Pediatric Cardiovascular Practice Questions

The most common cause of congestive heart failure (CHF) in older children is: a. acquired heart disease b. tetralogy of Fallot c. aortic stenosis d. congenital valve problems

A. The most common cause of congestive heart failure (CHF) in older children is acquired heart disease.

13.Which of the following best describes the quality of an innocent murmur? a. bowing and hissing following the second heart sound b. soft, short, systolic, and vibratory c. high pitched, diastolic, and organic d. to and fro, continuous, musical

A Incorrect. Bowing and hissing following the second heart sound are not a description of an innocent murmur. B Correct. An innocent murmur is described as soft, short, systolic, and vibratory, indicating there is no structural or functional heart disease. Over 80% of children have innocent murmurs sometime during childhood, most commonly beginning at age 3 or 4 years. Innocent murmurs are accentuated in high output states, especially with fever and anemia. C Incorrect. High pitched, diastolic, and organic are not a description of an innocent murmur. D Incorrect. To and fro, continuous, musical are not a description of an innocent murmur.

A pediatric client has a presumed diagnosis of coarctation of the aorta. The nurse is aware that which of the following symptoms are considered to be the classic clinical presentation(s) for the diagnosis? SELECT ALL THAT APPLY. a. upper-extremity hypertension b. bounding upper-extremity pulses c. diminished lower-extremity pulses d. intermittent claudication

A, C Coarctation of the aorta is associated with upper-extremity hypertension. Coarctation of the aorta is associated with diminished lower-extremity pulses.

A nurse is performing the preprocedure assessment for a pediatric client planned for cardiac catheterization. Which of the following assessments would provide an essential baseline for comparison following the procedure? SELECT ALL THAT APPLY. a. pedal pulses b. radial pulses c. pulse oximetry d. vitals

A,C,D Prior to the cardiac catheterization, the nurse should assess the pedal pulse distal to the catheterization site. Oxygen saturation via pulse oximetry must be evaluated prior to beginning the procedure. This assessment will provide the baseline for comparison following the catheterization. Vital signs must be evaluated prior to beginning the procedure. This assessment will provide the baseline for comparison following the catheterization.

Which of the following medications is the primary diuretic used in children to treat volume overload? a. furosemide (Lasix) b. spironolactone c. bumetanide (Bumex) d. chlorothiazide (Diuril)

A. Furosemide (Lasix), a potent loop diuretic, is the primary diuretic used in children to treat volume overload.

While assessing a child the nurse finds hepatomegaly. The nurse is aware that this condition is most associated with which of the following? a. congestive heart failure b. congenital heart defects c. maternal alcoholism d. prematurity

A. Hepatomegaly is most often associated with congestive heart failure. Inadequate emptying of the heart caused by volume overload or poor contractility results in cardiac failure. This generates an increase in venous volume with a subsequent increase in venous congestion. Systemic venous congestion results in liver engorgement and hepatomegaly.

The nurse is assessing a child and hears a widely split S2, which is not affected by the respiratory pattern. The physician verifies the finding and orders a chest X-ray, which shows an enlarged heart. An echocardiogram is ordered, which shows the defect. The finding by the nurse is a classic murmur found in which of the following cardiac defects? a. atrial septal defect b. tetralogy of Fallot c. patent ductus arteriosus d. transposition of the great arteries

A. In atrial septal defect, the infant is generally asymptomatic. There is often a soft systolic murmur and more classically a widely split S2 unaffected by respiratory pattern. Chest X rays will usually demonstrate an increased heart size.

Which of the following positions is used to evaluate jugular vein distention in older children? a. sitting b. standing c. lying flat d. head slightly raised

A. In the older child jugular vein distention is evaluated when the child is sitting.

Systolic murmurs are heard best in which of the following locations? a. between the first and second heart sounds b. in the right chest at the fourth intercostal space c. at the sternal border d. at the base of the heart

A. Systolic murmurs are heard best between the first and second heart sounds.

What is the purpose of the ductus arteriosus while the fetus is developing in utero? a. to divert blood from the fetal lungs to the fetal aorta b. to circulate blood throughout the fetal body and back to the placenta c. to move blood between the various chambers of the fetal heart d. to direct blood immediately to the fetal liver

A. The ductus arteriosus (a blood vessel connecting the aorta with the pulmonary artery) is used to divert blood from the fetal lungs to the fetal aorta as the lungs do not participate in gas exchange in utero. This structure usually closes after birth.

The nurse planning nutritional interventions for an infant with congestive heart failure who has a nursing diagnosis of Imbalanced nutrition: Less than body requirements related to poor caloric intake and increased metabolic demands as evidenced by poor weight gain and weight loss would most likely include in the nursing care plan which of the following interventions? a. Increase calorie density slowly by adding less water when mixing formula or powdered formula to expressed breast milk. b. Quickly increase the calorie density by adding less water when mixing formula or powdered formula to expressed breast milk. c. Administer bolus feedings via a nasogastric tube every 2 to 3 hours. d. Start rice cereal earlier than is normally recommended.

A. The nursing care plan would most likely include interventions such as increasing calorie density slowly by adding less water when mixing formula or powdered formula to expressed breast milk.

Which of the following outcome goals would be best for an adolescent male who has a nursing diagnosis of Imbalanced nutrition: Less than body requirements related to poor caloric intake and increased metabolic demands as evidenced by poor weight gain and weight loss? a. The child will ingest the appropriate number of calories for his age (50 calories per kilogram per 24 hours). b. The child will take in three meals per day. c. There will be an improvement in appetite during the next 3 days. d. The dietary department will consult with the child and his family to ascertain likes and dislikes and will serve more likes.

A. The outcome goal that would be best for this adolescent male is: The child will ingest the appropriate number of calories for his age (50 calories per kilogram per 24 hours). This is an appropriate goal for this nursing diagnosis since the problem is poor caloric intake.

Heart size has a correlation that continues into adulthood. The heart is the size of the: a. ear b. fist c. knee d. elbow

B.

When assessing a child for any possible cardiac anomalies, the nurse takes the right arm blood pressure (BP) and the BP in one of the legs. She finds that the right arm BP is greater than that found in the childs leg. The nurse reacts to these findings in which of the following ways? a. charts the findings and realizes they are normal b. suspects the child may have coarctation of the aorta c. places the child in the Trendelenburg position d. notifies the physician and alerts the surgery team

B. A right arm BP greater than a leg BP is indicative of coarctation of the aorta. Normally lower extremity BP is equal to or greater than arm BP.

Which of the following heart defects increases pulmonary blood flow? a. pulmonary stenosis b. patent ductus arteriosus c. pulmonary atresia d. tetralogy of Fallot

B. Patent ductus arteriosus increases pulmonary blood flow. Defects that increase pulmonary blood flow are caused by a shunting of the blood from the left side of the heart to the right side through an abnormal connection (left to right shunt). These infants exhibit clinical manifestations of congestive heart failure.

The nurse is assessing an infant with congestive heart failure (CHF). The nurse hears rales and rhonchi, observes nasal flaring and restlessness, and finds that the oxygen saturation is falling. What does the nurse most suspect? a. The infant has been over-medicated or undermedicated. b. There is an increase in lung fluid or a congenital heart defect. c. The infant has experienced a spontaneous pneumothorax. d. There is an electrolyte imbalance and probably respiratory acidosis.

B. Rales and rhonchi, nasal flaring, restlessness, and falling oxygen saturation indicate pulmonary congestion or a congenital heart defect. As pulmonary congestion worsens, there is leaking of fluid into the alveoli and interstitium of the lung leading to pulmonary edema.

A nurse is working with children and adolescents who have a known heart problem. The nurse is aware that when a child undergoes a procedure, the prevention of infectious endocarditis will involve which of the following interventions as a prophylaxis? a. gamma globulin 10 cubic centimeters in each of two deep muscle sites at least 24 hours before the procedure b. antibiotics, with the most frequent being penicillin or clindamycin for those with penicillin allergies c. intravenous glucose solution d. aspirin or Coumadin

B. The American Heart Association has set forth guidelines for antibiotic prophylaxis for prevention of infectious endocarditis in children with congenital heart disease prior to procedures associated with endocarditis. Antibiotics, with the most frequent being penicillin or clindamycin for those with penicillin allergies is the recommended prophylaxis.

Cardiac development is fairly complete by how many weeks of gestation? a.4 b. 12 c. 8 d. 16

C.

You are caring for a child who is on a diuretic and digoxin. Prior to giving the medications, you assess this child and find that the child has a bradycardia, has a ventricular arrhythmia, and is nauseated and wanting to vomit. What is the most likely explanation for these signs and symptoms? a. hyperkalemia b. drug incompatibility c. digitalis toxicity d. dehydration

C. The most likely explanation for these signs and symptoms is digitalis toxicity.

You are the nurse preparing to give a child a dose of digoxin. Before giving the digoxin, you would first check the apical pulse, and you would also be most interested in making sure which of the following levels were within normal? a. RBC count b. chloride levels c. potassium levels d. platelet

C. Before giving digoxin, you would first check the apical pulse and serum potassium level which should be normal. Hypokalemia in combination with digoxin can result in ventricular arrhythmias and can enhance digoxin toxicity.

19.Which of the following conditions is the most common cause of congestive heart failure in infants? a. cardiomyopathy b. endocarditis c. congenital heart disease d. myocarditis

C. Congenital heart disease is the most common cause of congestive heart failure in infants.

The nurse is assigned to care for a child who is scheduled for a catheterization for balloon dilation of narrow heart valves. Which of the following is most important for the nurse to do? a. Listen to the parents or caregivers fears and concerns and allay fears. b. Make certain the child has had nothing to eat or drink for 12 or more hours preceding the surgery. c. Ask about any latex allergy the child might have, and notify surgery immediately if there is a latex allergy. d. Take a last-minute set of vital signs before the surgery stretcher and staff members come for the child.

C. It is most important for the nurse to ask about any latex allergy the child might have, and notify surgery immediately if such an allergy exists. Some catheters used in the catheterization laboratory have latex balloons. If the child has a latex allergy, use of such a balloon can precipitate a life threatening reaction.

Systolic murmurs are considered abnormal if they are: a. grade I b. grade II c. grade III or greater d. grade 0

C. Systolic murmurs are considered abnormal if they are loud and grade III or greater. A grade III is loud but not accompanied by a thrill.

Which of the following factors determines stroke volume? a. size of the heart and size of the heart valves b. age of the person and the condition of the heart c. preload, afterload, and contractility d. blood pressure and hormonal influences

C. The determinants of stroke volume are preload, afterload, and contractility.

The nurse is feeding an infant who has congestive heart failure. The infant arches her back and averts her eyes from the nurse. The nurse is aware that the infant is giving cues indicating a need or want to: a. pass gas or be burped b. have a BM c. disengage and take a break d. take a nap

C. The infant is giving cues indicating a need or want to disengage and take a break from feeding.

The nurse assessing an infant will be most concerned about which of the following findings? a. peripheral cyanosis of the hands b. perioral cyanosis c. cyanosis of the lips or tongue d. cyanosis of the feet

C. The nurse will be most concerned about cyanosis of the lips or tongue. This finding may indicate a cardiovascular alteration. Cyanosis appears when hemoglobin, approximately 5g/dl of blood, circulates unbound to oxygen and the measured oxygen saturation drops below 85%.

Which of the following actions would the nurse take when finding an innocent murmur while listening to a childs heart? a. Refer the child and mother to a cardiologist. b. Advise the caregiver(s) to restrict the childs activity. c. Teach the family that this murmur needs no intervention. d. Get an order for oxygen, and administer it as soon as possible.

C. The nurse would teach the family that this murmur needs no intervention and is not pathological, indicating no structural or functional heart disease.

he three primary treatments for congestive heart failure are diuretics, afterload-reducing agents, and: a. analgesics b. antibiotics c. inotropes d. cortisone

C. The three primary treatments for congestive heart failure are diuretics, afterload-reducing agents, and inotropes.

Cardiac abnormalities account for what percentage of all congenital malformations? a. 5% b. 10% c. 20% d. 25%

D.

The nurse caring for a child who has had a heart catheterization is aware that the childs activity level is: a. unrestricted because this is a minor procedure b. restricted to being up and about with no exercise, lifting, or other activity, which would increase heart rate c. restricted to sitting in a chair for 4 hours after the procedure d. bed rest with the affected extremity straight for 4 to 8 hours, subject to hospital policy and physicians orders

D. After a heart catheterization the child should be kept in bed with the affected extremity straight for 4 to 8 hours, subject to hospital policy and physicians orders.

The nurse is assessing an infant with congestive heart failure (CHF). Which of the following symptoms would the nurse most likely find in this infant? a. jugular vein distention b. peripheral edema c. greatly elevated blood pressure d. diaphoresis during feeding

D. An infant with congestive heart failure exhibits diaphoresis during feeding caused by sympathetic stimulation.

Which of the following indicates the flow of blood in the human body? a. flows from an area of lower pressure to an area of higher pressure b. takes the path of most resistance and flows from the area of highest pressure to an area of low pressure c. goes from higher to lower pressure and takes the path of most resistance d. flows from an area of high pressure to an area of low pressure and takes the path of least resistance

D. Blood flows in the human body from an area of high pressure to an area of low pressure (flowing down hill) and takes the path of least resistance.

Which of the following terms describes the nurses finding that the angle between the nail and the nail bed of a child has been lost and the fingertips are wider and rounder? a. moon nails b. angle nails c. notching d. clubbin

D. Clubbing is a result of chronic cyanosis with the subsequent development of the loss of the angle between the nail and nailbed. The fingertips eventually become wider and rounder.

Which of the following are the main therapeutic interventions for Kawasaki disease in the first 10 days of the disease? a. antibiotics and Tylenol b. blood transfusions and a cortisone product c. diuretics and administration of packed cells d. intravenous immune globulin and aspirin

D. Intravenous immune globulin (IVIG) and aspirin are the main therapeutic interventions for KD in the first 10 days of the disease. IVIG usually results in rapid resolution of congestive heart failure, defervescence of fever, and normalization of sedimentation rate. IVIG reduces the incidence of coronary artery aneurysms. Aspirin is given to control the high remittent fever (101-105 F) and for inflammation.

Which of the following symptoms would the nurse most likely find in assessing a child with right ventricular failure? a. rales and rhonchi, falling oxygen saturation, and labored breathing b. falling blood pressure, falling pulse rate, and increased respirations c. diaphoresis, nausea and vomiting, and tingling in extremities d. hepatomegaly, jugular venous distention, and peripheral edema

D. Systemic venous congestion indicates right ventricular failure with symptoms of hepatomegaly, jugular venous distention, and peripheral edema.