Nurse 140 Ch. 26 The Child with a Cardiovascular Disorder

Which signs indicate congenital cardiac problems? (Select all that apply.) a. Greater than normal weight gain b. Clubbing of fingers c. Bradycardia d. Tachypnea e. Pulsations in neck veins f. Dyspnea

b. Clubbing of fingers d. Tachypnea e. Pulsations in neck veins f. Dyspnea These are all signs of cardiac problems. Usually, there is a weight loss for cardiac problems. Bradycardia is not a sign of these problems. REF: p. 623

Which comment made by a parent of a 1-month-old would alert the nurse about the presence of a congenital heart defect? a. He is always hungry. b. He tires out during feedings. c. He is fussy for several hours every day. d. He sleeps all the time.

b. He tires out during feedings. Fatigue during feeding or activity is common to most infants with congenital cardiac problems. REF: Page 629

A child develops carditis from rheumatic fever. Which areas of the heart are affected by carditis? a. Coronary arteries b. Heart muscle and the mitral valve c. Aortic and pulmonic valves d. Contractility of the ventricles

b. Heart muscle and the mitral valve The tissues that cover the heart and heart valves are affected. The heart muscle may be involved and the mitral valve is frequently involved. REF: Page 632

A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever? a. Subcutaneous nodules and fever b. Painful, tender joints and carditis c. Erythema marginatum and arthralgia d. Chorea and elevated sedimentation rate

b. Painful, tender joints and carditis The presence of two major Jones criteria would indicate a high probability of rheumatic fever. REF: Page 632

The nurse is caring for a child receiving digoxin (Lanoxin) for the diagnosis of heart failure. Which manifestation does the nurse recognize as a cardinal sign of digoxin toxicity? a. Respiratory distress b. Sudden change in pulse c. Constipation d. Headache

b. Sudden change in pulse Symptoms of toxicity include nausea, vomiting, anorexia, irregularity in rate and rhythm of the pulse, and a sudden change in the pulse. REF: p. 630

Which disorder causes unoxygenated blood to enter the systemic arterial circulation? a. Patent ductus arteriosus b. Tetralogy of Fallot c. Coarctation of the aorta d. Atrial stenosis

b. Tetralogy of Fallot Tetralogy of Fallot is a cyanotic heart disease. Patent ductus arteriosus, coarctation of the aorta, and atrial stenosis are acyanotic heart diseases; no deoxygenated or poorly oxygenated blood enters the systemic arterial circulation. REF: p. 627

What is accurate about the characteristics of high-density lipoproteins (HDLs)? a. They have high amounts of triglycerides. b. They have only small amounts of protein. c. They have little cholesterol. d. They aid in steroid production.

c. They have little cholesterol. HDLs have low amounts of triglycerides, large amounts of proteins, low amount of cholesterol, and are excreted via the liver. They have no role in the production of steroids. REF: Page 634

An infant with congestive heart failure is receiving digoxin (Lanoxin). What does the nurse recognize as a sign of digoxin toxicity? a. Restlessness b. Decreased respiratory rate c. Increased urinary output d. Vomiting

d. Vomiting Symptoms of digoxin toxicity include: nausea, vomiting, anorexia, irregularity in pulse rate and rhythm, and a sudden change in pulse. REF: Page 630

An infant with tetralogy of Fallot is experiencing a tet spell involving cyanosis and dyspnea. in which position should the infant be placed? 1. Fowler's 2. Knee-chest 3. Trendelenburg's 4. Prone

2. Knee-chest Paroxysmal hypercyanotic episodes, or tet spells, occur during the first 2 years of life with tetralogy of Fallot. Spontaneous cyanosis, respiratory distress, weakness, and syncope occur. They can last a few minutes to a few hours and are followed by lethargy and sleep. Parents and day care personnel must be instructed to place the child in a knee-chest position when a tet spell occurs. Recovery is usually rapid. REF: Tetralogy of Fallot

The nurse is recording the vital signs of an infant admitted with signs of respiratory distress. Which of the following observations should be reported to the health care provider? a. Blood pressure is higher in the legs than the arms b. Blood pressure is lower in the legs than in the arms c. Cyanosis of the lips d. Respiratory rate of 35 breaths/min 1. b and d 2. b and c 3. a and b 4. a and d

2. b and c Blood pressure is normally higher in the legs than the arms, therefore blood pressure that is lower in the legs could indicate cardiac pathology and should be reported promptly. Cyanosis of the lips indicates a lack of oxygenation which is often caused by a cardiac or respiratory pathology. REF: Coarctation of the aorta, Safety Alert

Prevention of rheumatic fever can be best be accomplished by: 1. keeping children with fever home. 2. sending children with sore throats home from school. 3. having sore throats cultured as soon as possible 4. treating all colds with antibiotics

3. having sore throats cultured as soon as possible Rheumatic fever (RF) is an autoimmune disease that occurs as a complication of untreated group A beta-hemolytic streptococcus infection of the throat. Prevention of infection and prompt treatment of group A beta-hemolytic streptococcal infections can prevent the occurrence of RF. REF: Rheumatic fever

A child who has had heart surgery returns to the pediatric unit with a chest tube and drainage bottles in place. What is a priority nursing responsibility when caring for a child with chest tubes? 1.) empty the chest tube drainage bottles each shift 2.) clamp the chest tubes when turning the patient 3.) place the drainage bottles on the bed when moving the bed 4.) keep the drainage bottle below the chest level at all times

4.) keep the drainage bottle below the chest level at all times Chest tube systems must be airtight to prevent lung collapse. Drainage systems are always kept below the level of the chest to prevent the backflow of secretions. This is especially important during transportation. REF: General treatment and nursing care of children with congenital heart defects.

The nurse is assessing a child admitted with possible Kawaski disease. A characteristic sign or symptom that the nurse should observe and document would be: 1. cardiac dysrhythmia. 2. decreased urine output. 3. peeling skin on fingers 4. decreased level of consciousness

3. peeling skin on fingers A manifestation with diagnosis of Kawasaki disease is development of an erythematous skin rash with swollen hands and desquamation (peeling) of the palms and soles. REF: Kawasaki disease

When administering digoxin (Lanoxin) to an infant, the medication should be withheld and the health care provider notified if the: 1. pulse rate is below 60 beats/min 2. infant is dyspneic 3. pulse rate is below 100 beats/min 4. respiratory rate is above 40 breaths/min

3. pulse rate is below 100 beats/min As a rule, if the pulse rate of an infant or child is below 100 beats/minute, the medication is withheld and the physician is notified. In older children, the pulse rate should be above 70 beats/minute. REF: Treatment and nursing care

A child with rheumatic fever begins involuntary, purposeless movements of her limbs. What does the nurse recognize that this indicates? a. Seizure activity b. Hypoxia c. Sydenhams chorea d. Decreasing level of consciousness

c. Sydenhams chorea As the effects of rheumatic fever affect the central nervous system, the child may develop Sydenhams chorea, manifested by involuntary, purposeless movements of the limbs. REF: Page 632

The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, How does Kawasaki disease affect my child's heart and blood vessels? On what understanding is the nurses response based? a. Inflammation weakens blood vessels, leading to aneurysm. b. Increased lipid levels lead to the development of atherosclerosis. c. Untreated disease causes mitral valve stenosis. d. Altered blood flow increases cardiac workload with resulting heart failure.

a. Inflammation weakens blood vessels, leading to aneurysm. Inflammation of vessels weakens the walls of the vessels and often results in aneurysm. REF: Page 635

Which assessment would lead the nurse to suspect that a newborn infant has a ventricular septal defect? a. A loud, harsh murmur with a systolic thrill b. Cyanosis when crying c. Blood pressure higher in the arms than in the legs d. A machinery-like murmur

a. A loud, harsh murmur with a systolic thrill A loud, harsh murmur combined with a systolic thrill is characteristic of a ventricular septal defect. REF: Page 626

Which symptoms are indicative of rheumatic fever (RF)? (Select all that apply.) a. Abdominal pain b. Migratory polyarthritis c. Peeling skin d. Chorea e. Vomiting

a. Abdominal pain b. Migratory polyarthritis d. Chorea Symptoms of RF range from mild to severe and may not occur for 1 to 6 weeks after a strep throat infection. The classic symptoms are migratory polyarthritis, skin eruptions, chorea, and inflammation of the heart. Subcutaneous nodules may appear beneath the skin but are less common in children. Abdominal pain, often mistaken for appendicitis, sometimes occurs. Fever varies from slight to very high. Pallor, fatigue, anorexia, and unexplained nosebleeds may be seen. REF: p. 631

Which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? (Select all that apply.) a. Atrial septal defects (ASDs) b. Tetralogy of Fallot c. Dextroposition of aorta d. Patent ductus arteriosus e. Ventricular septal defects (VSDs)

a. Atrial septal defects (ASDs) d. Patent ductus arteriosus e. Ventricular septal defects (VSDs) The congenital heart defects that cause increased pulmonary blood flow are ASDs, VSDs, and patent ductus arteriosus. REF: Page 628

What should the school nurse recommend when encouraging a heart-healthy diet for a child with high cholesterol? a. A fat intake reduction of 5-10% of total calories b. A fat intake reduction of 10-15% of total calories c. A fat intake reduction of 15-20% of total calories d. A fat intake reduction of 25-35% of total calories

d. A fat intake reduction of 25-35% of total calories For a child with increased cholesterol a fat reduction of 25-35% of total calories with less than 75 saturated fat and less than 200 mg of cholesterol per day is advised. REF: Page 634

The nurse explains that the difference between the systolic blood pressure reading and the diastolic blood pressure reading is called the __________ ___________.

pulse pressure The pulse pressure is the difference between the diastolic pressure and the systolic pressure. REF: Page 626

The nurse takes into consideration that the most common congenital heart defect is the ____________ ____________ defect.

ventricular septal VSDs are the most common congenital heart defect. REF: Page 633

An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). What does the nurse understand regarding why dyspnea occurs? a. Blood is circulated through the lungs again, causing pulmonary circulatory congestion. b. Blood is shunted past the pulmonary circulation, causing pulmonary hypoxia. c. Blood is shunted past cardiac arteries, causing myocardial hypoxia. d. Blood is circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.

a. Blood is circulated through the lungs again, causing pulmonary circulatory congestion When PDA is present, oxygenated blood recycles through the lungs, overburdening the pulmonary circulation. REF: Page 626

A 16-year-old patient is diagnosed with primary hypertension. What risk factors does the nurse mention when providing education on this diagnosis to the patient and his family? (Select all that apply.) a. Heredity b. Stress c. Congenital defect d. Obesity e. Poor diet

a. Heredity b. Stress d. Obesity e. Poor diet Primary, or essential, hypertension implies that no known underlying disease is present. Nevertheless, heredity, obesity, stress, and a poor diet and exercise pattern can contribute to any type of hypertension. REF: Page 625

Which diagnostic test is a standardized diagnostic test for rheumatic fever? a. Sedimentation rate b. WBC count c. Antistreptolysin O titer d. Rubella titer

c. Antistreptolysin O titer An elevated antistreptolysin O titer (ASO) is a standardized diagnostic test for rheumatic fever. REF: p. 631

What are the priority nursing actions when administering Diuril (chlorothiazide) to a child diagnosed with congestive heart failure (CHF)? a. Intake and output and periods of rest b. Measure pulse for 1 minute and review ECG c. Monitor serum electrolytes and daily weight d. Hold dose if patient vomits and until doctors write order to repeat dose

c. Monitor serum electrolytes and daily weight This medication can cause potassium depletion, so serum electrolytes must be monitored, and daily weight identifies and measures the effectiveness of the medication. REF: p. 631

The nurse is planning a hypertension-prevention program. What should be the main focus of the nurse when presenting information? a. Pharmacological treatment b. Surgical interventions available c. Patient education d. Reduction of aerobic exercise

c. Patient education The main focus of a hypertension-prevention program is patient education. REF: Page 634

Through what does the infant born with hypoplastic left heart syndrome acquire oxygenated blood? a. The patent ductus arteriosus b. A ventricular septal defect c. The closure of the foramen ovale d. An atrial septal defect

d. An atrial septal defect Because the right side of the heart must take over pumping blood to both the lungs and systemic circulation, the ductus arteriosus must remain open to shunt the oxygenated blood from the lungs. REF: Page 628

What does the nurse explain that a ventricular septal defect will allow? a. Blood to shunt left to right, causing increased pulmonary flow and no cyanosis b. Blood to shunt right to left, causing decreased pulmonary flow and cyanosis c. No shunting because of high pressure in the left ventricle d. Increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume

a. Blood to shunt left to right, causing increased pulmonary flow and no cyanosis Pulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis. REF: Page 626

How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? (Select all that apply.) a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding d. Substituting glucose water for formula e. Offering high-caloric formula

a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding e. Offering high-caloric formula Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft, large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held. REF: Page 630

What are the four structural heart anomalies that make up the tetralogy of Fallot? (Select the four that apply.) a. Hypertrophied right ventricle b. Patent ductus arteriosus c. Ventral septal defect d. Narrowing of pulmonary artery e. Dextroposition of aorta

a. Hypertrophied right ventricle b. Patent ductus arteriosus d. Narrowing of pulmonary artery e. Dextroposition of aorta The four anomalies that comprise tetralogy of Fallot are hypertrophied right ventricle, patent ductus arteriosus, stenosis of pulmonary artery, and dextroposition of the aorta. REF: Page 627

The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions? a. If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest. b. If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body. c. If the baby turns blue, I will immediately put the baby upright in an infant seat. d. If the baby turns blue, I will put the baby in supine position with his head elevated.

a. If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest. In the event of a paroxysmal hypercyanotic or tet spell, the infant should be placed in a knee-chest position. REF: Page 628

What assessment(s) in a child with tetralogy of Fallot would indicate the child is experiencing a paroxysmal hypercyanotic episode? (Select all that apply.) a. Spontaneous cyanosis b. Dyspnea c. Weakness d. Dry cough e. Syncope

a. Spontaneous cyanosis b. Dyspnea c. Weakness e. Syncope Indicators of a paroxysmal hypercyanotic episode or a tet episode are spontaneous cyanosis, dyspnea, weakness, and syncope. REF: Page 627

A father asks why his child with tetralogy of Fallot seems to favor a squatting position. What is the nurses best response? a. Squatting increases the return of venous blood back to the heart. b. Squatting decreases arterial blood flow away from the heart. c. Squatting is a common resting position when a child is tachycardic. d. Squatting increases the workload of the heart.

a. Squatting increases the return of venous blood back to the heart. The squatting position allows the child to breathe more easily because systemic venous return is increased. REF: Page 627

Which observation indicates that an infant with congestive heart failure (CHF) is carefully following the prescribed medical regimen? a. The child takes antibiotics daily. b. The child exhibits normal weight for age. c. The child has an elevated RBC. d. The child's pulse rate is less than 50 beats/minute.

b. The child exhibits normal weight for age. Signs and symptoms in infants with CHF are cyanosis, rapid respiration, rapid pulse, feeding difficulties, poor weight gain, edema, and frequent respiratory tract infections. The child fails to gain weight. A sudden increase in weight may indicate edema and the beginning of heart failure. Adequate weight for height demonstrates adequate nutritional intake and lack of edema. REF: p. 630

Which defects are associated with tetralogy of Fallot? (Select all that apply.) a. Atrial septal defect b. Ventricular septal defect c. Dextroposition of the aorta d. Pulmonary artery stenosis e. Hypertrophy of the right ventricle f. Patent ductus arteriosus

b. Ventricular septal defect c. Dextroposition of the aorta d. Pulmonary artery stenosis e. Hypertrophy of the right ventricle In tetralogy of Fallot there are four defects: stenosis or narrowing of the pulmonary artery, hypertrophy of the right ventricle, dextroposition of the aorta, and ventricular septal defect. REF: p. 627

Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant? a. Counting the apical rate for 30 seconds before administering the medication b. Withholding a dose if the apical heart rate is less than 100 beats/min c. Repeating a dose if the child vomits within 30 minutes of the previous dose d. Checking respiratory rate and blood pressure before each dose

b. Withholding a dose if the apical heart rate is less than 100 beats/min As a rule, if the pulse rate of an infant is below 100 beats/min, the medication is withheld and the physician is notified. REF: Page 630

How long should a 4-year-old child recovering from rheumatic fever need to receiv e monthly injections of penicillin G? a. 1 year b. 2 years c. 5 years d. 10 years

c. 5 years Children who recover from rheumatic fever should have a chemoprophylaxis protocol of penicillin G injections (about 200,000 units per dose) for a minimum of 5 years or up to the age of 18 to prevent further bouts of rheumatic fever. REF: Page 633

What finding would the nurse expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta? a. Blood pressure higher on the right side b. Blood pressure higher on the left side c. Blood pressure lower in the arms than in the legs d. Blood pressure lower in the legs than in the arms

d. Blood pressure lower in the legs than in the arms The characteristic symptoms of coarctation of the aorta are a marked difference in blood pressure and pulses between the upper and lower extremities. Pressure is increased proximal to the defect and decreased distal to the coarctation. REF: Page 627

The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, Why do my child's fingertips look like that? On what understanding does the nurse base a response? a. Clubbing occurs as a result of untreated congestive heart failure. b. Clubbing occurs as a result of a left-to-right shunting of blood. c. Clubbing occurs as a result of decreased cardiac output. d. Clubbing occurs as a result of chronic hypoxia.

d. Clubbing occurs as a result of chronic hypoxia. Clubbing of the fingers develops in response to chronic hypoxia. REF: Page 627

A pediatric patient is scheduled for a noninvasive procedure to determine if his heart is structurally normal and to localize a murmur. What diagnostic test does the nurse anticipate? a. Barium swallow b. Chest x-ray c. Electrocardiogram d. Echocardiogram

d. Echocardiogram Echocardiography is a noninvasive procedure that localizes murmurs and determines if the heart is structurally normal. REF: Page 625