Ch.23 Cardiovascular Dysfunction
35. Which of the following is a common, serious complication of rheumatic fever? 1. Seizures 2. Cardiac arrhythmias 3. Pulmonary hypertension 4. Cardiac valve damage
ANS: 4 4. Cardiac valve damage is the most significant complication of rheumatic fever.
10. Which of the following defects results in increased pulmonary blood flow? 1. Pulmonic stenosis 2. Tricuspid atresia 3. Atrial septal defect 4. Transposition of the great arteries
ANS: 3 3. The atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery.
13. Which of the following is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? 1. Pulmonary congestion 2. Congenital heart defect 3. Congestive heart failure 4. Systemic venous congestion
ANS: 3 3. The definition of 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.
5. Nursing interventions for the child after a cardiac catheterization would include which of the following? 1. Allow ambulation as tolerated. 2. Monitor vital signs every 2 hours. 3. Assess the affected extremity for temperature and color. 4. Check pulses above the catheterization site for equality and symmetry.
ANS: 3 3. The extremity that was used for access for the cardiac catheterization must be checked for temperature and color. Coolness and blanching may indicate arterial occlusion.
Which heart defect and hemodynamic change pairing is correct? A. Aoritic stenosis and obstruction to blood flow out off the heart B. Ventricular septal defect (VSD) and decreased pulmonary blood flow C. Tricuspid atresia and increased pulmonary blood flow D. Atrioventricular (AV) canal and mixed blood flow in which saturated and desaturated blood mix within the heart or great arteries.
ANS: A
You are working with a family with a child who has a congenital heart defect. Future surgery is planned and you are teaching the parent how to reduce cardiac demands. The parent needs more teaching when she says which of the following? A. I will wake my child for feeding every 2 hours so he can get enough calories to gain weight. B. When I give the digoxin, I will listen to the pulse for one full minute. C. I should protect my child from people who have respiratory infections. D. I will count the number of wet diapers to make sure my child is not getting to much or too little fluid.
ANS: A
Heart failure (HF) is a problem after the child has had a congenital heart defect repaired. The nurse knows a sign of HF is what? a. Wheezing b. Increased blood pressure c. Increased urine output d. Decreased heart rate
ANS: A A clinical manifestation of heart failure is wheezing from pulmonary congestion. The blood pressure decreases, urine output decreases, and heart rate increases.
A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition? a. Cyanosis b. Heart failure c. Decreased pulmonary blood flow d. Bounding pulses in upper extremities
ANS: B As blood is shunted into the right side of the heart, there is increased pulmonary blood flow and the child is at high risk for heart failure. Cyanosis usually occurs in defects with decreased pulmonary blood flow. Bounding upper extremity pulses are a manifestation of coarctation of the aorta.
12. Which of the following defects results in decreased pulmonary blood flow? 1. Atrial septal defect 2. Tetralogy of Fallot 3. Ventricular septal defect 4. Patent ductus arteriosus
ANS: 2 2. Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect
27. Which of the following should the nurse consider when preparing a school-age child and the family for heart surgery? 1. Unfamiliar equipment should not be shown. 2. Let child hear the sounds of an ECG monitor. 3. Avoid mentioning postoperative discomfort and interventions. 4. Explain that an endotracheal tube will not be needed if the surgery goes well.
ANS: 2 2. The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized
24. An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be which of the following? 1. Assess for neurologic defects. 2. Place the child in the knee-chest position 3. Begin cardiopulmonary resuscitation. 4. Prepare family for imminent death.
ANS: 2 2. The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated.
46. The nurse suspects shock in a child who is 1-day after surgery. The initial nursing action should be which of the following? 1. Obtain blood gases. 2. Administer oxygen. 3. Place on cardiac monitor. 4. Place in Trendelenburg position.
ANS: 2 2. The initial nursing action in shock is to establish ventilatory support. This would be done by the administration of oxygen.
What term is defined as the volume of blood ejected by the heart in 1 minute? a. Afterload b. Cardiac cycle c. Stroke volume d. Cardiac output
ANS: D Cardiac output is defined as the volume of blood ejected by the heart in 1 minute. Cardiac output = Heart rate x Stroke volume. Afterload is the resistance against which the ventricles must pump when ejecting blood (ventricular ejection). A cardiac cycle is the sequential contraction and relaxation of both the atria and ventricles. Stroke volume is the amount of blood ejected by the heart in any one contraction.
A chest radiography examination is ordered for a child with suspected cardiac problems. The childs parent asks the nurse, What will the x-ray show about the heart? The nurses response should be based on knowledge that the radiograph provides which information? a. Shows bones of the chest but not the heart b. Evaluates the vascular anatomy outside of the heart c. Shows a graphic measure of electrical activity of the heart d. Supplies information on heart size and pulmonary blood flow patterns
ANS: D Chest radiographs provide information on the size of the heart and pulmonary blood flow patterns. The bones of the chest are visible on chest radiographs, but the heart and blood vessels are also seen. Magnetic resonance imaging is a noninvasive technique that allows for evaluation of vascular anatomy outside of the heart. A graphic measure of electrical activity of the heart is provided by electrocardiography.
The nurse is giving discharge instructions to the parent of a 6-year-old child who had a cardiac catheterization 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? a. My child should not attend school for the next 5 days. b. I should change the bandage every day for the next 2 days. c. My child can take a tub bath but should avoid taking a shower for the next 4 days. d. I should expect the site to be red and swollen for the next 3 days.
ANS: B Discharge instructions for a parent of a child who recently had a cardiac catheterization should include changing the bandage every day for the next 2 days. The child should avoid strenuous exercise but can go back to school. The child should avoid a tub bath, but an older child could take a shower the first day after the catheterization. The site should not have swelling or redness; if there is, it should be reported to the health care practitioner.
What statement best identifies the cause of heart failure (HF)? a. Disease related to cardiac defects b. Consequence of an underlying cardiac defect c. Inherited disorder associated with a variety of defects d. Result of diminished workload imposed on an abnormal myocardium
ANS: B HF is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the bodys metabolic demands. HF is not a disease but rather a result of the inability of the heart to pump efficiently. HF is not inherited. HF occurs most frequently secondary to congenital heart defects in which structural abnormalities result in increased volume load or increased pressures on the ventricles.
A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate? a. 60 beats/min b. 90 beats/min c. 100 beats/min d. 120 beats/min
ANS: B If a 1-minute apical pulse is less than 90 beats/min for an infant or young child, the digoxin is withheld. Sixty beats/min is the cut-off for holding the digoxin dose in an adult. One hundred to 120 beats/min is an acceptable pulse rate for the administration of digoxin.
2. Which of the following is a complication that may occur after a cardiac catheterization? 1. Cardiac arrhythmia 2. Hypostatic pneumonia 3. Congestive heart failure 4. Rapidly increasing blood pressure
ANS: 1 1. Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient.
16. Which of the following drugs is an angiotensin-converting enzyme (ACE) inhibitor? 1. Captopril (Capoten) 2. Furosemide (Lasix) 3. Spironolactone (Aldactone) 4. Chlorothiazide (Diuril)
ANS: 1 1. Capoten is a drug which is an ACE inhibitor.
15. A beneficial effect of administering digoxin (Lanoxin) is that it: 1. Decreases edema. 2. Decreases cardiac output. 3. Increases heart size. 4. Increases venous pressure.
ANS: 1 1. Digoxin has a rapid onset and is useful increasing cardiac output, decreasing venous pressure, and as a result, decreasing edema.
33. What painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? 1. Osler nodes 2. Janeway lesions 3. Subcutaneous nodules 4. Aschoff nodes
ANS: 1 1. Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis.
42. One of the most frequent causes of hypovolemic shock in children is which of the following? 1. Sepsis 2. Blood loss 3. Anaphylaxis 4. Congenital heart disease
ANS: 2 2. Blood loss is the most frequent cause of hypovolemic shock in children
17. An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following? 1. 60 2. 70 3. 90 4. 100
ANS: 2 2. If a 1-minute apical pulse is less than 70 for an older child, the digoxin is withheld. 1. This is the cut-off for holding the digoxin dose in an adult.
An infant is diagnosed with transposition of the great vessels. Prostaglandin E1 is given intravenously. The parents ask how long the child will remain on the prostaglandin E1. What is the appropriate response by the nurse? a. Prostaglandin E1 will be given intermittently until corrective surgery is performed. b. Prostaglandin E1 will be given continuously until corrective surgery is performed. c. Prostaglandin E1 will be given continuously throughout the preoperative and postoperative periods until the child is stable. d. Prostaglandin E1 will be given intermittently throughout the preoperative and postoperative periods until the child is stable.
ANS: B To provide intracardiac mixing for a child with transposition of the great arteries, intravenous prostaglandin E1 is administered continuously to keep the ductus arteriosus open to temporarily increase blood mixing and provide an oxygen saturation of 75% or to maintain cardiac output until surgery. It is discontinued after surgery.
What medication used to treat heart failure (HF) is a diuretic? a. Captopril (Capten) b. Digoxin (Lanoxin) c. Hydrochlorothiazide (Diuril) d. Carvedilol (Coreg)
ANS: C Hydrochlorothiazide is a diuretic. Captopril is an ACE inhibitor, digoxin is a digital glycoside, and carvedilol is a beta-blocker.
Nursing care of the infant and child with congestive heart failure includes A. force fluids appropriate to age. B. monitor respirations during active periods. C. organize activities to allow for uninterrupted sleep. D. give larger feedings less often to conserve energy.
ANS: C 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.
After returning from cardiac catheterization, the nurse determines that the pulse distal to the catheter insertion site is weaker. How should the nurse respond? a. Elevate the affected extremity. b. Notify the practitioner of the observation. c. Record data on the assessment flow record. d. Apply warm compresses to the insertion site.
ANS: C The pulse distal to the catheterization site may be weaker for the first few hours after catheterization but should gradually increase in strength. Documentation of the finding provides a baseline. The extremity is maintained straight for 4 to 6 hours. This is an expected change. The pulse is monitored. If there are neurovascular changes in the extremity, the practitioner is notified. The site is kept dry. Warm compresses are not indicated.
Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse's knowledge of congenital heart defects, this system in clinical practice is A. helpful, because it explains the hemodynamics involved. B. helpful, because children with cyanotic defects are easily identified. C. problematic, because cyanosis is rarely present in children. D. problematic, because children with acyanotic heart defects may develop cyanosis.
ANS: D 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 using the actual pathophysiologic process and mechanism. Children with cyanosis may be easily identified, but that does not help with the diagnosis. Cyanosis is present when children have defects where there is mixing of oxygenated blood with unoxygenated blood.
What is considered a mixed cardiac defect? A. Pulmonic stenosis B. Atrial septal defect C. Patent ductus arteriosus D. Transposition of the great arteries
ANS: D Transposition of the great arteries allows the mixing of both oxygenated and unoxygenated blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect and patent ductus arteriosus are classified as defects with increased pulmonary blood flow.
Bacterial infective endocarditis (IE) should be treated with which protocol? a. Oral antibiotics for 6 months b. Oral antibiotics (penicillin) for 10 full days c. IV antibiotics, diuretics, and digoxin d. IV antibiotics (penicillin type) for 2 to 8 weeks
ANS: D Treatment for IE includes the administration of high-dose antibiotics given intravenously for 2 to 8 weeks to completely eradicate the infecting microorganism.
36. Which of the following is a major clinical manifestation of rheumatic fever? 1. Polyarthritis 2. Osler nodes 3. Janeway spots 4. Splinter hemorrhages of distal third of nails
ANS: 1 1. Polyarthritis, which is swollen, hot, red, and painful joints. The affected joints will change every 1 to 2 days. Primarily the large joints are affected.
11. Which of the following structural defects constitute tetralogy of Fallot? 1. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy 2. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy 3. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy 4. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy
ANS: 1 1. Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.
8. Which of the following should be included in the instructions to an active adolescent who is going home after a cardiac catheterization? 1. Avoid tub baths but may shower. 2. Maintain strict bed rest for 3 days. 3. Leave pressure dressing on for 7 days. 4. Stay home from school until Band-Aid is removed.
ANS: 1 1. The catheterization site should be kept relatively dry with a adhesive bandage. Showers are recommended.
26. 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 which of the following? 1. Child needs opportunities to play with peers. 2. Child needs to understand that peers' activities are too strenuous. 3. Parents can meet all the child's needs. 4. Constant parental supervision is needed to avoid overexertion.
ANS: 1 1. The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace.
37. Therapeutic management of the child with rheumatic fever includes: 1. Administration of penicillin. 2. Avoid salicylates (aspirin). 3. Strict bed rest for 4 to 6 weeks. 4. Administration of corticosteroids if chorea develops.
ANS: 1 1. The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice
21. The infant with congestive heart failure has a need for: 1. Increased calories. 2. Increased fluids. 3. Decreased protein. 4. Decreased fat.
ANS: 1 1. The metabolic rate of infants with congestive heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue.
22. As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended for this child because they are high in which of the following? 1. Chlorides 2. Potassium 3. Sodium 4. Vitamins
ANS: 2 2. Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with this electrolyte
25. The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which of the following is an important objective to decrease this risk? 1. Minimize seizures 2. Prevent dehydration 3. Promote cardiac output 4. Reduce energy expenditure
ANS: 2 2. In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes
45. Which of the following occurs in septic shock? 1. Hypothermia 2. Increased cardiac output 3. Vasoconstriction 4. Angioneurotic edema
ANS: 2 2. Increased cardiac output, which results in warm, flushed skin, is one of the manifestations of septic shock
34. The primary nursing intervention to prevent bacterial endocarditis is which of the following? 1. Institute measures to prevent dental procedures. 2. Counsel parents of high-risk children about prophylactic antibiotics. 3. Observe children for complications, such as embolism and heart failure. 4. Encourage restricted mobility in susceptible children.
ANS: 2 2. The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition.
40. Which of the following is the leading cause of death after heart transplantation? 1. Infection 2. Rejection 3. Cardiomyopathy 4. Congestive heart failure
ANS: 2 2. The posttransplant course is complex. The leading cause of death after cardiac transplant is rejection.
19. Which of the following is a common sign of digoxin toxicity? 1. Seizures 2. Vomiting 3. Bradypnea 4. Tachycardia
ANS: 2 2. Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower (not faster) heart rate but not a slower respiratory rate.
44. Which of the following clinical manifestations would the nurse expect to see as shock progresses in a child and becomes uncompensated shock? 1. Thirst 2. Irritability 3. Apprehension 4. Confusion and somnolence
ANS: 4 4. Confusion and somnolence are beginning signs of uncompensated shock
47. A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, the nurse should prepare which of the following medications for immediate administration? 1. Diphenhydramine (Benadryl) 2. Dopamine 3. Epinephrine 4. Calcium chloride
ANS: 3 3. After the first priority of establishing an airway, administration of epinephrine is the drug of choice.
30. The nurse is caring for a child after heart surgery. Which of the following should the nurse do if evidence is found of cardiac tamponade? 1. Increase analgesia. 2. Apply warming blankets. 3. Immediately report this to physician. 4. Encourage child to cough, turn, and breathe deeply.
ANS: 3 3. If evidence is noted of cardiac tamponade, blood or fluid in the pericardial space constricting the heart, the physician is notified immediately of this life-threatening complication
29. Which of the following is an important nursing consideration when suctioning a young child who has had heart surgery? 1. Perform suctioning at least every hour. 2. Suction for no longer than 30 seconds at a time. 3. Administer supplemental oxygen before and after suctioning. 4. Expect symptoms of respiratory distress when suctioning.
ANS: 3 3. If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia
18. A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following? 1. 60 2. 70 3. 90 to 110 4. 110 to 120
ANS: 3 3. If the 1-minute apical is below 90 to 110, the digoxin should not be given to a 6-month-old.
31. Which of the following is an important nursing consideration when chest tubes will be removed from a child? 1. Explain that it is not painful. 2. Explain that only a Band-Aid will be needed 3. Administer analgesics before procedure. 4. Expect bright red drainage for several hours after removal.
ANS: 3 3. It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing IV line
38. Which of the following actions by the school nurse is important in the prevention of rheumatic fever? 1. Encourage routine cholesterol screenings. 2. Conduct routine blood pressure screenings. 3. Refer children with sore throats for throat cultures. 4. Recommend salicylates instead of acetaminophen for minor discomforts.
ANS: 3 3. Nurses have a role in prevention; primarily in screening school-age children for sore throats caused by group A streptococci. This can be by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing.
48. Clinical manifestations of toxic shock syndrome include which of the following? 1. Severe hypertension 2. Subnormal temperature 3. Erythematous macular rash 4. Papular rash over extremities
ANS: 3 3. One of the diagnostic criteria for toxic shock syndrome is a diffuse macular erythroderma.
14. Which of the following is a clinical manifestation of the systemic venous congestion that can occur with congestive heart failure? 1. Tachypnea 2. Tachycardia 3. Peripheral edema 4. Pale, cool extremities
ANS: 3 3. Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion
6. After the child returns from cardiac catheterization, the nurse monitors the child's vital signs. The heart rate should be counted for how many seconds? 1. 10 2. 15 3. 30 4. 60
ANS: 4 4. After cardiac catheterization, the heart rate should be counted for a full minute to detect evidence of dysrhythmias or bradycardia.
43. Which of the following types of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy? 1. Neurogenic shock 2. Cardiogenic shock 3. Hypovolemic shock 4. Anaphylactic shock
ANS: 4 4. Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance
20. 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 which of the following? 1. It is a very safe, frequently used drug. 2. It is difficult to either overmedicate or undermedicate with digoxin. 3. Parents lack the expertise necessary to administer digoxin. 4. Parents must learn specific, important guidelines for administration of digoxin.
ANS: 4 4. Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects
39. When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what are thought to protect against cardiovascular disease? 1. Cholesterol 2. Triglycerides 3. Low-density lipoproteins (LDLs) 4. High-density lipoproteins (HDLs)
ANS: 4 4. HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high levels of proteins. It is thought that HDLs protect against cardiovascular disease.
41. When caring for the child with Kawasaki disease, the nurse should know which of the following? 1. Child's fever is usually responsive to antibiotics within 48 hours. 2. Principal area of involvement is the joints. 3. Aspirin is contraindicated. 4. Therapeutic management includes administration of gamma globulin and aspirin.
ANS: 4 4. High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness
7. 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. The most appropriate initial nursing action is which of the following? 1. Notify physician. 2. Apply new bandage with more pressure. 3. Place in Trendelenburg position. 4. Apply direct pressure above catheterization site.
ANS: 4 4. If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture.
28. Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. The nurse should do which of the following? 1. Keep child warm with blankets. 2. Apply a hypothermia blanket. 3. Record temperature on nurses' notes. 4. Report findings to physician.
ANS: 4 4. In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7° C or 100° F as part of the inflammatory response to tissue trauma. If the temperature is higher or continues after this period, it is most likely a sign of an infection and immediate investigation is indicated
23. Which of the following is a sign of hypokalemia? 1. Apnea 2. Oliguria 3. Twitching 4. Muscle weakness
ANS: 4 4. Muscle weakness is a characteristic clinical manifestation of hypokalemia.
3. José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: 1. Directed at his parents, because he is too young to understand. 2. Detailed in regard to the actual procedures so he will know what to expect. 3. Done several days before the procedure so that he will be prepared. 4. Adapted to his level of development so that he can understand.
ANS: 4 4. Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations.
32. What is the most common causative agent of bacterial endocarditis? 1. Staphylococcus albus 2. Streptococcus hemolyticus 3. Staphylococcus albicans 4. Streptococcus viridans
ANS: 4 4. Staphylococcus viridans is the most common causative agent in bacterial (infective) endocarditis
4. Which of the following explanations regarding cardiac catheterization is appropriate for a preschool child? 1. Postural drainage will be performed every 4 to 6 hours after the test. 2. It is necessary to be completely "asleep" during the test. 3. The test is very short, usually taking less than 1 hour. 4. When the procedure is done, you will have to keep your leg straight for at least 4 hours.
ANS: 4 4. The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position
9. Surgical closure of the ductus arteriosus would do which of the following? 1. Stop the loss of unoxygenated blood to the systemic circulation 2. Decrease the edema in legs and feet 3. Increase the oxygenation of blood 4. Prevent the return of oxygenated blood to the lungs
ANS: 4 4. The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary artery
A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which? a. Serum sodium b. Serum potassium c. Serum glucose d. Serum chloride
ANS: B A fall in the serum potassium level enhances the effects of digoxin, increasing the risk of digoxin toxicity. Increased serum potassium levels diminish digoxins effect. Therefore, serum potassium levels (normal range, 3.55.5 mmol/L) must be carefully monitored.
What cardiovascular defect results in obstruction to blood flow? a. Aortic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries
ANS: A Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Tricuspid atresia results in decreased pulmonary blood flow. The atrial septal defect results in increased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.
The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication? a. Pulmonary hypertension b. Right-to-left shunt of blood c. Pulmonary embolism d. Left ventricular hypertrophy
ANS: A Congenital heart defects with a large left-to-right shunt (e.g., in ventricular septal defect, patent ductus arteriosus, or complete AV canal), which cause increased pulmonary blood flow, may result in pulmonary hypertension. If these defects are not repaired early, the high pulmonary flow will cause changes in the pulmonary artery vessels, and the vessels will lose their elasticity. The blood does not shunt right to left, a pulmonary embolism is not a complication of ventricular septal defect, and the left ventricle does not hypertrophy.
What procedure uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? A. Echocardiography B. Electrocardiography C. Cardiac catheterization D. Electrophysiology
ANS: A Echocardiography uses high-frequency sound waves. The child must lie completely still. With the 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 where 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 where catheters with electrodes record the impulses of the heart directly from the conduction system.
The nurse should explain to the parents that their child is receiving furosemide (Lasix) for severe congestive heart failure because of its effects as A. a diuretic. B. a beta-blocker. C. a form of digitalis. D. an ACE inhibitor.
ANS: A Furosemide is a loop diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated with congestive heart failure.
Selective cholesterol screening is recommended for children older than the age of 2 years with which risk factor? a. Body mass index (BMI) = 95th percentile b. Blood pressure = 50th percentile c. Parent with a blood cholesterol level of 200 mg/dl d. Recently diagnosed cardiovascular disease in a 75-year-old grandparent
ANS: A Obesity is an indication for cholesterol screening in children. A BMI in the 95th percentile or higher is considered obese. Children who are hypertensive meet the criteria for screening, but blood pressure in the 50th percentile is within the normal range. A parent or grandparent with a cholesterol level of 240 mg/dl or higher places the child at risk. Early cardiovascular disease in a first- or second-degree relative is a risk factor. Age 75 years is not considered early.
A physician suspects that a child may have congenital cardiac disease. Which noninvasive diagnostic procedure would help to confirm the possibility of heart disease? A. EKG B. Echocardiogram C. Chest x-ray D. Pulse oximetry
ANS: B An echocardiogram is the most common test used to identify either a cardiac anomaly or evidence of heart disease. EKG provides evidence of electrical system conduction. Pulse oximetry provides information relative to perfusion. And a chest x-ray focuses on lungs and airway exchange, it may not be sensitive and specific to determine cardiac pathology.
Nursing care of the child with Kawasaki disease is challenging because of which occurrence? a. The childs irritability b. Predictable disease course c. Complex antibiotic therapy d. The childs ongoing requests for food
ANS: A Patient irritability is a hallmark of Kawasaki disease and is the most challenging problem. A quiet environment is necessary to promote rest. The diagnosis is often difficult to make, and the course of the disease can be unpredictable. Intravenous gamma globulin and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to eat. Soft foods and fluids should be offered to prevent dehydration.
What is an early sign of congestive heart failure that the nurse should recognize? A. Tachypnea B. Bradycardia C. Inability to sweat D. Increased urinary output
ANS: A Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic if experiencing congestive heart failure. There will usually be decreased urinary output in a child experiencing congestive heart failure.
If a child is being treated with ACE inhibitors as part of the therapeutic regimen for heart failure, which observation is noted would alert the nurse to a potential interaction? A. Diuretic therapy with Aldactone B. Child complains of being slightly dizzy at times C. Maintaining normal urine output D. Blood pressure monitoring at lower end of normal range
ANS: A The use of ACE inhibitors in combination with Aldactone, which is a potassium sparing inhibitor can lead to potential hyperkalemia. As such this type of diuretic therapy should not be used. ACE inhibitors typically are not associated with dizziness but continued monitoring for this presentation should be included. Normal urine output is a favorable sign. ACE inhibitors can cause hypotension so continued monitoring would be needed at this point.
A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38 C (100.4 F), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother? a. Immediately bring the child to the clinic for evaluation. b. Come to the clinic next week on a scheduled appointment. c. Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness. d. Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.
ANS: A These are the insidious symptoms of bacterial endocarditis. Because the child is in a high-risk group for this disorder (VSD repair), immediate evaluation and treatment are indicated to prevent cardiac damage. With appropriate antibiotic therapy, bacterial endocarditis is successfully treated in approximately 80% of the cases. The childs complaints should not be dismissed. The low-grade fever is not a symptom that the child can fabricate.
The nurse is caring for a child after cardiac surgery. What interventions should the nurse implement with regard to chest tubes placed to a water-seal drainage system? (Select all that apply.) a. Maintain sterility. b. Check for tube patency. c. Do not interrupt the water-seal drainage system. d. Clamp the chest tube when ambulating the child. e. Measure the drainage by emptying the collection chamber every shift.
ANS: A, B, C Nursing considerations with regard to chest tubes attached to a water-seal drainage system include (1) do not interrupt water-seal drainage unless the chest tube is clamped, (2) check for tube patency (fluctuation in the water-seal chamber), and (3) maintain sterility. The chest tube should not be clamped when ambulating the child and the drainage is measured in the collection chamber, not emptied.
An adolescent is being placed on a beta-blocker. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.) a.Medication may cause fatigue. b. Side effects may include impotence. c. Side effects may include bradycardia. d. Take the medication 1 hour before meals. e. Side effects may include peripheral edema.
ANS: A, B, C The adolescent should be instructed that the medication may cause fatigue, impotence, and bradycardia. The medications should be taken with meals and side effects do not include peripheral edema.
The nurse is caring for a child with secondary hypertension. What renal disorders are associated with secondary hypertension? (Select all that apply.) a. Renal tumor b. Hydronephrosis c. Vesicoureteral reflux d. Glomerulonephritis e. Urinary tract infection
ANS: A, B, D Renal disorders that can cause secondary hypertension include a renal tumor, hydronephrosis, and glomerulonephritis. Vesicoureteral reflux or urinary tract infections do not cause secondary hypertension.
The nurse is teaching an adolescent with hypertension foods recommended on the DASH diet. What foods should the nurse include in the teaching session? (Select all that apply.) a. Green beans b. Energy drinks c. Low-fat yogurt d. Chocolate milk e. Whole grain bread
ANS: A, C, E The DASH diet provides a lower salt diet that has been associated with improvement in BP and is believed to be beneficial for all patients with hypertension. DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet is plentiful in vegetables, fruits, whole grains, and low-fat dairy products and low in sugar and salt. Energy drinks are high in sugar, and chocolate milk is high in fat.
An adolescent is being placed on an ACE inhibitor. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.) a. Stay well hydrated. b. Increase intake of potassium. c. Avoid rapid position changes. d. Take the medication with meals. e. Side effects may include a cough.
ANS: A, C, E The adolescent should be instructed to stay well hydrated and avoid rapid position changes and that side effects may include a cough when on ACE inhibitors. ACE inhibitors do not deplete potassium, and they should be taken 1 hour before meals to increase absorption.
You are working with a new graduate on the pediatric unit and your patient is returning from the cardiac catheterization lab. You feel the graduate understands the important nursing interventions when she says which of the following. SATA A. "Check pulses especially below the catheterization site, for equality and symmetry." B. "Check vital signs, which may be taken as frequently as every 30 to 45 minutes with special emphasis on the heart rate, which is counted for 1 full minute for evidence of dysrhythmias or bradycardia." C. "Special attention needs to be given to the BP especially for hypertension which may indicate hemorrhage or bleeding from the catheterization site." D. "Check the dressing for evidence of bleeding or hematoma formation in the femoral or antecubital area." E. "Allow the child to ambulate because this will prevent skin breakdown from lying for so long in one place."
ANS: A, D
The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose and draws up 4 ml of the drug. The most appropriate nursing action is which? a. Mix the dose with juice to disguise its taste. b. Do not give the dose; suspect a dosage error. c. Check the heart rate; administer digoxin if the rate is greater than 100 beats/min. d. Check the heart rate; administer digoxin if the rate is greater than 80 beats/min.
ANS: B Infants rarely receive more than 1 ml (50 mcg, or 0.05 mg) of digoxin in one dose; a higher dose is an immediate warning of a dosage error. To ensure safety, compare the calculation with that of another staff member before giving digoxin.
An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented? a. Leukopenia b. Polycythemia c. Anemia d. Increased platelet level
ANS: B Persistent hypoxemia that occurs with tetralogy of Fallot stimulates erythropoiesis, which results in polycythemia, an increased number of red blood cells.
The nurse is teaching parents about administering digoxin (Lanoxin). What instructions should the nurse tell the parents? a. If the child vomits, give another dose. b. Give the medication at regular intervals. c. If a dose is missed, give a give an extra dose. d. Give the medication mixed with the childs formula.
ANS: B The family should be taught to administer digoxin at regular intervals. If a dose is missed, an extra dose should not be given; the same schedule should be maintained. If the child vomits, do not give a second dose. The drug should not be mixed with foods or other fluids because refusal to consume these would result in inaccurate intake of the drug.
A child is recovering from Kawasaki disease (KD). The child should be monitored for which? a. Anemia b. Electrocardiograph (ECG) changes c. Elevated white blood cell count d. Decreased platelets
ANS: B The most serious complication of KD is the development of coronary artery aneurysms and the potential for myocardial infarction in children with aneurysm formation. The nurse should monitor any ECG changes.
What blood flow pattern occurs in a ventricular septal defect? a. Mixed blood flow b. Increased pulmonary blood flow c. Decreased pulmonary blood flow d. Obstruction to blood flow from ventricles
ANS: B The opening in the septal wall allows for blood to flow from the higher pressure left ventricle into the lower pressure right ventricle. This left-to-right shunt creates increased pulmonary blood flow. The shunt is one way, from high pressure to lower pressure; oxygenated and unoxygenated blood do not mix. The outflow of blood from the ventricles is not affected by the septal defect.
The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be the nurses initial intervention? a. Apply warming blankets. b. Notify the practitioner of these findings. c. Give additional pain medication per protocol. d. Encourage child to cough, turn, and deep breathe.
ANS: B The practitioner is notified immediately. Increases of chest tube drainage to more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and tachycardia may indicate cardiac tamponadeblood or fluid in the pericardial space constricting the heartwhich is a life-threatening complication. Warming blankets are not indicated at this time. Additional pain medication can be given before the practitioner drains the fluid, but the notification is the first action. Encouraging the child to cough, turn, and deep breathe should be deferred until after evaluation by the practitioner.
After a patient returns from cardiac catheterization, the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). The most appropriate nursing intervention is to A. elevate the affected extremity. B. document the findings and continue to monitor. C. notify the health care provider of the finding. D. apply warm compresses to the insertion site.
ANS: B The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. It should gradually increase in strength. The extremity is kept straight and immobile, but elevation is not necessary. Because a weaker pulse is an expected finding, the nurse should document it and continue to monitor it. There is no need to notify the physician. The insertion site is kept dry. Warm compresses would increase the risk of bleeding from the insertion site.
An adolescent is being placed on a calcium channel blocker. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.) a. The medication may cause fatigue. b. The medication may increase heart rate. c. The medication may cause constipation. d. The medication may cause cold extremities. e. The medication may cause peripheral edema.
ANS: B, C, E Calcium channel blockers may cause an increase in heart rate, constipation, and peripheral edema. Beta-blockers can cause fatigue and cold extremities, but calcium channel blockers do not cause these potential side effects.
The nurse is caring for a child with Kawasaki disease in the acute phase. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Osler nodes b. Cervical lymphadenopathy c. Strawberry tongue d. Chorea e. Erythematous palms f. Polyarthritis
ANS: B, C, E Clinical manifestations of Kawasaki disease in the acute phase include cervical lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic fever.
You are discharging a 5 week old infant with a congenital heart defect who will be going home on digoxin. Which of the following answers by the father indicate the need for more teaching? SATA A. "I know I give the drug carefully by slowly directing it to the side and back of the mouth. B. "I give the medication every 12 hours and I can place it in a bit of formula so that way I know the baby will take it." C. "If I miss a dose, I do not give an extra dose but I give the next dose as ordered." D. "If the baby vomits, I should give it a second dose." E. "If more than two doses have been missed, I should call the doctor."
ANS: B, D
You are working in the pediatric clinic and a child presents with symptoms that are suspicious of the acute phase of Kawasaki disease. Which of the following symptoms are included? SATA A. Periungual desquamation (peeling that begins under the fingertips and toes) of the hands and feet is present B. The bulbar conjunctivae of the eyes become reddened with clearing around the iris. C. A temporary arthritis is evident which may effect larger weight bearing joints D. Inflammation of the pharynx and the oral mucosa develops with red cracked lips and the characteristic strawberry tongue. E. Loud pansystolic murmur along with the ECG changes are present.
ANS: B, D
What interventions should the nurse anticipate being administered to a child with supraventricular tachycardia (SVT)? a. Bed rest b. Applying ice to the face c. Administration of atropine d. Administration of adenosine (Adenocor) e. Having the child perform a Valsalva maneuver
ANS: B, D, E The treatment of SVT depends on the degree of compromise imposed by the dysrhythmia. In some instances, vagal maneuvers, such as applying ice to the face, massaging the carotid artery (on one side of the neck only), or having an older child perform a Valsalva maneuver (e.g., exhaling against a closed glottis, blowing on the thumb as if it were a trumpet for 30 to 60 seconds), can reverse the SVT. When vagal maneuvers fail, adenosine may be used to end the episode of SVT by impairing AV node conduction. IV adenosine is the first-line pharmacologic measure for termination of SVT in infants and children in the emergency setting. Administration of atropine or bed rest will not resolve SVT.
What child has a cyanotic congenital heart defect? a An infant with patent ductus arteriosus b. A 1-year-old infant with atrial septal defect c. A 2-month-old infant with tetralogy of Fallot d. A 6-month-old infant with repaired ventricular septal defect
ANS: C Tetralogy of Fallot is a cyanotic congenital heart defect. Patent ductus arteriosus, atrial septal defect, and ventricular septal defect are acyanotic congenital heart defects.
Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infants status, which finding is indicative of achieving this goal? a. Irritability when awake b. Capillary refill of more than 5 seconds c. Appropriate weight gain for age d. Positioned in high Fowler position to maintain oxygen saturation at 90%
ANS: C Appropriate weight gain for an infant is indicative of successful feeding and a reduction in caloric loss secondary to the HF. Irritability is a symptom of HF. The child also uses additional energy when irritable. Capillary refill should be brisk and within 2 to 3 seconds. The child needs to be positioned upright to maintain oxygen saturation at 90%. Positioning is helping to decrease respiratory effort, but the infant is still having difficulty with oxygenation.
A 1-year-old has been admitted for complete repair of a tetralogy of Fallot. What assessment finding should the nurse expect to be documented? a. Weight gain b. Pale skin color c. Increasing cyanosis d. Decrease in hemoglobin and hematocrit
ANS: C Elective repair of tetralogy of Fallot is usually performed in the first year of life. Indications for repair include increasing cyanosis and the development of hypercyanotic spells. The child would not have a weight gain, pale skin color, or decrease in hemoglobin and hematocrit.
The nurse finds that a 6-month-old infant has an apical pulse of 166 beats/min during sleep. What nursing intervention is most appropriate at this time? a. Administer oxygen. b. Record data on the nurses notes. c. Report data to the practitioner. d. Place the child in the high Fowler position.
ANS: C One of the earliest signs of HF is tachycardia (sleeping heart rate >160 beats/min) as a direct result of sympathetic stimulation. The practitioner needs to be notified for evaluation of possible HF. Although oxygen or a semiupright position may be indicated, the first action is to report the data to the practitioner.
A diagnosis of rheumatic fever is being ruled out for a child. Which lab test(s) is/are the most reliable? Select all that apply. A. Throat culture B. C-reactive protein (CRP) C. Antistreptolysin-O titer (ASO) titer D. Elevated white blood count (WBC) E. Erythrocyte sedimentation rate (ESR)
ANS: C The most reliable and best standardized lab for antistreptococcal antibodies is an Antistreptolysin-O (ASO) titer. A throat culture indicates a current streptococcal infection. C-reactive protein (CRP) lab test indicates inflammation. An elevated white blood count (WBC) may indicate a possible infection but does not indicate a causative agent. An erythrocyte sedimentation rate (ESR) indicates inflammation.
What is an important nursing responsibility when a dysrhythmia is suspected? A. Order an immediate electrocardiogram. B. Count the radial pulse every 1 minute for five times. C. Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate. D. Have someone else take the radial pulse simultaneously with the apical pulse.
ANS: C This is the nurse's first action. If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate. This may be indicated after conferring with the practitioner. The radial pulse rate needs to be compared with the apical pulse rate. It does not need to be counted for 1 minute five times. Only one nurse is needed to carry out this action.
The goals of therapeutic management for congestive heart failure is to A. increase afterload and perfusion to tissues. B. decrease preload and increase afterload. C. decrease preload, afterload and increase contractility. D. decrease contractility and increase preload and afterload.
ANS: C Treatment goals for congestive heart failure are aimed at decreasing preload (volume), afterload (resistance) and increasing contractility (improving efficiency).
The nurse is teaching an adolescent with elevated triglycerides foods that should be decreased. What foods should the nurse include in the teaching? (Select all that apply.) a. Avocados b. Canola oil c. White flour d. White rice e. Sugary cereals
ANS: C, D, E If triglycerides are elevated, dietary recommendations include decreasing the intake of foods high in simple carbohydrates such as white flour, white rice, white bread, white pasta, sugary cereals, juice, and soda. Avocados and canola oil have beneficial effects on HDL, which is the good cholesterol.
Surgical repair for patent ductus arteriosus (PDA) is done to prevent the complication of A. pulmonary infection. B. right-to-left shunt of blood. C. decreased workload on left side of heart. D. increased pulmonary vascular congestion.
ANS: D A 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 can occur. The increased pulmonary vascular congestion is the primary complication; pulmonary infection may occur, but it is not the priority complication. A PDA involves a left-to-right shunt of blood. The decreased workload on the left side of the heart is not a priority complication of a PDA.
What type of drug reduces hypertension by interfering with the production of angiotensin II? a. Diuretics b. Vasodilators c. Beta-blockers d. Angiotensin-converting enzyme (ACE) inhibitors
ANS: D ACE inhibitors act by interfering with the production of angiotensin II, which is a potent vasoconstrictor. Diuretics lower blood pressure by increasing fluid output. Vasodilators act on the vascular smooth muscle. By causing arterial dilation, blood pressure is lowered. Beta-blockers interfere with beta stimulation and depress renin output.
What should the nurse recognize as an early clinical sign of compensated shock in a child? A. Confusion B. Sleepiness C. Hypotension D. Apprehensiveness
ANS: D Apprehensiveness is indicative of compensated shock. Confusion is indicative of uncompensated shock. Sleepiness is not an indication of shock. Hypotension is a symptom of irreversible shock.
A cardiac assessment is required to determine if a child's physical symptoms are related to possible heart disease. The nurse is proceeding to auscultation techniques. When observing the nursing student perform this assessment, which action would indicate that additional training was required? A. Documentation of heart sounds in reference to anatomical location. B. Determination that there is no evidence of carotid bruits. C. Calculation of heart rate. D. Ascertaining whether there is evidence of splenic enlargement.
ANS: D Evidence of splenic enlargement requires palpation as an assessment technique. All of the other options are in-line with auscultation techniques.
A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what? a. Tetralogy of Fallot b. Coarctation of the aorta c. Pulmonary stenosis d. Ventricular septal defect
ANS: D Heart failure is common with ventricular septal defect that causes failure to thrive, respiratory infections, and an increase in exhaustion during feedings. There is a characteristic murmur. The other defects do not have left-to-right shunting.
The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication? a. Hypoxemia b. Right-to-left shunt of blood c. Decreased workload on the left side of the heart d. Pulmonary vascular congestion
ANS: D In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular congestion. Hypoxemia usually results from defects with mixed blood flow and decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure would stop this. There is increased workload on the left side of the heart with a PDA.
An adolescent is being treated for new-onset hypertension with medication. Firs line therapy previously tried was with dietary management but the decision has now been made to start oral medications. Which complaint if provided by the patient would indicate a potential concern? A. Patient states that he is no longer losing weight after being on the medication for one week's time. B. Patient states he is maintaining his oral intake of 8 glasses of water a day. C. He is taking the medication in the evening rather than taking the medication in the morning as prescribed as he thinks that he feels better and has less side effects. D. He reports that he occasionally feels "lightheaded" when getting out of a chair during the course of the school day in some of his classes.
ANS: D Safety aspects should be considered with use of anti-hypertensives and the possibility of orthostatic hypotension. As such the patient should be assessed for this event and prospective safety management should be instituted. Anti-hypertensive therapy is typically not associated with weight loss. Maintaining fluid hydration and the fact that the medication dosing is taken in the evening rather than the daytime to minimize size effects is showing individualization to patient's needs.
The primary therapy for secondary hypertension in children is A. weight reduction. B. low-salt diet. C. increased exercise and fitness. D. treatment of underlying cause.
ANS: D Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved. Weight reduction and a low-salt diet are usually effective in managing essential hypertension. Increased exercise and fitness are usually effective in managing essential hypertension.
What should nurses stress when counseling parents regarding the home care of the child with a cardiac defect before corrective surgery? A. The importance of reducing caloric intake to decrease cardiac demands B. The importance of relaxing discipline and limit setting to prevent crying C. The need to be extremely concerned about cyanotic spells D. The desirability of promoting normalcy within the limits of the child's condition
ANS: D The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake after cardiac surgery. The child needs discipline and appropriate limit setting, as would be done with any other child his or her age. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern.
The diagnosis of hypertension depends on accurate assessment of blood pressure (BP). What is the appropriate technique to measure a childs BP? a. Assess BP while the child is standing. b. Compare left arm with left leg BP readings. c. Use a narrow cuff to ensure that the readings are correct. d. Measure BP with the child in the sitting position on three separate occasions.
ANS: D The diagnosis of hypertension is made after the BP is elevated on three separate occasions. Take the BP in a quiet area with the appropriate size cuff and the child sitting. Although left arm and left leg BP readings may be compared, it is not the procedure to diagnose hypertension. The appropriate size cuff is indicated. The most common cause of inaccurate readings is the use of a cuff that is too small.
A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is A. the low Fowler position. B. the prone position. C. the supine position. D. the squatting position.
ANS: D The squatting or knee-chest position increases the return of blood flow to the heart for oxygenation in a child with a defect that consists of decreased pulmonary blood flow. The low Fowler, prone or supine position does not offer any physiologic advantage to the child related to cardiac compensation.