Chapter 12 Cardiovascular Disorders -- Peds

The parents of a neonate with a patent ductus arteriosus ask why their child is receiving ibuprofen if the child is not in pain. What is the nurse's best response? "Ibuprofen will help facilitate closure of the patent ductus arteriosus." "Ibuprofen is used prophylactically to prevent infection in children with cardiac disorders." "Ibuprofen will help keep the ductus open in order to provide additional blood flow to the body." "Routine pain medication is given to children with cardiac disorders to keep them calm."

"Ibuprofen will help facilitate closure of the patent ductus arteriosus."

The nurse educator is educating a group of parents about fetal circulation. Which statements made by a parent regarding fetal circulation indicate the need for further education? Select all that apply. "The fetal placenta acts like the lungs during pregnancy." "The fetus's lungs function normally during pregnancy." "Fetal circulation is dependent upon the electrical impulses of the heart." "The fetal heart acts like the lungs during pregnancy." "The patent ductus arteriosus acts like the lungs during pregnancy."

"The fetus's lungs function normally during pregnancy." "The fetal heart acts like the lungs during pregnancy." "The patent ductus arteriosus acts like the lungs during pregnancy."

The parents of a newborn diagnosed with tricuspid atresia ask the nurse, "Did something that happened during our son's birth cause the problem with his heart?" Which statement by the nurse indicates the nurse's comprehension of the most common cause of congenital cardiac malformations? "The most common known causes of congenital heart malformations are genetic factors." "The most common known causes of congenital heart malformations are teratogens." "The most common known cause of congenital heart malformations is maternal drug use." "There are no known causes of congenital heart malformations."

"The most common known causes of congenital heart malformations are genetic factors."

Before birth, __________% of blood bypasses the lungs?

90%

The nurse is assessing a 2-day-old infant and notes blood pressure in the arm of 69/45, with a blood pressure in the leg of 45/32. The nurse understands this discrepancy is associated with which disorder? Aortic arch abnormality Ventricular septal defect Atrial septal defect Patent ductus arteriosus

Aortic arch abnormality

Which congenital heart defect results in pulmonary hypertension from an increase in pulmonary blood? Atrial septal defect Tetralogy of Fallot Tricuspid atresia Aortic stenosis

Atrial septal defect

The nurse preceptor is preparing a teaching session for a group of nurses that will cover the etiology of congenital heart defects that may occur in childhood. What information should be included in the session? Select all that apply. Excessive sweating Autoimmune factors Genetic factors Teratogens Pain

Autoimmune factors Genetic factors Teratogens

The nurse is providing discharge teaching to parents of a child receiving digoxin (Lanoxin). Which items should the nurse include as signs of digoxin toxicity? Bradycardia Nausea Diarrhea Increase in appetite Flushing of the skin

Bradycardia Flushing of the Skin

The nurse is explaining cardiac conditions that result in the obstruction of blood flow in the heart. Which defects should be included in the teaching? Select all that apply. Tricuspid atresia Coarctation of the aorta Aortic stenosis Pulmonary atresia Ventricular septal defect (VSD)

Coarctation of the aorta Aortic stenosis Pulmonary atresia

The parents of a school-age child with congenital heart defect state they are having some dental work done. What recommendation should the nurse make? Inform the dentist of the condition so they can monitor during the procedure. Contact the provider for a prescription of prophylactic antibiotics. Inform the parent the child is at no increased risk during the procedure. Praise the parents for providing the appropriate health maintenance for their child.

Contact the provider for a prescription of prophylactic antibiotics.

A nurse is obtaining a history of a child with suspected rheumatic heart disease. Which question is more important for the nurse to ask to help confirm the diagnosis? When was the last time you traveled outside of the United States? Have you ever had a diagnosis of strep throat? Are your immunizations up-to-date? How long have you had a fever?

Have you ever had a diagnosis of strep throat?

The nurse is providing education to expectant mothers regarding modifiable risk factors for acquired heart disease. Which risk factors can be minimized through lifestyle changes? Autoimmune factors Genetic factors Hyperthermia Cocaine and alcohol use Exposure to infectious agents

Hyperthermia Cocaine and alcohol use Exposure to infectious agents

A nurse is conducting in-service over mixed disorders of the heart. Which statements are true of mixed disorders? Select all that apply. In mixed disorders, blood from the pulmonary circulation mixes with blood from systemic circulation in the chambers of the heart. Due to mixing of the blood, there is increased volume in the ventricles, resulting in an increase in cardiac output. Due to mixing of the blood, there is an increased volume in the ventricles, resulting in a decrease in cardiac output. Examples of mixed disorders include Ebstein's anomaly and hypoplastic left heart. Children with mixed disorders will have normal oxygen saturations.

In mixed disorders, blood from the pulmonary circulation mixes with blood from systemic circulation in the chambers of the heart. Due to mixing of the blood, there is increased volume in the ventricles, resulting in an increase in cardiac output. Examples of mixed disorders include Ebstein's anomaly and hypoplastic left heart.

What does the care of a child following cardiac catheterization include? Select all that apply. Monitoring pulses above and below the site Monitoring intake and output Placing the child in a side-lying position with the affected extremity down Instructing family members to keep the child quiet for 8 hours following the procedure Placing a dry, occlusive dressing over the site 24 hours after the procedure

Monitoring pulses above and below the site Monitoring intake and output Instructing family members to keep the child quiet for 8 hours following the procedure Placing a dry, occlusive dressing over the site 24 hours after the procedure

The nurse is caring for a toddler diagnosed with Kawasaki disease when the child states, "My heart hurts." What should the nurse assess for related to these symptoms? Elevated blood pressure Myocardial infarction Renal impairment and fluid overload Need to educate the child on truth telling

Myocardial infarction

The nurse is educating a group of new nurses and explaining congenital heart defects classified as having increased pulmonary blood flow. Which defects should be included in this teaching session? Select all that apply. Patent ductus arteriosus (PDA) Atrial septal defects (ASDs) Ventricular septal defects (VSDs) Tetralogy of Fallot (TOF) Tricuspid atresia

Patent ductus arteriosus (PDA) Atrial septal defects (ASDs) Ventricular septal defects (VSDs)

Which assessment findings by the nurse indicate possible indicators of congenital heart disease (CHD) in children? Select all that apply. Poor weight gain Dysmorphic features Large for gestational age Clubbing and erythema in fingers and toes Anemia

Poor weight gain Dysmorphic features Clubbing and erythema in fingers and toes

n infant presents to the emergency department with a monitored heart rate of 254. Which treatment would be appropriate for the nurse to institute? Nasal suctioning Prepare for unsynchronized defibrillation. Insert IV for fluid bolus. Obtain a weight in order to prepare medications.

Prepare for unsynchronized defibrillation.

The nurse is preparing to administer digoxin to a child in the hospital who routinely takes the medication at home. Which is the appropriate action for the nurse to take prior to administration? Request a second nurse to verify the dosage and amount prior to administration. Make sure the child\"s tray is present so they can take the dosage with food. Ask the mother if this is the same dosage administered at home. Obtain vital signs immediately after administration to note changes in heart rate.

Request a second nurse to verify the dosage and amount prior to administration.

An infant with total anomalous pulmonary venous return (TAPVR) suddenly develops tachypnea, cyanosis, tachycardia, and a change in level of consciousness. What is the correct interpretation for the nurse to make regarding these findings? The infant had a patent ductus arteriosus (PDA), which closed. The infant is showing incompetence of the tricuspid valve and blood flow to the lungs. The infant is showing signs of septic shock. The child has developed a respiratory infection.

The infant is showing signs of septic shock.

Which blood flow dynamics are involved in transposition of the great vessels (TGV)? Select all that apply. The systemic and pulmonary circulation are always mixed. The left ventricle sends oxygenated blood to the lungs. The aorta receives oxygenated blood from the right ventricle for systemic circulation. The aorta receives unoxygenated blood from the right ventricle for systemic circulation. An arterial or ventricular septal defect is a life-saving defect in an infant with TGV.

The left ventricle sends oxygenated blood to the lungs. The aorta receives unoxygenated blood from the right ventricle for systemic circulation. An arterial or ventricular septal defect is a life-saving defect in an infant with TGV.

A nurse reviewing the prenatal history of an expectant mother notes the use of lithium for bipolar disorders. How should the nurse interpret this finding? There is no risk to the unborn child. There is a demonstrated link between lithium and certain acquired heart diseases. The mother's diet will need to be closely monitored during pregnancy to avoid potential harm from the medication. Lithium only poses a threat to the unborn child if certain genetic factors are present.

There is a demonstrated link between lithium and certain acquired heart diseases.

The nurse is preparing a teaching session for new nurses on congenital heart defects classified as having decreased pulmonary blood flood flow. Which defects should be included in the teaching? Select all that apply. Tricuspid atresia Eisenmenger syndrome Ventricular septal defects (VSDs) Tetralogy of Fallot (TOF) Patent ductus arteriosus (PDA)

Tricuspid atresia Eisenmenger syndrome Tetralogy of Fallot (TOF)

In fetal circulation, which structure is responsible for carrying oxygenated blood to the fetus? Umbilical vein Pulmonary artery Patent ductus arteriosus Aorta

Umbilical vein

The nurse is auscultating the heart of a newborn infant and notes a holosystolic murmur and thrill in the left lower sternal border. Which defect should the nurse suspect? Ventricular septal defect (VSD) Atrial septal defect (ASD) Patent ductus arteriosus (PDA) Ebstein's anomaly

Ventricular septal defect (VSD)

In assessing an infant with right-sided heart failure, the nurse understands that the underlying condition prevents the right ventricle from pumping enough blood into the _____________, resulting in increased pressure in the right atrium and systemic venous system.

pulmonary artery

The nurse is counseling a client undergoing an electrocardiogram (EKG) about the electrical conduction of the heart. Which statement is correct regarding the anatomical structure that is found in the right atrium and is needed for the contraction of the aorta to get blood flow to the ventricles? "The sinoatrial (SA) node acts as the heart's pacemaker, helping the heart to set and maintain a steady heart rate." "The patent foramen ovale (PFO) acts as the heart's pacemaker, helping the heart set and maintain a steady heart rate." "The PQ interval acts as the heart's pacemaker, helping the heart set and maintain a steady heart rate." "The atrioventricular (AV) node acts as the heart's pacemaker, helping the heart set and maintain a steady heart rate."

"The sinoatrial (SA) node acts as the heart's pacemaker, helping the heart to set and maintain a steady heart rate."

A student nurse asks which classification of congenital heart defects results in the combining of blood between systemic and pulmonary circulation in the heart chambers, which results in a desaturation of blood oxygen levels and a decrease in cardiac output related to an increased volume load on ventricles. What is the appropriate nursing response? "This type of congenital heart defect is classified as a mixed defect." "You are describing a defect that is related to a decrease in pulmonary blood flow." "The defect that you are describing is brought on by an increased pulmonary blood flow." "This defect is referred to as an obstructive disorder."

"This type of congenital heart defect is classified as a mixed defect."

The nurse is measuring blood pressure on the leg of a sleeping toddler and receives an unusually high reading. What is the best action for the nurse? Confirm the appropriate size of the cuff and obtain a larger cuff if needed to recheck pressures. Confirm the appropriate size of the cuff and obtain a smaller cuff if needed to recheck pressures. Allow the child to rest and recheck with the same cuff in approximately 10 minutes. Document the finding and notify the practitioner.

Confirm the appropriate size of the cuff and obtain a larger cuff if needed to recheck pressures.

While assessing an infant diagnosed with a congenital heart defect (CHD) in the newborn intensive care unit, the nurse notes the results from the arterial blood gas indicate a PaO2 level of 30. After bagging the infant with 100% oxygen, the PaO2 level is 34. What does the nurse suspect related to the assessment findings and diagnosis? Normal newborn assessment findings, no abnormalities Pulmonary disease Continued mixing of oxygenated and nonoxygenated blood Metabolic disease

Continued mixing of oxygenated and nonoxygenated blood

The nurse is caring for a newborn who has been diagnosed with Tetralogy of Fallot and begins to turn dusky during the newborn assessment. The nurse bases the priority nursing intervention on the knowledge that what is occurring? Cyanosis Oxygenation Heart defect Patent ductus arteriosus

Cyanosis

Which of the following nursing interventions should be done for an infant with patent ductus arteriosus? Select all that apply. Daily weights Clustering care Monitoring urine output Wound care Continue sedatives

Daily weights Monitoring urine output Wound care

The mother of a child who is 72 hours post-cardiac catheterization calls the clinic to report a temperature of 102°. What is the best action for the nurse to take? Inform the mother it is normal to have some fever following a cardiac catheterization. Ask the mother to administer acetaminophen and recheck in 1 hour. Instruct the mother to bring the child in for evaluation. Instruct the mother to reduce activity and report any signs of changes to the affected extremity.

Instruct the mother to bring the child in for evaluation.

The mother of a premature infant asks the nurse to describe the patent ductus arteriosus. Which is the best description of this anomaly? It is a defect that allows blood to flow from the right to the left side of the heart, resulting in decreased oxygen flow to the body. It is not unusual for preterm infants to have a patent ductus arteriosus. The severity depends upon the age of the neonate and size of the opening. The defect is due to low pulmonary pressures in the vessels in utero. Substances produced in the lungs called prostaglandins help to keep this open. It will eventually close due to increased oxygenation.

It is not unusual for preterm infants to have a patent ductus arteriosus. The severity depends upon the age of the neonate and size of the opening.

Abby is a 4-year-old girl diagnosed with Turner syndrome and coarctation of the aorta. Which priority nursing intervention should the nurse perform? Ask the child if she has pain over her chest. Obtain a blood pressure reading in all four extremities. Place a sign on the door that reads: Nothing by Mouth. Prepare the family for immediate intubation.

Obtain a blood pressure reading in all four extremities.

An infant presents to the emergency department with a monitored heart rate of 254. Which treatment would be appropriate for the nurse to institute? Nasal suctioning Prepare for unsynchronized defibrillation. Insert IV for fluid bolus. Obtain a weight in order to prepare medications.

Obtain a weight in order to prepare medications.

The nurse is caring for a child with a congenital heart defect and notes an increased work of breathing with tachypnea, grunting, and nasal flaring. The nurse should suspect which complication has developed? Pulmonary edema Polycythemia Clubbing Hyperoxia

Pulmonary edema

The nurse is caring for an adolescent post cardiac transplant and notes episodes of tachycardia, lightheadedness, and irritability. Which additional assessment would support the possibility of rejection? Temperature of 98.4° orally Intake of 90% of meals for the last 24 hours Gain of 4 pounds in the last 2 days Respiratory rate varying between 20 and 24

Respiratory rate varying between 20 and 24

What is the best way to promote safe and effective care for a child with Kawasaki Disease? Select all that apply. Encourage the use of warm cloths to keep the child's body temperature up. Minimize painful movements by avoiding exercise. Emphasize the need for measles, mumps, rubella, and chickenpox immunizations. Stress the importance of loose clothing. Encourage clear liquids and soft foods.

Stress the importance of loose clothing. Encourage clear liquids and soft foods.

A nurse is reviewing the history of her patient prior to performing her assessment. The chart indicates that the child has the following signs and symptoms: "Tet" spells, clubbing of the fingers, irritability, and poor growth. The nurse knows that these findings are most consistent with what diagnosis? Tetralogy of Fallot Pulmonic stenosis Coarctation of the aorta Transposition of the great vessel

Tetralogy of Fallot