Chapter 21: Cardiac Disorders

The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse?

"Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." Explanation: This response best explains the meaning of the nursing diagnosis and it's cause. Although there are standardized care plans as a guide, each care plan must be individualized to the client. Stating, "The heart is a pump and it isn't pumping effectively" does not explain the nursing diagnosis. Telling the parents not to worry does not help in educating them.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever?

"Children who have this diagnosis may have had strep throat." Explanation: Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle.

The parents of a child with heart failure ask the nurse, "How will the digoxin he is getting help?" Which response by the nurse would be most appropriate?

"Digoxin helps to improve the heart's ability to contract ." Explanation: Digoxin is used to improve myocardial contractility. Diuretics are used to remove fluid build-up. Digoxin does not decrease blood pressure or dilate blood vessels.

The nurse is caring for a newborn who is scheduled for cardiac surgery to correct a diagnosed defect. Which statements by the mother demonstrate understanding of the situation? Select all that apply.

"I know my child uses up a lot of energy feeding but it doesn't seem to cause distress when I breastfeed." "I'm sure it is likely that my baby will be in intensive care after surgery. I believe I can pump so he can still receive my milk." "I hope my baby doesn't have to have feeding through a feeding tube after surgery, but I know that is a possibility." "I have read that human milk fortifier can be added to my breast milk for additional calorie needs if necessary." Explanation: Children with congenital heart defects typically have increased nutritional needs due to the increased energy expenditure associated with increased cardiac and respiratory workloads. Most infants do well with breastfeeding as long as feeding does not last for periods of more than about 20 minutes. Gavage is sometimes necessary postoperatively, and this can be accomplished with pumped breast milk, as well as human milk fortifier when necessary for calorie needs.

The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond?

"It's great you are providing nutritious meals, but small, frequent meals will tire your child less and promote weight gain." Explanation: Small, frequent feedings will reduce the amount of energy required to feed or eat and prevents overtiring the child. Questioning the parents as to whether they are making nutritious foods or foods preferred by the child does not address the issue of energy expenditure when eating 3 larger meals per day. Just stating that it is "hard to get your child to eat enough" also does not address the situation.

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education?

"Most infants do not need surgical repair for this." Explanation: Most infants do not need surgical repair for an ASD unless they are symptomatic. The hole will close spontaneously 87% of the time. The medication indomethacin is used to help close the opening of a PDA, and the medication prostaglandin E1 is used to keep a patent ductus arteriosus (PDA) open. These medications are not used for ASDs.

A nurse is taking the history of a 4-year-old child who will undergo a cardiac catheterization. Which statement by the parent may necessitate rescheduling of the procedure?

"My child seems listless and slightly warm." Explanation: Fever and other signs and symptoms of infection may necessitate rescheduling the procedure. Although information about allergies is important, not all contrast media contain iodine as a base. The nurse should assess the head pain and the child's fears in a developmentally appropriate way, but fear of the procedure does not warrant rescheduling. The report of itching on the child's chest should be evaluated and reported to the health care provider but does not necessarily warrant cancellation of the procedure unless determined that it is a sign of a viral infection.

The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation?

"The baby seems more comfortable over my shoulder." Explanation: The nurse should be alert to statements indicating that the baby seems to be more comfortable when she is sitting up or over her mother's shoulder than when she is lying flat. Grunting or rapid breathing would be a cause for concern. Drinking all of the bottle would be considered normal.

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed?

"We can stop the penicillin when her symptoms disappear." Explanation: For a child with rheumatic fever, drug therapy must be given for the full 10 to 14 days to ensure complete eradication of the infection. The drug must not be stopped when the signs and symptoms disappear. To prevent recurrent attacks, prophylactic antibiotic therapy is prescribed for at least 5 years or until the child is 18 years old. Additional prophylactic therapy should be instituted when dental or tonsillar surgery is planned.

The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents asks the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the nurse?

"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help." Explanation: For children with congenital defects with increased pulmonary blood flow, oxygen supplementation is not helpful. Oxygen acts as a pulmonary vasodilator. If pulmonary dilation occurs, pulmonary blood flow is even greater, causing tachypnea, increasing lung fluid retention, and eventually causing a much greater problem with oxygenation; therefore, preventing the development of pulmonary disease via early surgical correction is essential. Although oxygen must be ordered by the physician and it isn't the best treatment, the nurse stating, "While it seems that oxygen would help, it actually makes the condition worse. Treating the cause of the disease will help" best answers the question while also showing empathy.

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was:

80 beats per minute. Explanation: In an infant, if the apical pulse rate is less than 90 beats per minute, the dose is held and the physician should be notified.

Which nursing diagnosis would best apply to a child experiencing rheumatic fever?

Activity intolerance related to increased cardiac workload Explanation: TChildren will present with polyarthritis as multiple joints are inflamed and possibly have fluid accumulation. Fifty percent of the children present with carditis, usually as mitral valve insufficiency. As a result, the child experiences problems with activities due to increased cardiac workload. Chorea occurs in some children with rheumatic fever; however, it is not known if this manifestation will disturb the child's sleep. The prognosis for the child with rheumatic fever depends on the extent of myocardial involvement. Children with rheumatic fever may develop congestive heart failure; however, cardiomegaly is not a long-term effect of the disease. The prognosis for the child with rheumatic fever depends on the extent of myocardial involvement. The child is not at risk for self-directed violence because cerebral anoxia is not a manifestation of the disease.

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant?

Administer oxygen. Explanation: If a child is experiencing heart failure, the infant will need oxygen. One of the medications the infant would be on is a diuretic. An infant with heart failure will need smaller, more frequent feedings to conserve energy for feeding. Infants are not usually put on fluid restriction.

After assessing a child's blood pressure, the nurse determines the pulse pressure and finds that it is narrowed. What would the nurse identify as associated with this finding?

Aortic stenosis Explanation: A narrowed pulse pressure is associated with aortic stenosis. A widened pulse pressure is associated with patent ductus arteriosus, aortic insufficiency, fever, anemia, or complete heart block.

The nurse is caring for a 10-year-old boy following a cardiac catheterization. Four hours after the procedure, the nurse notes some minor bleeding at the site. Which action would be most appropriate?

Apply pressure 1 inch above the site. Explanation: If bleeding occurs after a cardiac catheterization, apply pressure 1 inch above the site to create pressure over the vessel, thereby reducing the blood flow to the area. The nurse should first apply pressure and then notify the physician if this measure is ineffective or the bleeding increases. The child should maintain the leg in a straight position for about 4 to 8 hours. However, this would not address the bleeding assessed at the site. Changing the dressing would not be effective.

After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow?

Atrial septal defect Explanation: Atrial septal defect is an example of a disorder involving increased pulmonary blood flow. Tetralogy of Fallot is a defect involving decreased pulmonary blood flow. Transposition of the great vessels and hypoplastic left heart syndrome are examples of mixed disorders.

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection?

Avoid drawing a blood specimen from the right femoral vein before the procedure Explanation: Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine.

What information would be included in the care plan of an infant in heart failure?

Begin formulas with increased calories. Explanation: Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering.

A 6-year-old girl had a cardiac catheterization at 9 a.m. At 11 a.m. the nurse notes hypotension as compared to baseline. Based on this assessment finding, which of the following would the nurse do first?

Check the insertion site. Explanation: Hypotension may signify hemorrhage due to perforation of the heart muscle or bleeding from the insertion site. Rechecking the blood pressure every 15 minutes is done during the first hour and then every 30 minutes for the next hour. Rechecking the blood pressure would be appropriate after the nurse checks the insertion site and determines that bleeding is not present. Pain or fever would be more likely with infection or thrombus formation. Pallor, diminished temperature, and altered capillary refill time in the affected extremity could signal compromised neurovascular status.

A 5-year-old child has a cardiac catheterization via the femoral artery. Which assessment would be most important to complete after the procedure?

Checking pedal pulses frequently. Explanation: Insertion of a catheter into the femoral vein can cause vessel spasm, interfering with blood circulation in the leg. Assessing pedal pulses ensures circulation is adequate.

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting?

Feeding problems Explanation: The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. In a child with CHF, tachypnea would be seen, not bradypnea. The heart beats faster in an attempt to increase blood flow. Failure to gain weight, weakness, and an enlarged liver and heart are other possible indicators of CHF but are not as common as tachycardia and may take longer to develop.

The nurse is caring for an infant with suspected patent ductus arteriosus. Which assessment finding would the nurse identify as helping to confirm this suspicion?

Harsh, continuous, machine-like murmur under the left clavicle Explanation: With patent ductus arteriosus, a harsh, continuous, machine-like murmur (usually loudest under the left clavicle) is heard at the first and second intercostal spaces. A thrill at the base, faint pulses, and systolic murmur heard best along the left sternal border point to aortic stenosis.

A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia?

Increased RBC Explanation: Polycythemia can occur in clients with a cyanotic heart defect. The body tries to compensate for having low oxygen levels and produces more red blood cells (RBCs). This would cause an increased result on the lab tests. This problem does not affect the white blood cells (WBCs).

The nurse is planning care for a 6-month-old infant with a large ventricular septal defect. Which nursing diagnosis should the nurse use to help guide the care for this client?

Ineffective tissue perfusion related to left heart dilation from increased pulmonary blood flow Explanation: Ventricular septal defect is the most common type of congenital cardiac disorder. With this disorder, an opening is present in the septum between the two ventricles. Blood shunts from left to right across the septum, impairing the efficiency of the heart because the blood that should be forced into the aorta and out to the body from contraction of the left ventricle shunts back into the pulmonary circulation, resulting in right ventricular hypertrophy and increased pressure in the pulmonary artery. This disorder does not impair gas exchange, cause impaired skin integrity, or cause ineffective airway clearance.

A 6-year-old girl is diagnosed with aortic stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother?

Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing Explanation: Balloon angioplasty by way of cardiac catheterization is the initial procedure for aortic stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed area. As the balloon is inflated, it breaks any adhesions and opens the area. The other answers refer to interventions related to patent ductus arteriosus, not aortic stenosis.

The nurse is caring for a child with congestive heart failure. Which of the following is true related to the diagnosis and the child with the diagnosis? Select all that apply.

It is treated with cardiac glycosides. Failure to gain weight is a clinical manifestation. Chest X-ray shows evidence of an enlarged heart. Explanation: Signs of congestive heart failure often seen in the older child include failure to gain weight. Treatment of CHF includes improving the cardiac function using cardiac glycosides, such as digoxin (Lanoxin). Chest radiographs reveal an enlarged heart.

A nurse is administering digoxin to a 3-year-old child. What would be a reason to hold the dose of digoxin?

Nausea and vomiting Explanation: Digoxin is a cardiac glycoside and antiarrhythmic. It can cause toxicity if the dosages increase due to poor absorption, dehydration, etc. Signs of digoxin toxicity are nausea and vomiting, lethargy, and bradycardia. The apical pulse should be taken for one full minute prior to administering digoxin. The dosage should be held if the pulse rate is less than 60 beats/min in an adolescent or less than 90 beats/min in an infant. The other symptoms listed do not relate to digoxin toxicity and could occur for numerous reasons.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?

Peeling hands and feet; fever Explanation: Kawasaki disease is an acute systemic vasculitis. Symptoms begin with very high fevers. One of the signs of Kawasaki disease is the peeling hands and feet and in perineal region. The child is usually tachycardic and laboratory values would indicate increased platelets and decreased hemoglobin. Another classic sign of Kawasaki is the strawberry tongue. The other symptoms are not necessarily characteristic of Kawasaki disease. The child should be evaluated if there are impalpable pulses because this could indicate a heart defect or some other serious illness.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?

Place the infant in the knee-chest position. Explanation: Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position.

Which health teaching concept should the nurse emphasize when instructing the parents of a child with polycythemia caused by a congenital heart disorder?

Prevent dehydration. Explanation: In children with polycythemia, hydration must be monitored so that dehydration does not occur. Otherwise, the polycythemia could become so severe that clotting or thrombophlebitis results. Seizures are not a threat with polycythemia. Jaundice is not associated with polycythemia. Encourage parents to observe the infant carefully when new activities are introduced so they can recognize the first signs of respiratory distress or the point at which the child is beginning to exceed exercise tolerance.

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta?

Pulses weaker in lower extremities compared to upper extremities Explanation: With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased systemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot.

An infant with congenital heart disease is not growing and developing adequately. The nurse will institute what feeding strategy?

Raise the caloric density of the feeding beyond 20 calories per ounce. Explanation: Increasing the caloric density of the feeding allows the infant to ingest more calories without increased volume and in a shorter period of time. This conserves energy. Calories per ounce can be increased by adding supplements to pumped breast milk. Using commercial formula could be necessary if a special formula is needed. However, breast milk is usually the infant's best source of nutrition. Feeding the infant every 2 hours and increasing the length of the feeding beyond 30 minutes will fatigue the child and allow for little rest between feedings.

In caring for the child with rheumatic fever, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care?

Risk for acute pain Explanation: Acute pain related to joint pain when extremities are touched or moved is a concern for the child with rheumatic fever. Diversional activities are important, but growth and development is not likely to be delayed. Chorea may be frustrating to the child but body image is not altered. Respiratory issues are not noted with rheumatic fever.

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess?

Strawberry tongue Explanation: Dry, fissured lips and a strawberry tongue are common findings with Kawasaki disease. Acne, hirsutism, and striae are associated with anabolic steroid use. Malar rash is associated with lupus. Café au lait spots are associated with neurofibromatosis.

The nurse is preparing to take a blood pressure reading for a 5-year-old child with coarctation of the aorta. How will the nurse proceed with the assessment?

Take a blood pressure reading on all four extremities. Explanation: The nurse will take a blood pressure reading on all four extremities on a child with coarctation of the aorta. Taking the blood pressure on the right arm is recommended in children with other conditions. The child should sit quietly for 5 minutes, not 60 seconds, prior to the blood pressure reading. The child does not need to lie supine during the assessment.

A newborn has been diagnosed with congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis?

Tetralogy of Fallot Explanation: Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of the aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.

A school nurse finds a 10-year-old's blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect?

The child will need the blood pressure checked two more times. Explanation: The child will need the blood pressure checked two more times. It is routine to check the blood pressure on three separate occasions to get the most accurate analysis of the blood pressure. The child usually does not need surgery or need to go to the emergency room. This is not a normal result in a blood pressure finding.

A nurse is obtaining the history from a woman who is in labor. Which of the following if reported by the mother would alert the nurse to the possibility that the newborn has an increased risk for a congenital heart defect?

The mother states she has lupus. Explanation: Having lupus while pregnant could contribute to a congenital heart defect. Acetaminophen, history of seizures and excessive sleeping during pregnancy are not associated with an increased risk for congenital heart defects.

A shunt is being inserted for a child with pulmonary atresia. Which of the following would the nurse include to explain this procedure to the parents?

The surgery will increase the blood flow to the lungs. Explanation: A shunt is usually used when the blood flow needs to increase to another area of the body. For a congenital heart defect, the shunt is placed to increase pulmonary blood flow by creating another pathway for blood to reach the lungs. A shunt is a palliative procedure and will not cure this type of defect.

A parent asks about the risk of a congenital heart defect (CHD) being passed on to another child since they already have one child that has it, but no one else in the family has one. What is the best response by the nurse?

There is less than a 7% chance a sibling would inherit a heart defect. Explanation: The risk to subsequent siblings of a child with CHD is approximately 2% to 6%, so genetics can play a role in the child having a cardiac defect.

Parents are told their infant has a hypoplastic left heart. How would the nurse explain this condition to the family?

This is a problem where the left side of the heart did not develop properly. Explanation: This is a problem where the left side of the heart did not develop properly. There is a three-step palliative surgery that can be implemented or the child will need a heart transplant.

A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education?

This is caused by an opening that usually closes by 1 week of age. Explanation: A PDA is caused by an opening called the ductus arteriosus. A PDA usually closes by 1 week of age. If it does not close, the defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

A 10-week-old infant continues to have a small ventricular septal defect (VSD) and is prescribed digoxin. When evaluating the infant's response to drug therapy, which assessment finding is related to the therapeutic action of the medication?

a reduced fluid accumulation in the lungs Explanation: Because up to 85% of VSDs are so small they close spontaneously, many children are managed only by close observation during the first years of life, perhaps with administration of a diuretic or digoxin to help prevent fluid from accumulating in the lungs. Placement of a septal occlude device during cardiac catheterization is done to prevent chronic pulmonary artery hypertension from developing or the heart from becoming infected (endocarditis) because of the recirculating and stagnant blood flow. Digoxin does not dilate arteries nor prevent infection or arrhythmia. The therapeutic effect is not to facilitate the closing of the defect.

A nurse is providing care to a child with Kawasaki disease. Which medication(s) would the nurse expect the health care provider to prescribe? Select all that apply.

aspirin IV immunoglobulin Explanation: Management of the child with Kawasaki disease includes a high dose of IV immunoglobulin therapy to relieve the symptoms and prevent coronary artery abnormalities, along with aspirin to control inflammation and fever. Aspirin may be continued for as long as 1 year in lower doses as an antiplatelet.

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note?

bounding pulse Explanation: A bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. Narrow or thready pulses may occur in children with heart failure or severe aortic stenosis. A normal pulse would not be expected with aortic regurgitation.

When assessing an infant born at 32 weeks' gestation, which finding would lead the nurse to suspect that the newborn has a patent ductus arteriosus (PDA)?

continuous murmur on auscultation Explanation: Presence of a continuous murmur on auscultation of the heart is indicative of patent ductus arteriosus (PDA) in preterm infants. Preterm infants are at an increased risk of developing PDA. Other assessment findings that indicate PDA include bounding pulse, increased pulse rate and low diastolic arterial pressure.

The nurse is planning care for an infant with a nursing diagnosis of decreased cardiac output related to a cardiac defect. What is the most appropriate outcome for this nursing diagnosis? The child will:\

demonstrate stable vital signs, capillary refill less than 3 seconds, and a urine output of 1-2 ml/kg/hr. Explanation: The most appropriate outcome for a nursing diagnosis of decreased cardiac output would be one that illustrates that the client has improved cardiac output. This can be illustrated by the client who has stable vital signs, capillary refill less than 3 seconds, and good urine output of at least 1-2 ml/kg/hr. Stable electrolyte values, clear breath sounds, and no weight gain illustrate that the child does not have an imbalanced fluid volume. Stable ABGs, decreased pulmonary secretions, and clear breath sounds are indicative of the child who has improved gas exchange.

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:

femoral pulse weaker than brachial pulse. Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure.

What evaluation best illustrates the effectiveness of furosemide therapy in a child diagnosed with congestive heart failure (CHF)? The child:

has clear breath sounds. Explanation: Furosemide is used to eliminate excess fluids from the body of the client with CHF. An evaluation of clear breath sounds would be an indicator that the client does not have pulmonary edema associated with CHF. An evaluation of activity level would be more reflective of activities that are provided for the client and whether enough rest is provided. A normal heart rate would be more specific to the effects of digoxin. An appropriate weight gain is more apt to reflect nutritional status.

The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder?

heart failure Explanation: Infective endocarditis would present with intermittent, unexplained low-grade fever, fatigue, anorexia, weight loss, or flu-like symptoms. Characteristics of cardiomyopathy include respiratory distress, fatigue, poor growth (dilated), chest pain, dizziness, and syncope. Abdominal pain, joint pain, fever, and irritability are signs of Kawasaki disease.

The nurse is conducting a physical examination of a child with a ventricular septal defect. Which finding would the nurse expect to assess?

holosystolic harsh murmur along the left sternal border Explanation: With ventricular septal defects, there is often a characteristic holosystolic harsh murmur along the left sternal border. Right ventricular heave, fixed split-second heart sound, and systolic ejection murmur are typically found with atrial septal defects.

The nurse is caring for a child with rheumatic fever who has polyarthritis. Which lab result would the nurse most anticipate with this child's diagnosis and symptoms?

increased erythrocyte sedimentation rate (ESR) Explanation: In a child with rheumatic fever who has polyarthritis, the erythrocyte sedimentation rate (ESR) is increased. Although the clotting time may be altered with the use of aspirin, this is not anticipated with the treatment. The white blood cell and leukocyte counts would be elevated.

The nurse sees a school-aged child in an ambulatory setting because of rheumatic fever. Which of the following would the nurse expect to find revealed by the health history?

knee pain, abdominal rash, subcutaneous nodules Explanation: Classic signs of rheumatic fever are joint pain, a rash on the trunk, and subcutaneous nodules near major joints.

A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers?

nonsterioidal anti-inflammatory drugs (NSAIDs) Explanation: Medications used in the treatment of rheumatic fever include penicillin, NSAIDs, and corticosteroids. Insulin would be given for diabetes and phenytoin for seizure disorders. Antivirals are not relevant to the treatment of a bacterial infection.

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of which of the following as the major mechanism involved?

obstruction of blood flow to the lungs Explanation: Tricuspid atresia is a congenital heart defect in which the valve between the right atrium and right ventricle fails to develop, resulting in no opening to allow blood to flow from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs. It is classified as a disorder of decreased pulmonary blood flow due to obstruction of blood flow to the lungs. Defects with connections involving the left and right sides, such as atrial or ventricular septal defects, will shunt blood from the higher-pressure left side to the lower-pressure right side and subsequently more blood will go to the lungs. A narrowed major vessel leads to an obstructive defect, interfering with the ability of the blood to flow freely through the vessel. Mixed defects such as transposition of the great vessels involve the mixing of well-oxygenated with poorly-oxygenated blood, leading to a systemic blood flow that contains a lower oxygen content.

Which action should the nurse implement for an infant who develops heart failure?

placing in a semi-Fowler position Explanation: Most children with heart failure feel more comfortable in a semi-Fowler position than in a supine position because the chest-elevated position lowers the abdominal contents, enlarging the thoracic cavity and allowing easier, more comfortable lung expansion. A child with heart failure does not need a milk restriction. The supine position will not help with lung expansion. An infant does not have a significant intake of salt.

What would be the most important measure to implement for an infant who develops heart failure?

placing the infant in a semi-Fowler position Explanation: Placing an infant with heart failure in a semi-Fowler position reduces the pressure of the abdominal contents against the chest and allows for better lung expansion. Keeping the infant supine would cause more pressure on the heart and lungs and increase the work of the heart and lungs. Infants with heart disease need calories to grow. They are given formula or breast milk which is fortified with extra nutrients. Thus the infant can have an intake of the same amount of fluid but receive extra nutrients.

An infant is hospitalized with heart failure. The health care provider has prescribed furosemide, enalapril, and carvedilol as part of the plan of care. Based on these medications, when reviewing the infant's laboratory results, which value is most important for the nurse to consider?

potassium Explanation: Potassium plays a major role in the heart's rhythm and muscle contractility. Furosemide and enalapril both affect potassium levels; furosemide depletes potassium and enalapril increases potassium levels. It is appropriate for the nurse to monitor calcium and glucose levels, but the potassium level has stronger implications related to the prescribed medications. Nurses should also monitor BUN levels for signs related to renal failure in children with heart failure but not necessarily as it relates to the prescribed medications.

An infant is prescribed digoxin. What should the nurse explain to the parents regarding the action of this medication?

slows and strengthens the heartbeat Explanation: Digoxin, a cardiac glycoside made from digitalis, acts directly on the heart to increase the contractility of the myocardium and the force of contraction to slow the heart rate. Digoxin does not increase the heart rate, thicken the walls of the myocardium, or prevent subacute bacterial endocarditis.

A nurse is caring for a newborn with congenital heart disease (CHD). Which finding would the nurse interpret as indicating distress?

subcostal retraction at the time of feeding Explanation: Subcostal retraction during feeding is indicative of distress associated with feeding in newborn infants with CHD. Feeding can be a stress to newborns with CHD who are seriously compromised. Additional features indicating distress in infants with CHD include increased respiratory rate, perspiration along the hairline during feeding, and feeding time longer than 30 minutes.

The nurse is caring for a newborn diagnosed with patent ductus arteriosus. Which finding will the nurse assess that is consistent with this diagnosis?

systolic murmur Explanation: On physical examination, the child with patent ductus arteriosus usually has a systolic murmur early in life and a continuous murmur as the child ages. Manifestations of patent ductus arteriosus do not include a slow heart rate, expiratory grunt, or absent femoral pulses.

A nurse is caring for a child who is experiencing heart failure. Which assessment data was most likely seen when initially examined?

tachycardia Explanation: If a child were experiencing heart failure, the most likely sign of this would be tachycardia, not bradycardia. The child may also experience hepatomegaly or oliguria, not splenomegaly or polyuria.

After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding that:

the contrast material used has a diuretic effect. Explanation: The contrast material has a diuretic effect so the nurse assesses the child closely for signs and symptoms of dehydration and hypovolemia. Although blood loss can occur, this is not the reason for monitoring the child's fluid balance. Catheter insertion into the heart does not initiate a diuretic response. Typically, food and fluid is withheld for 4 to 6 hours before the procedure.