Pediatric Success Cardiac

Which finding might delay a cardiac catheterization procedure on a 1-year-old? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

2. A child with severe diaper rash has potential for infection if the interventionist makes the standard groin approach. TEST-TAKING HINT: Consider the risk for infection as a delaying factor.

A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has: 1. Ventricular septal defect (VSD). 2. Aortic stenosis (AS). 3. Mitral valve prolapse. 4. Tricuspid atresia.

2. AS can progress, and the child can develop exercise intolerance that can be better when resting. TEST-TAKING HINT: What does each of the last words of the defects mean, and what do those cause?

BP screenings to detect end-organ damage should be done routinely beginning at what age? 1. Birth. 2. 3 years. 3. 8 years. 4. 13 years.

2. Age 3 years is the recommended age to establish a baseline BP in a normal healthy child. TEST-TAKING HINT: The test taker needs to know that 3 years of age is the recommended age to begin BP measurements in healthy children.

What associated manifestation might the nurse occasionally find in a child diagnosed with Wilms tumor? 1. Atrial fibrillation. 2. Hypertension. 3. Endocarditis. 4. Hyperlipidemia.

2. Because Wilms tumor sits on the kidney, it can be associated with secondary hypertension. It does not affect or cause the other conditions. TEST-TAKING HINT: Where is the Wilms tumor located?

A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

2. Checking for pulses, especially in the canulated extremity, would assure perfusion to that extremity and is the priority post procedure. TEST-TAKING HINT: The test taker would know that the priority is assessing the cannulated extremity, checking for adequate perfusion.

An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff? 1. Soy. 2. Latex. 3. Penicillin. 4. Dairy.

2. Children with spina bifida (myelo - meningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy. TEST-TAKING HINT: Material that composes the balloon catheter is made of latex, which is a common allergy in a child with a myelomeningocele.

The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness? 1. Kawasaki disease (KD). 2. Strep throat. 3. Malignant hypertension. 4. Atrial fibrillation.

2. Chorea can be a manifestation of RF, with a higher incidence in females. TEST-TAKING HINT: The test taker can eliminate answer 1 because KD can cause damage to coronary arteries.

The mother of a toddler reports that the child's father has just had a myocardial infarction (MI). Because of this information, the nurse recommends the child have a(n): 1. Electrocardiogram. 2. Lipid profile. 3. Echocardiogram. 4. Cardiac catheterization.

2. Current recommendations are for a lipid profile in children over 2 years with a first- or second-degree relative with stroke, myocardial infarction, angina, or sudden cardiac death. Also screen if parent, sibling, or grandparent has cholesterol of 240 mg/dL or greater. TEST-TAKING HINT: Think about the cause of the father's MI.

Which assessment indicates that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr.

3. The 50th percentile height and weight for age shows good growth and development, indicating good nutrition and perfusion. TEST-TAKING HINT: The test taker should know the expected responses of medications used to treat CHF.

On examination, a nurse hears a murmur at the left sternal border (LSB) in a child with diarrhea and fever. The parent asks why the pediatrician never said anything about the murmur. The nurse explains: 1. "The pediatrician is not a cardiologist." 2. "Murmurs are difficult to detect, especially in children." 3. "The fever increased the intensity of the murmur." 4. "We need to refer the child to an interventional cardiologist."

3. The increased CO of the fever increases the intensity of the murmur, making it easier to hear. TEST-TAKING HINT: Consider the pathophysiology of fever.

Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin indicates the need for further education? 1. "I will give the medication at regular 12-hour intervals." 2. "If he vomits, I will not give a make-up dose." 3. "If I miss a dose, I will not give an extra dose" 4. "I will mix the digoxin in some formula to make it taste better."

4. If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate. TEST-TAKING HINT: What if the child does not drink all the formula?

A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is _____________________.

Rheumatic fever or RF. To make the diagnosis of RF, major and minor criteria are used. Major criteria include carditis, subcutaneous nodules, erythema marginatum, chorea, and arthritis. Minor criteria include fever and previous history of RF. TEST-TAKING HINT: It is an inflammatory disease caused by group A beta-hemolytic streptococcus.

The nurse is caring for a 9-month-old who was born with a congenital heart defect (CHD). Assessment reveals a HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.

Congestive heart failure or CHF. TEST-TAKING HINT: All of these are signs of pump failure. The infant is likely to have diaphoresis only on the scalp. The signs are not unlike those of an adult with this condition.

The _____________________ serves as the septal opening between the atria of the fetal heart.

Foramen ovale. TEST-TAKING HINT: The foramen ovale is the septal opening between the atria of the fetal heart. The test taker needs to know basic fetal circulation.

A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has _____________________.

Kawasaki disease or KD. TEST-TAKING HINT: Classic signs of KD include red eyes with no discharge; dry, cracked lips; strawberry tongue; and red, swollen, and peeling palms and soles of the feet. Incidence of KD is higher in males. The strongest indicator for this disease is the hallmark strawberry tongue.

Patent ductus arteriosus causes what type of shunt? _____________________

Left to right. Blood flows from the higher pressure aorta to the lower pressure pulmonary artery, resulting in a left to right shunt. TEST-TAKING HINT: What is the CHD classification of PDA?

A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow of blood through the heart is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. TEST-TAKING HINT: The test taker should know that the classification for this defect is left to right.

The flow of blood through the heart with an atrial septal defect (ASD) is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. TEST-TAKING HINT: What is the CHD classification of ASD?

A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

Patent ductus arteriosus or PDA. TEST-TAKING HINT: This is a defect with increased pulmonary flow. It should close in the first few weeks of life.

Indomethacin may be given to close which congenital heart defect (CHD) in newborns? _____________________

Patent ductus arteriosus or PDA. TEST-TAKING HINT: Prostaglandins allow the duct to remain open; thus, a prostaglandin inhibitor, such as Indocin or ibuprofen, can help close the duct.

For the child with hypoplastic left heart syndrome, which drug may be given to allow the patent ductus arteriosus (PDA) to remain open until surgery? _____________________

Prostaglandin E. TEST-TAKING HINT: Prostaglandin E maintains ductal patency to promote blood flow until the Norwood procedure is begun. Consider the opposite of wanting to close the PDA.

Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident. 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

1, 2, 3, 4, 6. 1. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 2. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 3. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 4. Developmental delays can be caused by multiple hospitalizations and surgeries. The child usually catches up to the appropriate level. 5. Hypoxia can increase the risk for bacterial endocarditis, not viral pericarditis. 6. Brain damage can be caused by hypoxia, blood clots, and stroke. 7. Hypoxic episodes cause acidosis, not alkalosis. TEST-TAKING HINT: Hypoxic episodes in a child with CHD ("tet spells") can cause polycythemia and strokes.

Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

1, 2, 3. 1. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 2. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. 3. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation. TEST-TAKING HINT: KD is an inflammation of small- and medium-sized blood vessels.

Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

1, 2, 4, 6. 1. TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 4. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 6. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. TEST-TAKING HINT: Tetralogy of Fallot has four defects. Pulmonary stenosis causes decreased pulmonary flow.

1. What can an electrocardiogram (ECG) detect? Select all that apply. 1. Ischemia. 2. Injury. 3. Cardiac output (CO). 4. Dysrhythmias. 5. Systemic vascular resistance (SVR). 6. Occlusion pressure. 7. Conduction delay.

1, 2, 4, 7. 1. An electrocardiogram can indicate ischemia of the heart muscle. 2. An electrocardiogram can indicate injury to the heart muscle. 4. An electrocardiogram can show dysrhythmias. 7. An electrocardiogram does show conduction delays. TEST-TAKING HINT: The electrocardiogram checks the electrical system of the heart, not the mechanical system. CO is mechanical; occlusion pressure does not have to do with the electrocardiogram; and SVR measures pressures in the peripheral system.

The following are examples of acquired heart disease. Select all that apply. 1. Infective endocarditis. 2. Hypoplastic left heart syndrome. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). 6. Transposition of the great vessels.

1, 3, 4, 5. 1. Infective endocarditis is an example of an acquired heart problem. 2. Hypoplastic left heart syndrome is a CHD. 3. RF is an acquired heart problem. 4. Cardiomyopathy is an acquired heart problem. 5. KD is an acquired heart problem. 6. Transposition of the great vessels is a CHD. TEST-TAKING HINT: "Acquired" means occurring after birth and seen in an otherwise normal and healthy heart.

Which statement by the mother of a child with rheumatic fever (RF) shows she has an understanding of prevention for her other children? 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A streptococcus, I will give them their antibiotic." 4. "If their culture is positive for staphylococcus A, I will give them their antibiotic."

1, 3. 1. Do not use an antibiotic if the disease is not bacterial in origin. Most sore throats are viral. 2. RF is a bacterial infection caused by group A beta-hemolytic streptococcus, and the drug of choice is penicillin. 3. RF is caused by a streptococcus infection, not by staphylococcus. 4. RF is cause by a streptococcus infection, not by staphylococcus. TEST-TAKING HINT: The test taker needs to know the cause of RF and how it is treated.

Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.

1, 4, 5, 6, 7. 1. Rocking by the parents will comfort the infant and decrease demands. 4. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. 5. An infant sucking the fists could indicate hunger. 6. Change bed linens only when necessary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the child. TEST-TAKING HINT: Do all that can be done to decrease demands on the child.

A 16-year-old being treated for hypertension has laboratory values of hemoglobin B 16 g/dL, hematocrit level 43%, sodium 139 mEq/L, potassium 4.4 mEq/L, and total cholesterol of 220 mg/dL. Which drug does the nurse suspect the patient takes based on the total cholesterol? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

1. Beta blockers are used with caution in patients with hyperlipidemia, hyperglycemia, and impotence. TEST-TAKING HINT: The test taker needs to know side effects of drugs.

Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)? 1. Chickenpox or influenza. 2. E. coli or staphylococcus. 3. Mumps or streptococcus A. 4. Streptococcus A or staphylococcus.

1. Both chickenpox and influenza are viral in nature, so consider stopping the aspirin because of the danger of Reye syndrome. TEST-TAKING HINT: Consider Reye syndrome when the patient is taking aspirin and has a viral infection.

A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy.

1. CHD is found often in children with Down syndrome. TEST-TAKING HINT: A child with a syndrome, such as Down, is likely to have other abnormalities.

A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using firm nipples with small openings to slow feedings.

1. Formula can be supplemented with extra calories, either from a commercial supplement, such as Polycose, or from corn syrup. Calories in formula could increase from 20 kcal/oz to 30 kcal/oz or more. TEST-TAKING HINT: Allow the child to get the most nutrition most effectively.

The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen.

1. High-dose immunoglobulin G and salicylate therapy for inflammation are the current treatment for KD. TEST-TAKING HINT: Consider antiinflammatory medications for treatment of KD.

Which patient could require feeding by gavage? 1. Infant with congestive heart failure (CHF). 2. Toddler with repair of transposition of the great vessels. 3. Toddler with Kawasaki disease (KD) in the acute phase. 4. School-age child with rheumatic fever (RF) and chorea.

1. The child may experience increased cardiac demand while feeding. Feedings by gavage eliminate that work and still provide high-calorie intake for growth. TEST-TAKING HINT: The test taker should consider how gavage feedings would affect the work of the heart.

Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.

1. The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia. TEST-TAKING HINT: The test taker could eliminate answers 2, 3, and 4 by knowing that they do not cause hypoxemia in CHF.

A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.

1. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk for digoxin toxicity. TEST-TAKING HINT: The test taker knows that furosemide causes the loss of potassium and can cause digoxin toxicity.

The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS).

2. In the older child, COA causes dizziness, headache, fainting, elevated blood pressure, and bounding radial pulses. TEST-TAKING HINT: The test taker should recognize that the child's BP is elevated and her pulses are bounding, which are symptoms of COA.

Aspirin has been ordered for the child with rheumatic fever (RF) in order to: 1. Keep the patent ductus arteriosus (PDA) open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis.

2. Joint inflammation is experienced in RF; aspirin therapy helps with inflammation and pain. TEST-TAKING HINT: Know the manifestations of RF.

Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear , and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr. 2. 1 cc/kg/hr. 3. 30 cc/hr. 4. 1 oz/hr.

2. Normal pediatric urine output is 1 cc/kg/hr. TEST-TAKING HINT: The test taker needs to know that normal urine output for a child is 1 cc/kg/hr.

While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left.

2. Polycythemia is the result of the body attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood cells to carry the oxygen. TEST-TAKING HINT: The test taker needs to know what laboratory values hypoxia can affect.

The Norwood procedure is used to correct: 1. Transposition of the great vessels. 2. Hypoplastic left heart syndrome. 3. Tetralogy of Fallot (TOF). 4. Patent ductus arteriosus (PDA).

2. The Norwood procedure is specific to hypoplastic left heart syndrome. TEST-TAKING HINT: Review surgical treatment of CHD.

What should the nurse assess prior to administering digoxin? Select all that apply. 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

2. The apical pulse rate is assessed because digoxin decreases the HR, and if the HR is <60, digoxin should not be administered. TEST-TAKING HINT: The test taker should know that the sclera and liver function tests have nothing to do with digoxin. Cough could be associated with ACE inhibitors.

A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of which drug? 1. Calcium channel blocker. 2. Beta blocker. 3. ACE inhibiter. 4. ARB.

2. The beta blocker not only affects the heart and lungs but also blocks the beta sites in the liver, reducing the amount of glycogen available for use, causing hypoglycemia. The lower HR and BP also suggest ingestion of a cardiac medication. TEST-TAKING HINT: Know the drug's side effects. In this case, the glucose is blocked.

While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2. The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. Patent ductus arteriosus (PDA). 3. Ventricular septal defect (VSD). 4. Bronchopulmonary dysplasia.

2. The main identifier in the stem is the machine-like murmur, which is the hallmark of a PDA. TEST-TAKING HINT: The test taker need to know common murmur sounds

The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse's best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for physicians to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

2. Usually a VSD will close on its own within the first year of life. TEST-TAKING HINT: Know the various treatments depending on size of the defect. VSD is the most common CHD

Congenital heart defects (CHDs) are classified by which of the following? Select all that apply. 1. Cyanotic defect. 2. Acyanotic defect. 3. Defects with increased pulmonary blood flow. 4. Defects with decreased pulmonary blood flow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.

3, 4, 5, 6. 3. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 4. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 5. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. 6. Heart defects are now classified as defects with increased or decreased pulmonary blood flow. TEST-TAKING HINT: Know the new classifications, not the older ones

Which drug should not be used to control secondary hypertension in a sexually active adolescent female who uses intermittent birth control? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

3. ACE inhibitors and angiotensin II receptor blockers can cause birth defects. The others are not teratogenic. TEST-TAKING HINT: The test taker needs to know which of these drugs are teratogenic.

Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him the aspirin that is ordered for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain."

3. Aspirin is the drug of choice for treatment of RF. TEST-TAKING HINT: The test taker should know that aspirin is the drug of choice and that manipulation of the joint should be limited during the acute phase.

Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."

3. Children can be irritable for 2 months after the symptoms of the disease start. TEST-TAKING HINT: The test taker must know about KD to choose the best response

A heart transplant may be indicated for a child with severe heart failure and: 1. Patent ductus arteriosus (PDA). 2. Ventricular septal defect (VSD). 3. Hypoplastic left heart syndrome. 4. Pulmonic stenosis (PS).

3. Hypoplastic left heart syndrome is treated by the Norwood procedure, or heart transplant. TEST-TAKING HINT: Consider severe heart failure and which complex of CHD.

Which medication should the nurse give to a child diagnosed with transposition of the great vessels? 1. Ibuprofen. 2. Betamethasone. 3. Prostaglandin E. 4. Indocin.

3. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery. TEST-TAKING HINT: The test taker would know that children who have transposition of the great vessels also have another cardiac defect, and the common one is PDA.

The most common cardiac dysrhythmia in pediatrics is: 1. Ventricular tachycardia. 2. Sinus bradycardia. 3. Supraventricular tachycardia. 4. First-degree heart block.

3. Supraventricular tachycardia is most common in children. TEST-TAKING HINT: Consider a tachycardiac rhythm in a pediatric patient.

Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

3. The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so fluid in the lungs can go to the base of the lungs, allowing better expansion. TEST-TAKING HINT: Infants are not able to concentrate urine well and may have sodium depletion, so they need a normal source of sodium.

During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.

3. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. TEST-TAKING HINT: The child self-assumes this position during the spell.

In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).

3. With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lowerthan- expected BP and weak pulses in the lower extremities. TEST-TAKING HINT: The test taker must know the anatomy of the defects and what assessments are to be made in each one.

Which vaccines must be delayed for 11 months after the administration of gamma globulin? Select all that apply. 1. Diphtheria, tetanus, and pertussis. 2. Hepatitis B. 3. Inactivated polio virus. 4. Measles, mumps, and rubella. 5. Varicella.

4, 5. 1. Diphtheria, tetanus, and pertussis can be given following administration of gamma globulin. These are killed vaccines, and the only vaccines not administered would be live vaccines such as measles, mumps, rubella. 2. Hepatitis B can be administered following gamma globulin. Live vaccines are held for at least 11 months. 3. Inactivated polio virus can be given following gamma globulin administration. Live vaccines are held for 11 months. 4. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months. 5. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months. TEST-TAKING HINT: The test taker needs to know which vaccines are killed and which are live.

The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

4. Applying direct pressure 1 inch above the puncture site will localize pressure over the vessel site. TEST-TAKING HINT: Consider the risk for volume depletion.

A toddler who has been hospitalized for vomiting due to gastroenteritis is sleeping and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child? 1. Rapid pulmonary flutter. 2. Sinus bradycardia. 3. Rapid atrial fibrillation. 4. Supraventricular tachycardia.

4. SVT is often above 200 and a result of dehydration, which a vomiting child could have. The rapid rate causes a low CO, resulting in low BP and prolonged capillary refill. TEST-TAKING HINT: The HR is regular and very rapid for a child of any age. The child has been vomiting, which can result in dehydration.

During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.

4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery. TEST-TAKING HINT: The test taker should choose the response that decreases the preload in this patient.

A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

4. Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life. TEST-TAKING HINT: The test taker would know that the severity of the damage to the heart valves determines how long prophylaxic antibiotics will be administered

A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called _____________________.

Tetralogy of Fallot or TOF. "Tet" spells are characteristic of TOF. TEST-TAKING HINT: Know the congenital heart defect classifications.