ventricular hypertrophy. 4) Pulmonic stenosis (PS). 6) Patent ductus arteriosus (PDA).