CH47 The Child With Alterations in Cardiovascular Function

Which athletic activity should the nurse recommend for a school-age child who is diagnosed with pulmonary artery hypertension? 1. Golf 2. Basketball 3. Cross-country running 4. Soccer

Answer: 1 Explanation: 1. A child with pulmonary artery hypertension should have exercise tailored to avoid dyspnea, such as golf. 2. Soccer, basketball, and cross-country running are all aerobic activities requiring heavy exertion. 3. Soccer, basketball, and cross-country running are all aerobic activities requiring heavy exertion. 4. Soccer, basketball, and cross-country running are all aerobic activities requiring heavy exertion. Page Ref: 1219

A toddler is prescribed digoxin (Lanoxin) for cardiac failure. Which should the nurse instruct the toddler's parents to monitor for as a manifestation associated with digoxin toxicity? 1. Bradycardia 2. Tinnitus 3. Ataxia 4. Hypotension

Answer: 1 Explanation: 1. Early signs of digoxin (Lanoxin) toxicity are bradycardia and arrhythmias 2. Digoxin (Lanoxin) toxicity does not cause tinnitus (ringing in the ears). 3. Digoxin (Lanoxin) toxicity does not cause ataxia (unsteady gait). 4. Digoxin (Lanoxin) toxicity does not cause hypotension (low blood pressure). Page Ref: 1216

A school-age client is diagnosed with rheumatic fever. Which parental statement indicates the need for further education by the nurse? 1. "I understand rheumatic fever is a strep infection of the heart." 2. "My child will be on bed rest for several weeks." 3. "My child will be treated with aspirin and/or corticosteroids." 4. "Once my child has recovered, she will still need to be monitored for sequelae to the disease."

Answer: 1 Explanation: 1. Rheumatic fever is not a strep infection of the heart but an autoimmune connective tissue disease in response to a previous strep infection. This statement requires clarification. 2. This statement is correct. No further clarification is needed. 3. This statement is correct and needs no clarification. 4. Children who have had one episode of rheumatic fever are at greater risk for future episodes. In addition, long-term valve damage may occur. This statement needs no further clarification. Page Ref: 1220=1221

Which clinical manifestation does the nurse anticipate for a pediatric client who is admitted with congestive heart failure (CHF)? 1. Tachycardia 2. Weight loss 3. Hypertension 4. Bradycardia

Answer: 1 Explanation: 1. Tachycardia is a sign of congestive heart failure because the heart attempts to improve cardiac output by beating faster. 2. The weight, instead of decreasing, increases, because of retention of fluids. 3. Blood pressure does not increase in CHF. 4. Bradycardia is a serious sign and can indicate impending cardiac arrest. Page Ref: 1212

A child is admitted to the pediatric medical unit with a diagnosis of Kawasaki disease. Which provider prescription should the nurse question? 1. Contact isolation 2. Oral aspirin every 8 hours 3. Echocardiogram 4. Vital signs every 4 hours

Answer: 1 Explanation: 1. The child is not contagious so contact isolation is not appropriate. 2. Aspirin is used as an anti-inflammatory and is prescribed around the clock. This is appropriate. 3. This examination will be used as a baseline to compare against as the child recovers to assist in monitoring for cardiac lesions. 4. The child will need close monitoring during the early period of the disease. Page Ref: 1222

Which is the priority action by the school nurse for an adolescent who drops to the ground and is unresponsive during a high school basketball game? 1. Initiating cardiopulmonary resuscitation (CPR) 2. Calling 911 3. Offering the parents comfort 4. Assessing for hemorrhage

Answer: 1 Explanation: 1. This situation is an example of cardiac concussion. Survival chances improve if CPR is initiated immediately. 2. Other people can call 911. Cardiac resuscitation must be initiated immediately. 3. This is an appropriate action but not a priority. 4. This type of injury often has no external symptoms of injury. Page Ref: 1223-1224

Which parental statement indicates correct understanding for the reason a cardiac catheterization is needed for a child who is diagnosed with a congenital heart defect? 1. "This procedure will keep the ductus arteriosus open and oxygenated and unoxygenated blood mixed." 2. "This procedure is used to close the ductus arteriosus to prevent mixing of arterial and venous blood." 3. "This procedure will redirect the blood so that blood bypasses the right ventricle." 4. "This procedure connects the ventricle to the atrium."

Answer: 1 Explanation: 1. This statement is accurate. 2. A stent maintains an opening; it does not close an opening. 3. A stent maintains the ductus as patent. It does not bypass the ventricle. 4. This is not the purpose of the stent. Page Ref: 1209-1211

An infant with tetralogy of Fallot (TOF) is having a hypercyanotic episode ("tet" spell). Which nursing interventions are appropriate? Select all that apply. 1. Administer oxygen. 2. Place the child in knee-chest position. 3. Administer morphine and propranolol intravenously as ordered. 4. Draw blood for a serum hemoglobin. 5. Administer diphenhydramine (Benadryl) as ordered.

Answer: 1, 2, 3 Explanation: 1. When an infant with TOF has a hypercyanotic episode, interventions should be geared toward decreasing the pulmonary vascular resistance. Therefore, the nurse would place the infant in knee-chest position (to decrease venous blood return from the lower extremities) and administer oxygen, morphine, and propranolol (to decrease the pulmonary vascular resistance). 2. When an infant with TOF has a hypercyanotic episode, interventions should be geared toward decreasing the pulmonary vascular resistance. Therefore, the nurse would place the infant in knee-chest position (to decrease venous blood return from the lower extremities) and administer oxygen, morphine, and propranolol (to decrease the pulmonary vascular resistance). 3. When an infant with TOF has a hypercyanotic episode, interventions should be geared toward decreasing the pulmonary vascular resistance. Therefore, the nurse would place the infant in knee‑chest position (to decrease venous blood return from the lower extremities) and administer oxygen, morphine, and propranolol (to decrease the pulmonary vascular resistance). 4. The nurse would not draw blood until the episode had subsided because unpleasant procedures are postponed. 5. Benadryl is not appropriate for this child. Page Ref: 1202

Which treatment options should the nurse anticipate for a 10-month-old infant admitted to the emergency department with supraventricular tachycardia? Select all that apply. 1. Administering intravenous adenosine (Adenocard) 2. Administering intravenous amiodarone (Cardarone) 3. Preparing for cardioversion 4. Applying ice to the face 5. Having the child perform a Valsalva maneuver

Answer: 1, 2, 3, 4 Explanation: 1. Adenosine or amiodarone may be given when vagal maneuvers are unsuccessful. Cardioversion is used in an urgent situation. 2. Adenosine or amiodarone may be given when vagal maneuvers are unsuccessful. Cardioversion is used in an urgent situation. 3. Adenosine or amiodarone may be given when vagal maneuvers are unsuccessful. Cardioversion is used in an urgent situation. 4. Supraventricular tachycardia episodes are initially treated with vagal maneuvers to slow the heart rate including the application of ice or iced saline solution to the face to reduce the heart rate. 5. A 10-month-old child cannot be instructed to hold her breath and bear down as with a bowel movement. Page Ref: 1223-1224

Which strategies should the nurse recommend for a school-age client who is at risk for developing hypertension as an adult? Select all that apply. 1. Using seasoning substitutes for salt 2. Providing a list of foods high in sodium 3. Decreasing television time 4. Increasing physical activity 5. Monitoring blood pressure daily

Answer: 1, 2, 3, 4 Explanation: 1. Habits that are implemented during childhood will decrease the likelihood of developing hypertension as an adult. The nurse should recommend the use of seasoning substitutes to replace added salt. 2. Habits that are implemented during childhood will decrease the likelihood of developing hypertension as an adult. The nurse should provide a list of foods that are high in sodium. 3. Habits that are implemented during childhood will decrease the likelihood of developing hypertension as an adult. The nurse should recommend a decrease in television screen time. 4. Habits that are implemented during childhood will decrease the likelihood of developing hypertension as an adult. The nurse should recommend an increase in physical activity. 5. Monitoring blood pressure daily is not an activity that reduces the child's likelihood of developing hypertension as an adult. Page Ref: 1225

Which cardiovascular manifestations should the nurse anticipate for a pediatric client diagnosed with early compensated hypovolemic shock? Select all that apply. 1. Tachycardia 2. Weak distal pulses 3. Thready distal pulses 4. Normal blood pressure 5. Decrease in systolic blood pressure

Answer: 1, 2, 4 Explanation: 1. Tachycardia is a cardiovascular manifestation the nurse anticipates for the pediatric client who is diagnosed with early compensated hypovolemic shock. 2. Weak distal pulses are cardiovascular manifestations the nurse anticipates for the pediatric client who is diagnosed with early compensated hypovolemic shock. 3. Thready distal pulses are cardiovascular manifestations the nurse anticipates for the pediatric client who is diagnosed with moderate uncompensated hypovolemic shock. 4. Normal blood pressure for age is a cardiovascular manifestation the nurse anticipates for the pediatric client who is diagnosed with early compensated hypovolemic shock. 5. A decrease in systolic blood pressure is a cardiovascular manifestation the nurse anticipates for the pediatric client who is diagnosed with moderate uncompensated hypovolemic shock. Page Ref: 1227

Which feeding techniques should the nurse include in the teaching session for the parents of an infant who is being discharged in order to gain weight for the corrective surgery needed for a congenital heart defect? Select all that apply. 1. Breastfeed if possible. 2. Complete each feeding within 30 minutes. 3. Position the infant flat to promote swallowing. 4. Dilute the formula with extra water to ensure adequate fluid intake. 5. Burp the infant frequently.

Answer: 1, 2, 5 Explanation: 1. Breastfeeding is recommended because it provides antibodies to help protect the infant from infection. 2. Allowing the infant to nurse for more than 30 minutes will burn more calories than calories are gained. 3. The infant should be positioned at a 45-degree angle to reduce the workload of the heart. 4. The formula should not be diluted beyond the label recommendations, as it would lower the caloric count. 5. This is appropriate for the infant with a congenital heart defect as well as the normal infant. Page Ref: 1197-1199

Which assessment data would cause the nurse to suspect that a pediatric client is experiencing hypovolemic shock? Select all that apply. 1. Dyspnea 2. Bradycardia 3. Tachycardia 4. Capillary refill time greater than 3 seconds. 5. Blood pressure 72/42 mmHg

Answer: 1, 3, 4 Explanation: 1. Increased work of breathing is an early sign of shock, indicating compensation for decreased cardiac output and volume. 2. Bradycardia is a late and ominous sign of shock indicating that the child is no longer able to compensate. 3. Tachycardia is an early compensatory mechanism for hypovolemia in a child. 4. Decreased capillary refill time would be an early indicator of decreased fluid volume and compensation. 5. Decreased blood pressure is a later finding and would not occur until other compensatory mechanisms were exhausted. Page Ref: 1227

Which is the priority nursing action when providing care to a pediatric client who is diagnosed with hypovolemic shock? 1. Assessing the cause of bleeding 2. Establishing an open airway and administering oxygen 3. Administering analgesics for pain control 4. Providing replacement of volume

Answer: 2 Explanation: 1. Airway patency and replacement of volume are priorities before assessing the cause of the bleeding. 2. Airway patency and oxygen delivery (breathing) are always first in the treatment for a client with health concerns. 3. Pain would be a consideration but would not be attended to as a first priority. 4. Replacement of volume is vital but would follow establishing airway and breathing. Page Ref: 1227-1228

Which assessment finding indicates adequate peripheral perfusion for a child after a cardiac catheterization? 1. Capillary refill is greater than 3 seconds. 2. Lower extremities are warm, with a capillary refill of less than 3 seconds. 3. Sensation is decreased with a weakened dorsalis pedis pulse. 4. Dorsalis pedis pulse is palpable but posterior tibial pulse is weak.

Answer: 2 Explanation: 1. If the capillary refill is over 3 seconds; if any of the pedal pulses are absent and/or weakened; or if the extremity is cool, cyanotic, or lacking sensation, circulation might not be adequate. 2. The nurse checks the extremity to determine adequacy of circulation following a cardiac catheterization. An extremity that is warm with capillary refill of less than 3 seconds has adequate circulation. Other indicators of adequate circulation include palpable pedal (dorsalis and posterior tibial) pulses, adequate sensation, and pinkness of skin color. 3. If the capillary refill is over 3 seconds; if any of the pedal pulses are absent and/or weakened; or if the extremity is cool, cyanotic, or lacking sensation, circulation might not be adequate. 4. If the capillary refill is over 3 seconds; if any of the pedal pulses are absent and/or weakened; or if the extremity is cool, cyanotic, or lacking sensation, circulation might not be adequate. Page Ref: 1193

An infant who is diagnosed with a mild heart defect will not have surgical correction for at least 2 years. Which information should the nurse include in the discharge teaching regarding management in the home environment? 1. "Your child will have a low-grade fever until the defect is repaired." 2. "It is important for your child to maintain normal activity." 3. "Your child is not at risk for congestive heart failure." 4. "It is important to avoid antipyretics for the treatment of fever."

Answer: 2 Explanation: 1. Low-grade fever is not a normal finding in a child with a mild cyanotic heart defect and could be a sign of infective endocarditis. 2. A child with a mild cyanotic heart defect should be treated as normally as possible without activity adjustment. 3. Any child with a heart defect could develop congestive heart failure. 4. Fevers are treated with antipyretics so that dehydration is avoided. Page Ref: 1208

Which parental statement regarding the use of cyclosporin A after a heart transplant indicate correct understanding of the information presented by the nurse? 1. "This medication is used to treat hypertension." 2. "This medication is used to reduce serum cholesterol level." 3. "This medication is used to prevent rejection." 4. "This medication is used to treat infections."

Answer: 3 Explanation: 1. Calcium channel blockers may be used to treat hypertension. 2. Lovastatin is given to reduce serum cholesterol level. 3. Cyclosporin A is given to prevent rejection. 4. An antibiotic may be given to treat an infection. Page Ref: 1218

Which is the rationale the nurse provides to the parents of an infant diagnosed with congestive heart failure (CHF) for the prescribed spironolactone? 1. Produces rapid diuresis 2. Blocks reabsorption of sodium and water in renal tubules 3. Spares potassium 4. Promotes vascular relaxation

Answer: 3 Explanation: 1. Furosemide (Lasix) produces rapid diuresis and blocks reabsorption of sodium and water in renal tubules. 2. Furosemide (Lasix) produces rapid diuresis and blocks reabsorption of sodium and water in renal tubules. 3. Spironolactone (Aldactone) is a maintenance diuretic that is potassium-sparing. Hypokalemia would increase the risk of Lanoxin toxicity. 4. Angiotensin-converting enzyme (ACE) inhibitors promote vascular relaxation. Page Ref: 1213

A 2-month-old infant with a congenital heart defect is admitted to the pediatric intensive care unit with congestive heart failure. Which intervention should the nurse include in the infant's plan of care? 1. Monitor respirations during active periods. 2. Give larger feedings less often to conserve energy. 3. Organize activities to allow for uninterrupted sleep. 4. Force fluids appropriate for age.

Answer: 3 Explanation: 1. Respirations are difficult to monitor during active periods, making this an unrealistic goal. 2. Feedings should be small-volume, high-calorie. 3. It is important to allow for uninterrupted sleep to decrease metabolic demands on the heart. 4. Fluids should be restricted to high-calorie and low-volume in order to avoid overloading the lungs with fluid. Page Ref: 1214-1216

Which initial laboratory data does the nurse anticipate for a child who is admitted to the hospital with a cyanotic heart defect? 1. A low platelet count 2. A high white blood cell count 3. A high hemoglobin 4. A low hematocrit

Answer: 3 Explanation: 1. The platelets would be normal. 2. The white blood cell count would not be high unless an infection was present. 3. The child's bone marrow responds to chronic hypoxemia by producing more red blood cells to increase the amount of hemoglobin available to carry oxygen to the tissues. This occurs in cases of cyanotic heart defects. 4. The hematocrit would not be low. Page Ref: 1200

Which heart defect should the nurse suspect for an infant whose upper extremities have stronger pulses than the lower extremities and blood pressure is higher in the arms than in the legs? 1. Transposition of the great vessels 2. Patent ductus arteriosus 3. Coarctation of the aorta 4. Atrial septal defect

Answer: 3 Explanation: 1. These defects are not associated with blood pressures that are different in upper and lower extremities. 2. These defects are not associated with blood pressures that are different in upper and lower extremities. 3. Coarctation of the aorta can present with stronger pulses in the upper extremities than in the lower extremities and higher blood pressure readings in the arms than in the legs because of obstruction of circulation to the lower extremities. 4. These defects are not associated with blood pressures that are different in upper and lower extremities. Page Ref: 1209

The nurse is teaching a pregnant client about fetal circulation. Which is the correct sequence of blood flow that indicates the pregnant client understands the information presented? 1. Ductus arteriosus 2. Ductus venosus 3. Foramen ovale

Answer: 3, 1, 2 Explanation: 1. The ductus arteriosus connects the pulmonary artery to the aorta and is the last structure that blood reaches. 2. The ductus venosus connects the umbilical vein to the inferior vena cava bypassing the liver. It is the first structure that blood reaches. 3. The foramen ovale connects the right atrium to the left ventricle and bypasses the lungs. It is the second structure that blood reaches. Page Ref: 1195

Which clinical manifestations does the nurse anticipate for a pediatric client who is diagnosed with the subacute stage of Kawasaki disease? Select all that apply. 1. High fever 2. Diarrhea 3. Thrombocytosis 4. Joint pain 5. Beau lines

Answer: 3, 4 Explanation: 1. High fever is a clinical manifestation anticipated for a pediatric client diagnosed with the acute stage of Kawasaki disease. 2. Diarrhea is a clinical manifestation anticipated for a pediatric client diagnosed with the acute stage of Kawasaki disease. 3. Thrombocytosis is a clinical manifestation anticipated for a pediatric client diagnosed with the subacute stage of Kawasaki disease. 4. Joint pain is a clinical manifestation anticipated for a pediatric client diagnosed with the subacute stage of Kawasaki disease. 5. Beau lines are a clinical manifestation anticipated for a pediatric client diagnosed with the convalescent stage of Kawasaki disease. Page Ref: 1221

Which cardiovascular manifestations should the nurse anticipate for a pediatric client diagnosed with moderate uncompensated hypovolemic shock? Select all that apply. 1. Tachycardia 2. Weak distal pulses 3. Thready distal pulses 4. Normal blood pressure 5. Decrease in systolic blood pressure

Answer: 3, 5 Explanation: 1. Tachycardia is a cardiovascular manifestation the nurse anticipates for the pediatric client who is diagnosed with early compensated hypovolemic shock. 2. Weak distal pulses are cardiovascular manifestations the nurse anticipates for the pediatric client who is diagnosed with early compensated hypovolemic shock. 3. Thready distal pulses are cardiovascular manifestations the nurse anticipates for the pediatric client who is diagnosed with moderate uncompensated hypovolemic shock. 4. Normal blood pressure for age is a cardiovascular manifestation the nurse anticipates for the pediatric client who is diagnosed with early compensated hypovolemic shock. 5. A decrease in systolic blood pressure is a cardiovascular manifestation the nurse anticipates for the pediatric client who is diagnosed with moderate uncompensated hypovolemic shock. Page Ref: 1227

Which laboratory test does the nurse anticipate for a child who is admitted to the hospital with suspected rheumatic fever? 1. Erythrocyte sedimentation rate 2. Throat culture 3. C-reactive protein 4. Antistreptolysin-O (ASO) titer

Answer: 4 Explanation: 1. An erythrocyte sedimentation rate and a C-reactive protein can indicate inflammation. 2. A culture can indicate a current streptococcal infection. 3. An erythrocyte sedimentation rate and a C-reactive protein can indicate inflammation. 4. The laboratory test for antistreptococcal antibodies is an antistreptolysin-O (ASO) titer. Page Ref: 1219

Which is an appropriate statement for the nurse to include in the discharge instructions to the parents of a child who is recovering from cardiac surgery? 1. "The child will have a fever for several weeks following the surgery." 2. "The child will be restricted from most play activities." 3. "The child will not receive routine immunizations." 4. "The child will receive prophylactic antibiotics prior to any dental procedures."

Answer: 4 Explanation: 1. Any unexplained fever should be reported. 2. The child should live a normal and active life following repair of a cardiac defect. 3. Immunizations should be provided according to the schedule. 4. Parents should be taught that the child should receive prophylactic antibiotics to prevent endocarditis, according to the American Heart Association. Page Ref: 1200

Which teaching point should the nurse include in the discharge instructions for a pediatric client who has undergone cardiac surgery? 1. Should not receive routine immunizations. 2. Should be restricted from most play activities. 3. Fever is expected for several weeks following the surgery. 4. Prophylactic antibiotics are required for any dental, oral, or upper respiratory tract procedures.

Answer: 4 Explanation: 1. Immunizations should be provided according to the schedule. 2. The child should live a normal and active life following repair of a cardiac defect. 3. Fever is not expected for a prolonged period after surgery, and any unexplained fever should be reported. 4. Parents should be taught that the child should receive prophylactic antibiotics to prevent endocarditis. Page Ref: 1199

Which age-appropriate information should the nurse provide to a 4-year-old girl who is being emotionally prepared for open heart surgery? 1. The name of the surgeon who will be performing the procedure 2. What the surgical procedure will entail 3. The purpose of the heart-lung machine used during the procedure 4. What the environment will look and sound like when the child wakes up

Answer: 4 Explanation: 1. The parents know the name of the surgeon. It will mean nothing to a 4-year-old child. 2. The child will be asleep during surgery and therefore does not need to know about the procedure. 3. This is beyond the understanding of a 4-year-old. 4. The child should be prepared in terms of what she will see, hear, smell, or feel. Page Ref: 1199

The nurse admits a child with a ventricular septal defect (VSD) to the pediatric unit. Which is the priority nursing diagnosis for this child? 1. Hypothermia related to decreased metabolic state 2. Acute Pain related to the effects of a congenital heart defect 3. Ineffective Tissue Perfusion (peripheral) related to cyanosis secondary to congenital heart defect 4. Impaired Gas Exchange related to pulmonary congestion secondary to the increased pulmonary blood flow

Answer: 4 Explanation: 1. Ventricular septal defects do not cause pain, fever, or deficient fluid volume. 2. Ventricular septal defects do not cause pain, fever, or deficient fluid volume. 3. VSDs are left to right shunts, which increases pulmonary blood flow without cyanosis. 4. Because of the increased pulmonary congestion, impaired gas exchange would be an appropriate nursing diagnosis. Page Ref: 1207