PEDS: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder 3

Réussis tes devoirs et examens dès maintenant avec Quizwiz!

A parent asks about the risk of a congenital heart defect 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? a) There is a less than 7% chance a sibling would inherit a heart defect. b) This was probably caused by environmental factors, not genetics. c) These occur related to medication the mother was taking while pregnant. d) There is no chance this will be passed to another child since we do not know what caused it.

There is a less than 7% chance a sibling would inherit a heart defect.

A parent asks about the risk of a congenital heart defect 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? a) There is a less than 7% chance a sibling would inherit a heart defect. b) These occur related to medication the mother was taking while pregnant. c) This was probably caused by environmental factors, not genetics. d) There is no chance this will be passed to another child since we do not know what caused it.

There is a less than 7% chance a sibling would inherit a heart defect. Correct 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.

A nurse is caring for a child that just had open-heart surgery and the parents are asking why there are wires coming out of the chest of the infant. What is the best response by the nurse? a) These wires are connected to the heart and will detect if your child's heart gets out of rhythm. b) The wires are left in the heart one month after surgery for potential arrhythmias. c) The wires are measuring the fluid level in the heart. d) The wires will administer ongoing electrical shocks to the heart to maintain rhythm.

These wires are connected to the heart and will detect if your child's heart gets out of rhythm.

A nurse is caring for a child that just had open-heart surgery and the parents are asking why there are wires coming out of the chest of the infant. What is the best response by the nurse?

These wires are connected to the heart and will detect if your child's heart gets out of rhythm. The wires may be connected to a pacemaker. Connection to the temporary pacemaker is usually until the child is out of danger for arrhythmia.

A nurse is caring for a child that just had open-heart surgery and the parents are asking why there are wires coming out of the chest of the infant. What is the best response by the nurse? a) These wires are connected to the heart and will detect if your child's heart gets out of rhythm. b) The wires will administer ongoing electrical shocks to the heart to maintain rhythm. c) The wires are left in the heart one month after surgery for potential arrhythmias. d) The wires are measuring the fluid level in the heart.

These wires are connected to the heart and will detect if your child's heart gets out of rhythm. Correct Explanation: The wires may be connected to a pacemaker. Connection to the temporary pacemaker is usually until the child is out of danger for arrhythmia.

Parents are told their infant has a hypoplastic left heart. What is the type of education that would be included for this family? a) This is a problem where the left side of the heart did not develop properly. b) This is a problem where the right side of the heart did not develop properly. c) The infant will have immediate surgery to completely correct the heart defect. d) There are no surgeries that can help the child live with this heart defect.

This is a problem where the left side of the heart did not develop properly. Correct 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 child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? a) This is a test that will check how blood is flowing through the heart. b) This is a test that will check the electrical impulses in the heart. c) This test can only determine the size of the heart. d) This test is an invasive test that will measure the blockage in the heart.

This is a test that will check how blood is flowing through the heart.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?

This is a test that will check how blood is flowing through the heart. Echocardiograms can determine the size of the heart and how the heart is pumping blood. An echocardiogram does not check the electrical impulses or the size of the heart. This is a non-invasive test.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? a) This test is an invasive test that will measure the blockage in the heart. b) This is a test that will check how blood is flowing through the heart. c) This is a test that will check the electrical impulses in the heart. d) This test can only determine the size of the heart.

This is a test that will check how blood is flowing through the heart. Explanation: Echocardiograms can determine the size of the heart and how the heart is pumping blood. An echocardiogram does not check the electrical impulses or the size of the heart. This is a non-invasive test.

A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education? a) Your child may need multiple surgeries to correct this defect. b) This is caused by an opening that usually closes by 1 week of age. c) This type of defect is caused by having a genetic predisposition for it. d) An IV for fluids will be started immediately.

This is caused by an opening that usually closes by 1 week of age.

A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education? a) This is caused by an opening that usually closes by 1 week of age. b) This type of defect is caused by having a genetic predisposition for it. c) Your child may need multiple surgeries to correct this defect. d) An IV for fluids will be started immediately.

This is caused by an opening that usually closes by 1 week of age. Correct Explanation: A PDA is caused by an opening that usually closes by 1 week of age called the ductus arteriosus. 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 parent asks why their infant with a cyanotic heart defect turns blue. What is the best response by the nurse? a) This is considered a medical emergency and needs immediate surgery. b) This is due to a decreased amount of oxygen to the peripheral tissue. c) This is due to the lack of oxygen to the brain. d) This is a sign of heart failure.

This is due to a decreased amount of oxygen to the peripheral tissue.

A parent asks why their infant with a cyanotic heart defect turns blue. What is the best response by the nurse? a) This is a sign of heart failure. b) This is due to a decreased amount of oxygen to the peripheral tissue. c) This is considered a medical emergency and needs immediate surgery. d) This is due to the lack of oxygen to the brain.

This is due to a decreased amount of oxygen to the peripheral tissue. Correct Explanation: Cyanosis associated with certain congenital heart defects is due to the body naturally compensating and decreasing the amount of oxygen to the peripheral tissue. This keeps the oxygen with the vital organs to sustain life. The lack of oxygen is not in the brain; it is in the systemic flow of the body. Cyanosis is a common finding with these types of heart defects and in general, does not usually need immediate surgery or is a sign of heart failure.

A parent is told their infant has a heart defect with a left to right shunt. What is the best way for the nurse to explain this type of shunting to the parent? a) This type of shunting causes an increase of blood to the systemic circulation. b) This type of shunting causes an increase of blood to the lungs. c) This type of shunting causes a decrease of blood to the brain. d) This type of shunting causes a decrease of blood to the lungs.

This type of shunting causes an increase of blood to the lungs. Explanation: This type of shunting causes an increase of blood to the lungs. A right to left shunt causes an increase in blood to the systemic circulation that is mixed with deoxygenated blood.

The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy the process of digitalization is done for which of the following reasons? a) To decrease the pain to a tolerable level b) To build the blood levels to a therapeutic level c) To establish a maintenance dose of the drug d) To increase the heart rate

To build the blood levels to a therapeutic level

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction? a) Abdominal distress b) Stomach upset c) Wheezing d) Nausea with diarrhea

Wheezing

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction?

Wheezing The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset is common with oral antibiotics and is not something that needs to be reported immediately. Nausea with diarrhea is common with oral antibiotics and does not need to be reported immediately. Abdominal distress is common with oral antibiotics and does not need to be reported immediately.

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which of the following reactions? a) Wheezing b) Stomach upset c) Nausea with diarrhea d) Abdominal distress

Wheezing Correct Explanation: The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset is common with oral antibiotics and is not something that needs to be reported immediately. Nausea with diarrhea is common with oral antibiotics and does not need to be reported immediately. Abdominal distress is common with oral antibiotics and does not need to be reported immediately.

The nurse is caring for a pediatric client diagnosed with tetralogy of Fallot. After speaking with the physician, the parents state to the nurse, "The doctor said something about our child having too many red blood cells. We don't understand how that could happen?" What is the best response by the nurse?

Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder." To compensate for low blood oxygen levels, the kidneys produce the hormone erythropoietin to stimulate the bone marrow to produce more red blood cells (RBCs). This increase in RBCs is called polycythemia. Polycythemia can lead to an increase in blood volume and possibly blood viscosity, further taxing the workload of the heart. The correct response is the clearest and easiest description for the parents to understand. Telling the parents the doctor was discussing polycythemia with them doesn't answer their question.

Infants with congenital heart disease should not be allowed to become dehydrated because this makes them prone to a) cerebrovascular accident. b) jaundice. c) tachycardia. d) seizures.

cerebrovascular accident (can develop thrombi if they become dehydrated)

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the a) child will have to remain NPO for 6 to 8 hours after the procedure to prevent vomiting. b) procedure is noninvasive and not frightening for children. c) child will require a general anesthetic and needs to be prepared for this. d) child will return with a bulky pressure dressing over the catheter insertion area.

child will return with a bulky pressure dressing over the catheter insertion area.

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the a) child will have to remain NPO for 6 to 8 hours after the procedure to prevent vomiting. b) child will return with a bulky pressure dressing over the catheter insertion area. c) child will require a general anesthetic and needs to be prepared for this. d) procedure is noninvasive and not frightening for children.

child will return with a bulky pressure dressing over the catheter insertion area. Correct Explanation: Cardiac catheterization is typically performed with the child awake but using conscious sedation. A dressing will be placed on the catheter insertion site.

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: a) bounding pulse. b) narrow pulse. c) hepatomegaly. d) femoral pulse weaker than brachial pulse.

femoral pulse weaker than brachial pulse.

You would teach the mother of a boy with tetralogy of Fallot that if he suddenly becomes cyanotic and dyspneic to a) lie him supine with the head turned to one side. b) lie him prone, being sure he can breathe easily. c) place him in a semi-Fowler's position in an infant seat. d) place him in a knee-chest position.

place him in a knee-chest position. Explanation: Placing a child in a knee-chest or squatting position traps blood in the legs, allowing the child to better oxygenate that remaining in the trunk.

An infant girl is prescribed digoxin. The nurse would teach her parents that the action of this drug is to: a) prevent subacute bacterial endocarditis. b) increase her heart rate. c) thicken the walls of the myocardium. d) slow and strengthen her heartbeat.

slow and strengthen her heartbeat.

An infant girl is prescribed digoxin. You would teach her parents that the action of this drug is to a) slow and strengthen her heartbeat. b) increase her heart rate. c) prevent subacute bacterial endocarditis. d) thicken the walls of the myocardium.

slow and strengthen her heartbeat. Correct Explanation: Digoxin is a cardiac glycoside that slows and strengthens the heartbeat.

After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding that: a) the contrast material used has a diuretic effect. b) the prolonged preprocedure fasting state places the child at risk for dehydration. c) blood loss during the procedure can be significant. d) the insertion of the catheter into the heart stimulates a diuretic response.

the contrast material used has a diuretic effect.

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." 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 reviewing nutritional recommendations with the parents of a teen diagnosed with hyperlipidemia. Which statements indicate an understanding of the recommended diet for this condition?

• "I should plan to have vegetables with each evening meal served." • "Adding fresh fruits to my child's lunch is a good idea." • "My child loves chicken and I can still serve it but I need to remove the skin." Hyperlipidemia refers to high levels of lipids (fats/cholesterol) in the blood. High lipid levels are a risk factor for the development of atherosclerosis, which can result in coronary artery disease, a serious cardiovascular disorder occurring in adults. Dietary management is the first step in the prevention and management of hyperlipidemia in children older than 2 years of age. The diet should consist primarily of fruits, vegetables, low-fat dairy products, whole grains, beans, lean meat, poultry, and fish. As in adults, fat should account for no more than 30% of daily caloric intake. Fat intake may vary over a period of days, as many young children are picky eaters. Limit saturated fats by choosing lean meats, removing skin from poultry before cooking, and avoiding palm, palm kernel, and coconut oils as well as hydrogenated fats

The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements?

• "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed." • "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." • "We will be sure to not allow our child to ride a bicycle for at least 2 weeks." With the Gore® Helex device, strenuous activity should be avoided for 2 weeks after the procedure, so neither soccer or bicycle riding would be allowed. Children should be monitored for the possible presence of atrial arrhythmias (lifelong) after surgical closure for the defect. Infection is a complication that must be monitored for and reported to the physician, and medications must be given as prescribe

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? Select all that apply. a) 12-year-old child whose digoxin level was 0.9 ng/ mL on a blood draw this morning b) 4-month-old child with an apical heart rate of 102 beats per minute c) 16-year-old child with a heart rate of 54 beats per minute d) 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse e) 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning

• 16-year-old child with a heart rate of 54 beats per minute • 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning • 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children?

• 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse • 16-year-old child with a heart rate of 54 beats per minute • 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning The nurse should not administer digoxin to children with the following issues: The adolescent with an apical pulse under 60 beats per minute, the child with a digoxin level above 2 ng/mL, and the child who exhibiting signs of digoxin toxicity.

The nurse is caring for a child diagnosed with rheumatic fever. The nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse? a) Provide age-appropriate diversional activities b) Instruct the child's family about the long term need for treatment c) Encourage the child to have frequent rest periods between activities d) Carefully handle the child's knees, ankles, elbows and wrists when moving the child. e) Administer salicylates after meals or with milk

• Carefully handle the child's knees, ankles, elbows and wrists when moving the child. • Administer salicylates after meals or with milk

The nurse is caring for a child diagnosed with rheumatic fever. The nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse?

• Carefully handle the child's knees, ankles, elbows and wrists when moving the child. • Administer salicylates after meals or with milk Pain control and relief are the highest priorities for the child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever and relieve joint inflammation and pain

The nurse is assessing a child with aortic stenosis. Which findings would the nurse most likely assess? Select all that apply. a) Dizziness with prolonged standing b) Blood pressure in arms significantly higher than in legs c) Moderately loud systolic murmur at the base of the heart d) Thrill palpated at base of heart e) Chest pain with activity

• Chest pain with activity • Dizziness with prolonged standing • Thrill palpated at base of heart A moderately loud systolic murmur at the base of the heart and blood pressure that is significantly higher in the arms than in the legs, possibly 20 mm Hg or higher, suggests coarctation of the aorta

The nurse is assessing a child with suspected rheumatic fever. What findings would the nurse expect to assess? Select all that apply. a) Diastolic murmur b) Involuntary limb movement c) Tender swollen joints d) Macular rash on trunk e) Nonpalpable subcutaneous nodules

• Involuntary limb movement • Macular rash on trunk • Tender swollen joints

A child with suspected dyslipidemia undergoes laboratory testing. The nurse is reviewing the results. Which of the following would the nurse interpret as supporting the diagnosis? Select all that apply. a) LDL level of 90 mg/dL b) Total cholesterol level of 180 mg/dL c) LDL level of 120 mg/dL d) LDL level of 140 md/dL e) Total cholesterol level of 150 mg/dL f) Total cholesterol level of 220 mg/dL

• LDL level of 140 md/dL • Total cholesterol level of 220 mg/dL Correct Explanation: A total cholesterol level over 200 mg/dL and LDL level above 130 mg/dL are considered high and would support the diagnosis of dyslipidemia. Total cholesterol levels between 170 to 199 mg/dL and LDL levels between 110 to 129 mg/dL are considered borderline. Total cholesterol levels less than 170 mg/dL and LDL levels less than 110 mg/dL are acceptable in children.

The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatments would the nurse expect to administer if ordered? Select all that apply. a) Intravenous immunoglobulin b) Nonsteroidal anti-inflammatory drugs c) Digoxin d) Corticosteroids e) Penicillin

• Nonsteroidal anti-inflammatory drugs • Corticosteroids • Penicillin

Which findings are major criteria used to help the physician diagnose acute rheumatic fever in a child? Select all that apply. a) Heart block with a prolonged PR interval b) Temperature of 101.2° F(38.4° C) c) Elevated erythrocyte sedimentation rate d) Painless nodules located on the wrists e) Pericarditis with the presence of a new heart murmur

• Painless nodules located on the wrists • Pericarditis with the presence of a new heart murmur

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. Which of the following would the nurse expect to find? Select all that apply. a) Shortness of breath when playing b) Crackles on lung auscultation c) Hypertension d) Bradycardia e) Tiring easily when eating

• Shortness of breath when playing • Crackles on lung auscultation • Tiring easily when eating Correct Explanation: Manifestations of heart failure include difficulty feeding or eating or becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension.

The young child had a chest tube placed during cardiac surgery. Which findings may indicate the development of cardiac tamponade? Select all that apply. a) The child's apical heart rate is strong and easily auscultated. b) The child is resting quietly. c) The child's heart rate has increased from 88 beats per minute to 126 beats per minute. d) The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube. e) The child's right atrial filling pressure has decreased.

• The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube. • The child's heart rate has increased from 88 beats per minute to 126 beats per minute.

The child has returned to the nurse's unit following a cardiac catheterization. The insertion site is located at the right groin. Peripheral pulses were easily palpated in bilateral lower extremities prior to the procedure. Which finding should be reported to the child's physician? a) The child is reporting nausea. b) The child has a runny nose. c) The right groin is soft without edema. d) The child's right foot is cool with a pulse assessed only with the use of a Doppler. e) The child has a temperature of 102.4° F (39.1° C).

• The child's right foot is cool with a pulse assessed only with the use of a Doppler. • The child has a temperature of 102.4° F (39.1° C). • The child is reporting nausea.

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply. a) Shortness of breath when playing b) Bradycardia c) Crackles on lung auscultation d) Hypertension e) Tiring easily when eating

• Tiring easily when eating • Shortness of breath when playing • Crackles on lung auscultation

A child with suspected dyslipidemia undergoes laboratory testing. The nurse is reviewing the results. Which finding would the nurse interpret as supporting the diagnosis? Select all that apply. a) Total cholesterol level of 180 mg/dL b) LDL level of 120 mg/dL c) Total cholesterol level of 220 mg/dL d) LDL level of 140 md/dL e) LDL level of 90 mg/dL f) Total cholesterol level of 150 mg/dL

• Total cholesterol level of 220 mg/dL • LDL level of 140 md/dL

Nursing students are reviewing information about the different types of congenital heart defects. They demonstrate understanding of the information when they identify which of these as disorders with increased pulmonary blood flow? Select all that apply. a) Ventricular septal defect b) Atrioventricular canal defect c) Patent ductus arteriosus d) Pulmonary stenosis e) Coarctation of the aorta

• Ventricular septal defect • Patent ductus arteriosus • Atrioventricular canal defect

A child is having surgery for a congenital heart defect. The parent asks about their 1-year-old's growth and developmental delays and what they can expect after surgery. What is the best response by the nurse? a) "You can expect to continue to see delays." b) "This was caused by the lack of oxygen and it is usually permanent." c) "As long as you decrease external stimuli, the child should catch up." d) "After surgery, most children will catch up."

"After surgery, most children will catch up."

A child is having surgery for a congenital heart defect. The parent asks about their 1-year-old's growth and developmental delays and what they can expect after surgery. What is the best response by the nurse? a) "After surgery, most children will catch up." b) "You can expect to continue to see delays." c) "This was caused by the lack of oxygen and it is usually permanent." d) "As long as you decrease external stimuli, the child should catch up."

"After surgery, most children will catch up." Correct Explanation: A child with a congenital heart defect who has growth and developmental delays will usually catch up after the defect is fixed. There is no way of predicting exactly what each child will do and it is not appropriate to tell a parent that these delays are permanent when that is unknown until the defect is corrected by surgery.

A child is having surgery for a congenital heart defect. The parent asks about their 1-year-old's growth and developmental delays and what they can expect after surgery. What is the best response by the nurse? a) "You can expect to continue to see delays." b) "As long as you decrease external stimuli, the child should catch up." c) "This was caused by the lack of oxygen and it is usually permanent." d) "After surgery, most children will catch up."

The nurse is teaching an inservice 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? a) "The onset and progression of this disorder is rapid." b) "Children who have this diagnosis may have had strep throat." c) "This disorder is caused by genetic factors." d) "Being up to date on immunizations is the best way to prevent this disorder."

"Children who have this diagnosis may have had strep throat."

"Children who have this diagnosis may have had strep throat." 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 nurse is teaching an inservice 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? a) "The onset and progression of this disorder is rapid." b) "This disorder is caused by genetic factors." c) "Being up to date on immunizations is the best way to prevent this disorder." d) "Children who have this diagnosis may have had strep throat."

"Children who have this diagnosis may have had strep throat." Correct 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 nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure? a) "He does not seem short of breath." b) "He gets sweaty when he eats." c) "He does not seem sick." d) "He seems to have a normal appetite."

"He gets sweaty when he eats."

The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?

"He likes to stop and squat wherever he walks." The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance. Constant movement and quick walking are normal for a toddler. Activity level with a daily nap is typical of a toddler. Difficulty breathing would suggest a problem.

A nurse is taking the history of a 4-year-old boy who will undergo a cardiac catheterization. Which statement by his mother may necessitate rescheduling of the procedure? a) "He is very scared and nervous about the procedure." b) "He is not taking any medication." c) "He seems listless and slightly warm." d) "He is allergic to iodine and shellfish."

"He seems listless and slightly warm."

A nurse is taking the history of a 4-year-old boy who will undergo a cardiac catheterization. Which of the following statements by his mother may necessitate rescheduling of the procedure? a) "He is very scared and nervous about the procedure." b) "He is not taking any medication." c) "He is allergic to iodine and shellfish." d) "He seems listless and slightly warm."

"He seems listless and slightly warm." Correct 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 address the child's fears in a developmentally appropriate way, but fear of the procedure does not warrant rescheduling. Not using any medication would not be a reason for rescheduling the procedure.

The nurse is assessing the past medical history of an infant with a suspected cardiovascular disorder. Which response by the mother warrants further investigation? a) "I was really nauseous throughout my whole pregnancy." b) "I am on a low dose of steroids." c) "His Apgar score was an 8." d) "I had the flu during my last trimester."

"I am on a low dose of steroids."

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 smaller frequent meals will tire your child less and promote weight gain." Small, frequent feedings will reduce the amount of energy required to feed or eat and prevents overtiring the child. Questioning if the parents are making nutritious foods or foods the child likes 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

A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can to reduce the risk of this type of condition occurring in her baby. Which of the following should the nurse mention to this patient? a) "There is really nothing you can do. b) "Make sure you are fully immunized." c) "Make sure that you encourage your child to exercise as he grows up." d) "Make sure you encourage a low-sodium diet in your child as he grows up."

"Make sure you are fully immunized."

"Make sure you are fully immunized." The cause of congenital heart disease often cannot be documented, although it is associated with familial patterns of inheritance and possibly triggers such as rubella (German measles) and varicella (chickenpox) infection during pregnancy. Women need to enter pregnancy fully immunized to help prevent infection during pregnancy. Encouraging the child to eat a low-sodium diet and exercise as he grows up will help prevent acquired heart disease, not congenital heart disease

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education? a) "Most infants do not need surgical repair for this." b) "Surgery is usually performed in the first two months of life for this." c) "The medication indomethacin is used to try to close the hole." d) "The medication prostaglandin E1 is used to try to close the hole."

"Most infants do not need surgical repair for this."

A child will be undergoing a Holter monitor test. Which statement by the mother indicates the need for further instruction?

"My child cannot have any thing to eat or drink after midnight the day of the test." Ambulatory electrocardiographic monitoring (Holter) testing is an exam that spans approximately 24 hours. The test is done to review the activity of the heart. The individual is encouraged to follow their normal activities during the test. There is no need for the child to be NPO prior to or during the test.

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching? a) "We need to avoid a tub bath for the next 3 days." b) "Strenuous activity should be limited for the next 3 days." c) "The feeling of the heart skipping a beat is common." d) "We need to watch for changes in skin color or difficulty breathing."

"The feeling of the heart skipping a beat is common."

"The feeling of the heart skipping a beat is common." Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. This statement is appropriate because tub baths should be avoided for about 3 days. This statement is appropriate because strenuous activity is limited for about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported.

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching? a) "We need to watch for changes in skin color or difficulty breathing." b) "Strenuous activity should be limited for the next 3 days." c) "We need to avoid a tub bath for the next 3 days." d) "The feeling of the heart skipping a beat is common."

"The feeling of the heart skipping a beat is common." Explanation: Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. This statement is appropriate because tub baths should be avoided for about 3 days. This statement is appropriate because strenuous activity is limited for about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported.

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? a) "She needs to take the drug for the full 14 days." b) "If she needs dental surgery, we might need additional medication." c) "We can stop the penicillin when her symptoms disappear." d) "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."

"We can stop the penicillin when her symptoms disappear."

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? a) "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years." b) "If she needs dental surgery, we might need additional medication." c) "We can stop the penicillin when her symptoms disappear." d) "She needs to take the drug for the full 14 days."

"We can stop the penicillin when her symptoms disappear."

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." 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

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? a) "We can stop the penicillin when her symptoms disappear." b) "She needs to take the drug for the full 14 days." c) "If she needs dental surgery, we might need additional medication." d) "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."

"We can stop the penicillin when her symptoms disappear." Correct 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 ask 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 the nurse?

"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help." 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.

An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize? a) "You'll have to wear the monitor for 24 hours." b) "You get some medicine that will make you sleepy." c) "You need to report any symptoms you are having during the test." d) "You need to lie very still during this test."

"You need to report any symptoms you are having during the test."

A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which of the following should the nurse say to the girl's mother in response to these findings? a) "Your daughter has a functional heart murmur; I recommend that you limit her physical activity so that her heart rate is not elevated for long periods of time." b) "Your daughter has an organic heart murmur, which indicates that she has some degree of heart disease. The doctor will provide a referral to a good cardiologist." c) Not say anything, as the girl has an insignificant heart murmur and there is no reason to alarm the mother or her. d) "Your daughter has an innocent heart murmur, which is nothing to worry about."

"Your daughter has an innocent heart murmur, which is nothing to worry about."

A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which of the following should the nurse say to the girl's mother in response to these findings? a) Not say anything, as the girl has an insignificant heart murmur and there is no reason to alarm the mother or her. b) "Your daughter has an organic heart murmur, which indicates that she has some degree of heart disease. The doctor will provide a referral to a good cardiologist." c) "Your daughter has a functional heart murmur; I recommend that you limit her physical activity so that her heart rate is not elevated for long periods of time." d) "Your daughter has an innocent heart murmur, which is nothing to worry about."

"Your daughter has an innocent heart murmur, which is nothing to worry about." Correct Explanation: The symptoms described indicate an innocent heart murmur. Although innocent murmurs are of no consequence, parents need to be told when their child has one because this finding will undoubtedly be discovered again at a future health assessment or during a febrile illness, anxiety, or pregnancy. Activities need not be restricted when a child has an innocent murmur and the child requires no more frequent health appraisals than other children. If a murmur is present as the result of heart disease or a congenital disorder, it is an organic heart murmur.

The infant has been hospitalized and develops hypercyanosis. The physician has ordered the nurse to administer 0.1 mg of morphine sulfate per every kilogram of the infant's body weight. The infant weighs 15.2 lb (6.81 kg). Calculate the infant's morphine sulfate dose. Record your answer using one decimal place. ___________ mg

0.681 = 0.7mg

The infant has been hospitalized and develops hypercyanosis. The physician has ordered the nurse to administer 0.1 mg of morphine sulfate per every kilogram of the infant's body weight. The infant weighs 15.2 pounds. Calculate the infant's morphine sulfate dose. Round your answer to the nearest tenth. _____mg

0.7 Correct Explanation: The infant weighs 15.2 pounds (2.2 pounds = 1 kg.) 15.2 pounds x 1 kg/2.2 pounds = 6.818 kg The infant weighs 6.818 kg. For each kilogram of body weight, the infant should receive 0.1 mg of morphine sulfate. 6.818 kg x 0.1 mg/1 kg = 0.6818 mg Rounded to the tenth place = 0.7 mg The infant will receive 0.7 mg of morphine sulfate.

You take an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant? a) 150 beats per minute b) 60 beats per minute c) 80 beats per minute d) 100 beats per minute

100 beats per minute

You take an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant? a) 150 beats per minute b) 100 beats per minute c) 80 beats per minute d) 60 beats per minute

100 beats per minute Explanation: Because digoxin slows the heart rate, it is important that it is not already beating at a slow rate before administration.

The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy? a) 94 to 112/56 to 60 mm Hg b) 80 to 90/40 to 64 mm Hg c) 80 to 100/64 to 80 mm Hg d) 100 to 120/70 to 80 mm Hg

100 to 120/70 to 80 mm Hg

The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy?

100 to 120/70 to 80 mm Hg The normal adolescent's blood pressure averages 100 to 120/70 to 80 mm Hg. The average infant's blood pressure is about 80/55 mm Hg. The toddler or preschooler's blood pressure averages 90 to 110/55 to 75 mm Hg. The normal school-ager's blood pressure averages 100 to 120/60 to 75 mm Hg

The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant's heart rate? a) 70 to 80 bpm b) 90 to 160 bpm c) 60 to 68 bpm d) 80 to 105 bpm

90 to 160 bpm

The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant's heart rate?

90 to 160 bpm The normal infant heart rate averages 90 to 160 beats per minute (bpm); the toddler's or preschooler's is 80 to 115, the school-age child's is 60 to 100 bpm.

The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding? a) 80/40 mm Hg b) 110/60 mm Hg c) 100/60 mm Hg d) 90/64 mm Hg

90/64 mm Hg

The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding? a) 100/60 mm Hg b) 110/60 mm Hg c) 90/64 mm Hg d) 80/40 mm Hg

90/64 mm Hg Explanation: The toddler's or preschooler's blood pressure averages 80 to 100/64 mm Hg. The normal infant's blood pressure is about 80/40 mm Hg. The school-age child's blood pressure averages 94 to 112/56 mm Hg. An adolescent's blood pressure averages 100 to 120/50 to 70 mm Hg.

The nurse is explaining possible side effects of corticosteroids to the caregiver of a child diagnosed with rheumatic fever. The caregiver comments, "I don't understand what hirsutism means." The nurse would be correct in explaining that hirsutism is which of the following? a) A "moon face" appearance b) Repetitive movements c) Facial grimaces d) Abnormal hair growth

Abnormal hair growth

The nurse is explaining possible side effects of corticosteroids to the caregiver of a child diagnosed with rheumatic fever. The caregiver comments, "I don't understand what hirsutism means." The nurse would be correct in explaining that hirsutism is which of the following? a) Facial grimaces b) Repetitive movements c) A "moon face" appearance d) Abnormal hair growth

Abnormal hair growth Correct Explanation: The child whose pain is not con trolled with salicylates may be ad ministered corticosteroids. Side effects such as hirsutism (abnormal hair growth) and "moon face" may be noted. Facial grimaces and repetitive involuntary movements are symptoms of chorea.

The nurse is conducting a physical examination of an infant with a suspected cardiovascular disorder. Which assessment finding is suggestive of sudden ventricular distention? a) Accentuated third heart sound b) Decreased blood pressure c) Heart murmur d) Cool, clammy, pale extremities

Accentuated third heart sound

Which of the following nursing diagnoses would best apply to a child with rheumatic fever? a) Risk for self-directed violence related to development of cerebral anoxia b) Activity intolerance related to inability of heart to sustain extra workload c) Ineffective breathing pattern related to cardiomegaly d) Disturbed sleep pattern related to hyperexcitability

Activity intolerance related to inability of heart to sustain extra workload

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

Activity intolerance related to inability of heart to sustain extra workload Children with rheumatic fever need to reduce activity to relieve stress during the course of the illness

Which of the following nursing diagnoses would best apply to a child with rheumatic fever? a) Disturbed sleep pattern related to hyperexcitability b) Activity intolerance related to inability of heart to sustain extra workload

Activity intolerance related to inability of heart to sustain extra workload Explanation: Children with rheumatic fever need to reduce activity to relieve stress during the course of the illness.

A nurse is caring for an infant who is experiencing heart failure. Which of the following would be the most appropriate care for this infant? a) Administer oxygen. b) Restrict fluids. c) Provide large, less frequent feedings. d) Administer antidiuretic.

Administer oxygen.

A nurse is caring for an infant who is experiencing heart failure. Which of the following would be the most appropriate care for this infant? a) Provide large, less frequent feedings. b) Administer oxygen. c) Administer antidiuretic. d) Restrict fluids.

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.

The nurse is caring for a 10-year-old girl with a suspected heart arrhythmia. The nurse would expect to prepare the child for which test to identify and quantitate the arrhythmia? a) Arteriogram b) Echocardiogram c) Chest radiograph d) Ambulatory electrocardiographic monitoring

Ambulatory electrocardiographic monitoring

The nurse is caring for a 10-year-old girl with a suspected heart arrhythmia. The nurse would expect to prepare the child for which test to identify and quantitate the arrhythmia? a) Ambulatory electrocardiographic monitoring b) Arteriogram c) Echocardiogram d) Chest radiograph

Ambulatory electrocardiographic monitoring Correct Explanation: Ambulatory electrocardiographic monitoring is indicated to identify and quantitate arrhythmias in a 24-hour period during normal daily activities. An echocardiogram is done to provide a specific diagnosis of structural defects, to determine hemodynamics, and to detect valvular defects. A chest radiograph is indicated to detect abnormalities of structures within the chest. An arteriogram is ordered to observe blood flow to parts of the body and detect lesions and confirm a diagnosis.

Which of the following would be included in discharge teaching by the nurse of a child that had a patch placed surgically for an ASD? a) Antibiotics should be administered before invasive procedures. b) Need for frequent rest periods at home c) Intake of 80 ounces of fluid daily d) Teaching about how to take daily blood pressures

Antibiotics should be administered before invasive procedures.

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? a) Apply pressure 1 inch above the site. b) Change the dressing. c) Contact the physician. d) Ensure that the child's leg is kept straight.

Apply pressure 1 inch above the site.

A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify what as a major Jones criterion? a) Subcutaneous nodules b) Erythema marginatum c) Arthralgia d) Carditis

Arthralgia Arthralgia is considered a minor criterion. Carditis , Erythema marginatum, and Subcutaneous nodules are considered a major criterion.

The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? 1. Allow early ambulation to encourage activity participation. 2. Check pulses above the catheter insertion site for strength and quality. 3. Assess extremity distal to the insertion site for temperature and color. 4. Change the dressing to evaluate the site for infection.

Assess extremity distal to the insertion site for temperature and color.

Coarctation of the aorta demonstrates few symptoms in newborns. Which of the following is an important assessment to make on all newborns to help reveal this condition? a) Recording an upper extremity blood pressure b) Observing for excessive crying c) Auscultating for a cardiac murmur d) Assessing for the presence of femoral pulses

Assessing for the presence of femoral pulses

Coarctation of the aorta demonstrates few symptoms in newborns. Which of the following is an important assessment to make on all newborns to help reveal this condition? a) Auscultating for a cardiac murmur b) Recording an upper extremity blood pressure c) Assessing for the presence of femoral pulses d) Observing for excessive crying

Assessing for the presence of femoral pulses Correct Explanation: Infants with a narrowing (coarctation) of the aorta have decreased pressure in the lower extremities or absence of femoral pulses.

A group of nurses is reviewing the cardiovascular system and its function. Which of the following statements is the most accurate regarding the cardiovascular system in the child? a) At birth the right and left ventricle are about the same size. b) Between the ages of 5 and 6 the left ventricle grows to about two times the size of the right. c) The heart rate of the child decreases if the child has a fever. d) The heart matures and functions like an adult's between 12 and 15 years of age.

At birth the right and left ventricle are about the same size.

A group of nurses is reviewing the cardiovascular system and its function. Which of the following statements is the most accurate regarding the cardiovascular system in the child? a) The heart rate of the child decreases if the child has a fever. b) At birth the right and left ventricle are about the same size. c) The heart matures and functions like an adult's between 12 and 15 years of age. d) Between the ages of 5 and 6 the left ventricle grows to about two times the size of the right.

At birth the right and left ventricle are about the same size. Correct Explanation: At birth, both the right and left ventricles are about the same size, but by a few months of age, the left ventricle is about two times the size of the right. If the infant has a fever, respiratory distress, or any increased need for oxygen, the pulse rate goes up to increase the cardiac output. Although the size is smaller, by the time the child is 5 years old, the heart has matured, developed, and functions just as the adult's heart.

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. Which of the following interventions should the nurse take to prevent infection? a) Keep the child NPO for 2 to 4 hours before the procedure b) Avoid drawing a blood specimen from the right femoral vein before the procedure c) Apply EMLA cream to the catheter insertion site d) Record pedal pulses

Avoid drawing a blood specimen from the right femoral vein before the procedure

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 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.

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. Which of the following interventions should the nurse take to prevent infection? a) Keep the child NPO for 2 to 4 hours before the procedure b) Record pedal pulses c) Apply EMLA cream to the catheter insertion site d) Avoid drawing a blood specimen from the right femoral vein before the procedure

Avoid drawing a blood specimen from the right femoral vein before the procedure Correct 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.

Which of the following would be included in the care of an infant in heart failure? a) Begin formulas with increased calories. b) Encourage larger, less frequent feedings. c) Maintain child in the supine position. d) Administer digoxin even if the infant is vomiting

Begin formulas with increased calories.

Which of the following would be included in the care of an infant in heart failure? a) Maintain child in the supine position. b) Encourage larger, less frequent feedings. c) Begin formulas with increased calories. d) Administer digoxin even if the infant is vomiting.

Begin formulas with increased calories. Correct 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 times 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 nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note? a) Appropriate mastery of developmental milestones b) Pitting periorbital edema c) Bounding pulse d) Preference to resting on the right side

Bounding pulse

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia? a) Child C with a total cholesterol level of 190 mg/dL and LDL of 125 mg/dL. b) Child D with a total cholesterol level of 220 mg/dL and LDL of 138 mg/dL. c) Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. d) Child B with a total cholesterol level of 175 mg/dL and LDL of 105 mg/dL.

Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL.

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia?

Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. Total cholesterol levels below 170 mg/dL and LDL levels less than 100 mg/dL are considered within the acceptable range. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels greater than or equal to 200 mg/dL and LDL levels greater than or equal to 130 mg/dL are considered elevated and place this child at greatest risk

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia? a) Child B with a total cholesterol level of 175 mg/dL and LDL of 105 mg/dL. b) Child C with a total cholesterol level of 190 mg/dL and LDL of 125 mg/dL. c) Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. d) Child D with a total cholesterol level of 220 mg/dL and LDL of 138 mg/dL.

Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. Explanation: Total cholesterol levels below 170 mg/dL and LDL levels less than 100 mg/dL are considered within the acceptable range. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels greater than or equal to 200 mg/dL and LDL levels greater than or equal to 130 mg/dL are considered elevated and place this child at greatest risk.

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the:

Child will return with a bulky pressure dressing over the catheter insertion area. Cardiac catheterization is typically performed with the child awake but using conscious sedation. A dressing will be placed on the catheter insertion site

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks she has noticed that the child seems to have lack of coordination. In addition she reports the child has had facial grimaces and repetitive involuntary movements. The signs the caregiver reports indicate the child has which of the following? a) Arthralgia b) Polyarthritis c) Carditis d) Chorea

Chorea

Chorea Correct Explanation: Chorea is a disorder characterized by emotional instability, purposeless movements, and muscular weakness. The onset of chorea is gradual, with increasing incoordination, facial grimaces, and repetitive involuntary movements.

When caring for a child that has just had a cardiac catheterization, which of the following would indicate a sign of hypotension? a) Diaphoresis and tachycardia b) Cold clammy skin and increased heart rate c) Syncope and tachypnea d) Decreased heart rate and dizziness

Cold clammy skin and increased heart rate

When caring for a child that has just had a cardiac catheterization, which of the following would indicate a sign of hypotension? a) Decreased heart rate and dizziness b) Syncope and tachypnea c) Diaphoresis and tachycardia d) Cold clammy skin and increased heart rate

Cold clammy skin and increased heart rate Explanation: Cold, clammy skin, increased heart rate, and dizziness are signs of hypotension that may be a complication after a cardiac catheterization. Decreased heart rate, syncope, and tachypnea would also be very concerning, but not necessarily a sign of hypotension.

The nurse is performing an ECG on a 12-year-old boy. On completion, she notices that boy's P-R interval is lengthened. Which of the following does this finding indicate? a) Difficulty with coordination between the SA and AV nodes (first-degree heart block) b) Ventricular hypertrophy c) Ventricles not fully contracting (pericarditis) d) Hypertrophied atria

Difficulty with coordination between the SA and AV nodes (first-degree heart block)

The nurse is performing an ECG on a 12-year-old boy. On completion, she notices that boy's P-R interval is lengthened. Which of the following does this finding indicate? a) Difficulty with coordination between the SA and AV nodes (first-degree heart block) b) Ventricular hypertrophy c) Hypertrophied atria d) Ventricles not fully contracting (pericarditis)

Difficulty with coordination between the SA and AV nodes (first-degree heart block) Explanation: On an ECG tracing, a longer-than-usual P wave suggests the atria are hypertrophied making it take longer than usual for the electrical conduction to spread over the atria. A lengthened P-R interval suggests there is a difficulty with coordination between the SA and AV nodes (first-degree heart block). A heightened R wave indicates ventricular hypertrophy is present. An R wave which is decreased in height suggests the ventricles are not contracting fully, as happens if they are surrounded by fluid (pericarditis). Elongation of the T wave occurs in hyperkalemia; depression of the T wave is associated with anoxia; depression of the ST segment is associated with abnormal calcium levels.

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed? a) Indomethacin b) Digoxin c) Furosemide d) Alprostadil

Digoxin

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed? a) Indomethacin b) Digoxin c) Alprostadil d) Furosemide

Digoxin Correct Explanation: Digoxin is indicated for atrial fibrillation. It increases the contractility of the heart muscle by decreasing conduction and increasing force. Alprostadil is indicated for temporary maintenance of ductus arteriosus patency in infants with ductal-dependent congenital heart defects. Furosemide is used for the management of edema associated with heart failure. Indomethacin is used to close a patent ductus arteriosus.

The nurse is administering medications to the child with congestive heart failure. Large doses of which of the following medications are used initially in the treatment of CHF to attain a therapeutic level? a) Ferrous sulfate b) Digoxin (Lanoxin) c) Furosemide (Lasix) d) Albuterol sulfate

Digoxin (Lanoxin)

Digoxin (Lanoxin) Correct Explanation: The use of large doses of digoxin, at the beginning of therapy, to build up the blood levels of the drug to a therapeutic level is known as digitalization.

The nurse is collecting data on a 5 year old child admitted with the diagnosis of congestive heart failure. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Clubbing of the fingers b) Scissoring of the legs with toes pointed down c) Failure to gain weight d) Jerking movements of the arms and legs

Failure to gain weight Explanation: In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and clubbing of the fingers is seen in cystic fibrosis.

Tetralogy of Fallot consists of the following four anomalies: aortic stenosis, atrial septal defect, dextroposition (overriding) of the aorta, and hypertrophy of the left ventricle. a) False b) True

False

Tetralogy of Fallot consists of the following four anomalies: aortic stenosis, atrial septal defect, dextroposition (overriding) of the aorta, and hypertrophy of the left ventricle. a) False b) True

False Correct Explanation: Tetralogy of Fallot consists of four anomalies: pulmonary stenosis, ventricular septal defect (usually large), dextroposition (overriding) of the aorta, and hypertrophy of the right ventricle.

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which of the following signs and symptoms would the infant most likely be exhibiting? a) Rapid weight gain b) Yellowish color c) Bradycardia d) Feeding problems

Feeding problems

After assessing a child, the nurse suspects coarctation of the aorta based on which of the following? a) Hepatomegaly b) Narrow pulse c) Femoral pulse weaker than brachial pulse d) Bounding pulse

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.

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

Femoral pulse weaker than brachial pulse. 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.

The nurse performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a: a) Grade IV. b) Grade I. c) Grade III. d) Grade II.

Grade IV. A heart murmur characterized as loud with a precordial thrill is classified as Grade IV. Grade II is soft and easily heard. Grade I is soft and hard to hear. Grade III is loud without thrill.

A school nurse is caring for a child with a severe sore throat and fever. What action would the nurse recommend to the parent? a) Give acetaminophen for the fever and pain, and have the child rest. b) Have the child go to the emergency room. c) Have the child drink fluids that contain electrolytes. d) Have the child be seen by the primary care provider.

Have the child be seen by the primary care provider.

A school nurse is caring for a child with a severe sore throat and fever. Which of the following would be the best recommendation by the nurse to the parent? a) Have the child drink fluids that contain electrolytes. b) Have the child go to the emergency room. c) Give acetaminophen for the fever and pain, and have the child rest. d) Have the child be seen by the primary care provider.

Have the child be seen by the primary care provider. Correct Explanation: Children with sore throats and fevers should be seen by their primary care provider to rule out strep throat. This is extremely important due to the fact they may contract an acquired heart disease called rheumatic fever. Taking acetaminophen, resting, and drinking fluids are all good recommendations, but the best recommendation is to see the provider. Going to the emergency room is not necessary at this time.

A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? 1. Gallop and rales. 2. Blood pressure discrepancies in the extremities. 3. Right ventricular hypertrophy on ECG. 4. Heart murmur.

Heart murmur.

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. Which of the following should the nurse mention in explaining how this diagnostic test works? a) High-frequency sound waves are directed toward the heart b) A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy c) X-rays are directed toward the heart d) A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video

High-frequency sound waves are directed toward the heart

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. Which of the following should the nurse mention in explaining how this diagnostic test works? a) High-frequency sound waves are directed toward the heart b) A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video c) X-rays are directed toward the heart d) A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy

High-frequency sound waves are directed toward the heart

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. Which of the following should the nurse mention in explaining how this diagnostic test works? a) A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video b) High-frequency sound waves are directed toward the heart c) A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy d) X-rays are directed toward the heart

High-frequency sound waves are directed toward the heart Correct Explanation: Echocardiography, or ultrasound cardiography, has become the primary diagnostic test for congenital heart disease. For this, high-frequency sound waves, directed toward the heart, are used to locate and study the movement and dimensions of cardiac structures, such as the size of chambers, thickness of walls, relationship of major vessels to chambers, and the thickness, motion, and pressure gradients of valves. You can remind parents echocardiography does not use x-rays so it can be repeated at frequent intervals without exposing their child to the possible risk of radiation. The other answers refer to other types of diagnostic tests, including X-ray studies, radioangiocardiography, and phonocardiography.

On assessment immediately following cardiac surgery, which condition would the nurse expect to find in an infant? a) Hypertension b) Hypovolemia c) Hyperexcitability d) Hypothermia

Hypothermia

A nurse is reviewing blood work on a patient with a cyanotic heart defect. Which of the following results would most likely be seen in a patient experiencing polycythemia? a) Increased WBC b) Increased RBC c) Decreased RBC d) Decreased WBC

Increased RBC

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 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).

Increased RBC Correct Explanation: Polycythemia can occur in patients 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).

An 8-month-old has a ventricular septal defect. Which nursing diagnosis below would best apply? a) Impaired skin integrity related to poor peripheral circulation b) Impaired gas exchange related to a right-to-left shunt c) Ineffective airway clearance related to altered pulmonary status d) Ineffective tissue perfusion related to inefficiency of the heart as a pump

Ineffective tissue perfusion related to inefficiency of the heart as a pump

An 8-month-old has a ventricular septal defect. Which nursing diagnosis below would best apply? a) Impaired skin integrity related to poor peripheral circulation b) Ineffective tissue perfusion related to inefficiency of the heart as a pump c) Ineffective airway clearance related to altered pulmonary status d) Impaired gas exchange related to a right-to-left shunt

Ineffective tissue perfusion related to inefficiency of the heart as a pump Correct Explanation: A ventriculoseptal defect permits blood to flow across a septum, creating an ineffective pump.

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. The nurse should tell the mother which of the following? a) Surgical closure by ductal ligation b) Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization c) Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions d) No treatment is necessary, as the defect will resolve spontaneously

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother? a) Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization b) No treatment is necessary, as the defect will resolve spontaneously c) Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions d) Surgical closure by ductal ligation

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions

A 6-year-old girl is diagnosed with pulmonary 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 valve, followed by inflation of the balloon to break up adhesions Balloon angioplasty by way of cardiac catheterization is the procedure of choice for pulmonary stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed valve. As the balloon is inflated, it breaks valve adhesions and relieves the stenosis. The other answers refer to interventions related to patent ductus arteriosus, not pulmonary stenosis.

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. The nurse should tell the mother which of the following? a) No treatment is necessary, as the defect will resolve spontaneously b) Surgical closure by ductal ligation c) Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions d) Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions Correct Explanation: Balloon angioplasty by way of cardiac catheterization is the procedure of choice for pulmonary stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed valve. As the balloon is inflated, it breaks valve adhesions and relieves the stenosis. The other answers refer to interventions related to patent ductus arteriosus, not pulmonary stenosis.

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. Which of the following is the best response from the nurse? a) It will determine disturbances in heart conduction. b) It will show if blood is being shunted. c) This image will clarify the structures within the heart. d) It will determine if the heart is enlarged.

It will determine if the heart is enlarged.

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse?

It will determine if the heart is enlarged. Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. Which of the following is the best response from the nurse? a) It will show if blood is being shunted. b) This image will clarify the structures within the heart. c) It will determine if the heart is enlarged. d) It will determine disturbances in heart conduction.

It will determine if the heart is enlarged. Correct Explanation: Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI.

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child? a) Presacral region b) Lower extremities c) Hands d) Face

Lower extremities

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?

Lower extremities Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities

When caring for a child with Kawasaki Disease, the nurse would know which of the following? a) Joint pain is a permanent problem. b) Management includes administration of aspirin and IVIG. c) Steroid creams are used for the hand peeling. d) Antibiotics should be administered exactly every 8 hours by IV.

Management includes administration of aspirin and IVIG.

When caring for a child with Kawasaki disease, the nurse would know that:

Management includes administration of aspirin and IVIG. Kawasaki disease is managed with IVIG and aspirin to prevent cardiac complications. Joint pain is not necessarily a permanent problem associated with Kawasaki disease. Antibiotics and steroid creams are not used for this disorder.

When caring for a child with Kawasaki Disease, the nurse would know which of the following? a) Joint pain is a permanent problem. b) Steroid creams are used for the hand peeling. c) Management includes administration of aspirin and IVIG. d) Antibiotics should be administered exactly every 8 hours by IV.

Management includes administration of aspirin and IVIG. Correct Explanation: Kawasaki disease is managed with IVIG and aspirin to prevent cardiac complications. Joint pain is not necessarily a permanent problem associated with Kawasaki disease. Antibiotics and steroid creams are not used for this disorder.

The nurse is auscultating heart sounds of a child with a mitral valve prolapse. The nurse should expect which assessment finding? a) Abnormal splitting of S2 sounds b) Intensifying of S2 sounds c) Mild to late ejection click at the apex d) Clicks on the upper left sternal border

Mild to late ejection click at the apex

A nurse is administering digoxin to a 3-year-old. Which of the following would be a reason to hold the dose of digoxin? a) Hypertension b) Fever and tinnitus c) Nausea and vomiting d) Ataxia

Nausea and vomiting

A nurse is administering digoxin to a 3-year-old. Which of the following would be a reason to hold the dose of digoxin? a) Ataxia b) Fever and tinnitus c) Nausea and vomiting d) Hypertension

Nausea and vomiting Explanation: Nausea and vomiting are signs of digoxin toxicity. The other symptoms listed here are not necessarily signs of a digoxin toxicity.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. Which of the following would be the priority nursing intervention? a) Observe vitals every two hours. b) Notify the doctor immediately. c) Administer epinephrine. d) Elevate the head of the bed.

Notify the doctor immediately.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?

Notify the doctor immediately. The nurse would notify the doctor immediately. Cardiac tamponade is a medical emergency and should be addressed. The child can die if intervention is postponed. It would not be appropriate to perform any interventions until confirming that this is the actual diagnosis

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. Which of the following would be the priority nursing intervention? a) Observe vitals every two hours. b) Elevate the head of the bed. c) Notify the doctor immediately. d) Administer epinephrine.

Notify the doctor immediately. Correct Explanation: The nurse would notify the doctor immediately. Cardiac tamponade is a medical emergency and should be addressed. The child can die if intervention is postponed. It would not be appropriate to perform any interventions until confirming that this is the actual diagnosis.

The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess? 1. Obesity from overeating. 2. Clubbing of the nail beds. 3. Squatting during play activities. 4. Exercise intolerance.

Obesity from overeating.

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of what factor as the major mechanism involved? a) Narrowing of the major vessel b) Obstruction of blood flow to the lungs c) Mixing of well-oxygenated and poorly oxygenated blood d) Increased pulmonary blood flow

Obstruction of blood flow to the lungs

A client's newborn is diagnosed with Tetralogy of Fallot. When explaining this condition to the client, which of the following defects would the nurse's description include? a) Atrial septal defect b) Overriding of the aorta c) Stenosis of the aorta d) Left ventricular hypertrophy

Overriding of the aorta

Overriding of the aorta Explanation: One of the components in the Tetralogy of Fallot is overriding of the aorta. Tetralogy of Fallot is a congenital heart disease with 4 components. The defects in the Tetralogy of Fallot include ventricular septal defect, overriding of the aorta, pulmonary stenosis, and right ventricular hypertrophy. Atrial septal defect, stenosis of the aorta and left ventricular hypertrophy are not components of Tetralogy of Fallot.

When educating the family of an ill infant with an atrioventricular canal defectseptic defect, what information would be included in the education if the doctor is planning on performing palliative care until the infant is healthier? a) VSD patching surgery should be performed immediately. b) Palliative pulmonary artery banding should help the infant grow. c) The medication indomethacin is used to try to close the hole. d) Most infants do not need surgical repair for this if palliative procedures are performed.

Palliative pulmonary artery banding should help the infant grow.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? a) Peeling hands and feet and fever b) Decreased heart rate and impalpable pulse c) Low blood pressure and decreased heart rate d) Irritability and dry mucous membranes

Peeling hands and feet and fever

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

Peeling hands and feet and fever One of the signs of Kawasaki disease is the peeling hands and feet. The other symptoms are not necessarily characteristic of Kawasaki disease.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? a) Irritability and dry mucous membranes b) Decreased heart rate and impalpable pulse c) Low blood pressure and decreased heart rate d) Peeling hands and feet and fever

Peeling hands and feet and fever Explanation: One of the signs of Kawasaki disease is the peeling hands and feet. The other symptoms are not necessarily characteristic of Kawasaki disease.

A child is diagnosed with tetralogy of Fallot and during a temper tantrum turns blue. Which of the following would the nurse do first? a) Assess for an irregular heart rate. b) Assess for an increased respiratory rate. c) Place child in the knee-to-chest position. d) Explain to the child the need to calm down since it is affecting the heart.

Place child in the knee-to-chest position.

A child is diagnosed with tetralogy of Fallot and during a temper tantrum turns blue. Which of the following would the nurse do first? a) Assess for an increased respiratory rate. b) Place child in the knee-to-chest position. c) Assess for an irregular heart rate. d) Explain to the child the need to calm down since it is affecting the heart.

Place child in the knee-to-chest position. Correct Explanation: Place child in the knee-to-chest position. This position is the first priority of the child with tetralogy of Fallot. Cyanosis is caused by the heart defect and placing the child in this position will decrease the cyanosis.

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. What should the nurse instruct the parents to do in the event that the child becomes cyanotic? a) Administer prescribed amoxicillin b) Administer low-dose aspirin c) Perform hands-on CPR d) Place him in a knee-chest position

Place him in a knee-chest position

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. Which of the following should the nurse instruct the parents to do in the event that the child becomes cyanotic? a) Perform hands-on CPR b) Administer prescribed amoxicillin c) Place him in a knee-chest position d) Administer low-dose aspirin

Place him in a knee-chest position Explanation: Before parents leave the hospital with a newborn who has a congenital heart disorder, be certain they have the name and number of the health professional to call if they have a question about their infant's health. Review with them the steps to take if their child should become cyanotic, such as placing the child in a knee-chest position. "Hands on" CPR is not recommended for children as it is for adults. Remind parents that children with many types of congenital heart disorders or rheumatic fever need prophylactic low-dose aspirin therapy to avoid blood clotting; although becoming a controversial practice, they may be prescribed antibiotic therapy such as oral amoxicillin before oral surgery.

The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority? a) Use a calm, comforting approach. b) Administer propranolol (0.1 mg/kg IV). c) Provide supplemental oxygen. d) Place the child in a knee-to-chest position.

Place the child in a knee-to-chest position.

The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?

Place the child in a knee-to-chest position. The priority nursing action is to place the infant or child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen would be provided as ordered. Once a child is placed in the knee-to-chest position, medications would be given as ordered.

The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority? a) Provide supplemental oxygen. b) Use a calm, comforting approach. c) Administer propranolol (0.1 mg/kg IV). d) Place the child in a knee-to-chest position.

Place the child in a knee-to-chest position. Correct Explanation: The priority nursing action is to place the infant or child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen would be provided as ordered. Once a child is placed in the knee-to-chest position, medications would be given as ordered.

While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? 1. Provide supplemental oxygen by face mask. 2. Administer a dose of IV morphine sulfate. 3. Begin cardiopulmonary resuscitation. 4. Place the infant in a knee-to-chest position.

Place the infant in a knee-to-chest position.

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

Place the infant in the knee-chest position. 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.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority? a) Start an IV for fluids. b) Prepare the infant for surgery. c) Raise the head of the bed. d) Place the infant in the knee-chest position.

Place the infant in the knee-chest position. Correct 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 of the following would be most important to implement for an infant who develops heart failure? a) Placing her in a semi-Fowler's position b) Keeping her supine and playing quiet games c) Planning ways to reduce salt intake d) Restricting milk intake daily

Placing her in a semi-Fowler's position

Which of the following would be most important to implement for an infant who develops heart failure? a) Restricting milk intake daily b) Keeping her supine and playing quiet games c) Placing her in a semi-Fowler's position d) Planning ways to reduce salt intake

Placing her in a semi-Fowler's position Correct Explanation: Placing an infant with heart failure in a semi-Fowler's position reduces the pressure of abdominal contents against the chest and gives the heart the opportunity to function more effectively.

When reviewing the record of a child with tetralogy of Fallot, which of the following would you expect to discover? a) Polycythemia b) Anemia c) Leukopenia d) Increased platelet level

Polycythemia

When reviewing the record of a child with tetralogy of Fallot, which of the following would you expect to discover? a) Anemia b) Increased platelet level c) Polycythemia d) Leukopenia

Polycythemia Correct Explanation: Children who cannot oxygenate red cells well often produce excess red blood cells or develop polycythemia.

Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? 1. Previous streptococcal throat infection. 2. History of open heart surgery at 5 years of age. 3. Playing too much soccer and not getting enough rest. 4. Exposure to a sibling with pneumonia.

Previous streptococcal throat infection.

A parent brings an infant in for poor feeding. Which of the following assessment data would most likely indicate a coarctation of the aorta? a) Pulses weaker in upper extremities compared to lower extremities b) Cyanosis with feeding c) Pulses weaker in lower extremities compared to upper extremities d) Cyanosis with crying

Pulses weaker in lower extremities compared to upper extremities

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

Pulses weaker in lower extremities compared to upper extremities An infant with coarctation of the aorta has decreased systemic circulation, causing this problem. The cyanosis would be associated with tetralogy of Fallot.

A parent brings an infant in for poor feeding. Which of the following assessment data would most likely indicate a coarctation of the aorta? a) Cyanosis with feeding b) Pulses weaker in lower extremities compared to upper extremities c) Cyanosis with crying d) Pulses weaker in upper extremities compared to lower extremities

Pulses weaker in lower extremities compared to upper extremities Explanation: An infant with coarctation of the aorta has decreased systemic circulation causing this problem. The cyanosis would be associated with tetralogy of Fallot.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

Serum potassium level Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug. Serum sodium levels may be obtained in children with heart failure to ensure that an increased sodium level is not causing edema. The erythrocyte sedimentation rate identifies inflammation and is unrelated to the use of diuretics and digoxin. Oxygen saturation levels may be done to evaluate for hypoxemia, but these results would be unrelated to the use of digoxin and diuretics

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor? a) Erythrocyte sedimentation rate b) Serum sodium level c) Oxygen saturation level d) Serum potassium level

Serum potassium level Correct Explanation: Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug. Serum sodium levels may be obtained in children with heart failure to ensure that an increased sodium level is not causing edema. The erythrocyte sedimentation rate identifies inflammation and is unrelated to the use of diuretics and digoxin. Oxygen saturation levels may be done to evaluate for hypoxemia, but these results would be unrelated to the use of digoxin and diuretics.

An infant girl is prescribed digoxin. The nurse would teach her parents that the action of this drug is to:

Slow and strengthen her heartbeat. Digoxin is a cardiac glycoside that slows and strengthens the heartbeat.

The nurse assesses a child for clubbing. What would the nurse identify as the initial sign? a) Shininess of the nail ends b) Softening of the nail beds c) Rounding of the fingers d) Thickening of the nail ends

Softening of the nail beds

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding? a) Softening of the nail beds b) Intact rooting reflex c) Steady weight gain since birth d) Appropriate mastery of developmental milestones

Softening of the nail beds

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding?

Softening of the nail beds Softening of nail beds is the first sign of clubbing due to chronic hypoxia. Rounding of the fingernails is followed by shininess and thickness of nail ends.

A nurse is caring for a newborn with congenital heart disease (CHD). Which of the following would the nurse interpret as indicating distress? a) Reduced respiratory rate during feeding b) Feeding lasting for 15-20 minutes c) Perspiration on body after feeding d) Subbcostal retraction at the time of feeding

Subbcostal retraction at the time of feeding Correct 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.

A nurse is caring for a newborn with congenital heart disease (CHD). Which finding would the nurse interpret as indicating distress? a) Reduced respiratory rate during feeding b) Perspiration on body after feeding c) Feeding lasting for 15-20 minutes d) Subcostal retraction at the time of feeding

Subcostal retraction at the time of feeding

A nurse is caring for a child who is experiencing heart failure. Which of the following assessment data was most likely seen when initially examined? a) Polyuria b) Tachycardia c) Bradycardia d) Splenomegaly

Tachycardia

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure? a) Tachycardia b) Bradycardia c) Inability to sweat d) Splenomegaly

Tachycardia

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure? a) Bradycardia b) Inability to sweat c) Tachycardia d) Splenomegaly

Tachycardia Correct Explanation: Tachycardia is one of the signs of heart failure. Bradycardia, inability to sweat, and splenomegaly are not necessarily signs of heart failure.

A nurse is caring for a child who is experiencing heart failure. Which of the following assessment data was most likely seen when initially examined? a) Bradycardia b) Tachycardia c) Splenomegaly d) Polyuria

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, but not splenomegaly or polyuria.

At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important? a) Allowing the child to talk about the procedure b) Allowing the child to adapt to the light room gradually c) Taking pedal pulses for the first 4 hours d) Assuring the child that the procedure is now over

Taking pedal pulses for the first 4 hours

At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important? a) Allowing the child to adapt to the light room gradually b) Assuring the child that the procedure is now over c) Taking pedal pulses for the first 4 hours d) Allowing the child to talk about the procedure

Taking pedal pulses for the first 4 hours Correct 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 newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis? a) Coarctation of aorta b) Pulmonary stenosis c) Aortic stenosis d) Tetralogy of Fallot

Tetralogy of Fallot

A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis?

Tetralogy of Fallot 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 aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis

A newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis? a) Coarctation of aorta b) Aortic stenosis c) Pulmonary stenosis d) Tetralogy of Fallot

Tetralogy of Fallot Correct 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 aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.

A newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis? a) Aortic stenosis b) Tetralogy of Fallot c) Pulmonary stenosis d) Coarctation of aorta

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 aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.

A nurse is providing education to a family about cardiac catheterization. What information would be included in the education? a) The procedure will be performed even if the child has a fever. b) The child will be able to move their leg again immediately after the procedure. c) The catheter will be placed in the brachial artery. d) The catheter will be placed in the femoral artery.

The catheter will be placed in the femoral artery.

A nurse is providing education to a family about cardiac catheterization. What information would be included in the education?

The catheter will be placed in the femoral artery. The femoral artery is the correct placement of the cardiac catheter. The child will need to lie still for several hours after the procedure. The procedure is usually postponed if the child has a fever.

A nurse is providing education to a family about cardiac catheterization. Which of the following would be included in the education? a) The child will be able to move their leg again immediately after the procedure. b) The procedure will be performed even if the child has a fever. c) The catheter will be placed in the brachial artery. d) The catheter will be placed in the femoral artery.

The catheter will be placed in the femoral artery. Correct Explanation: The femoral artery is the correct placement of the cardiac catheter. The child will need to lie still for several hours after the procedure. The procedure is usually postponed if the child has a fever.

A child is being placed on a cardiopulmonary bypass machine. The nurse understands the heart will pump again on its own when what occurs? a) The child starts getting warm again b) When cardioplegia is administered c) When digoxin is administered d) When chest compressions are performed

The child starts getting warm again

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. 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 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? a) The child will need the blood pressure checked two more times. b) This is a normal result for a child this age. c) The child will probably need surgery. d) Advise the child go to the emergency room.

The child will need the blood pressure checked two more times. Correct 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 nursing instructor is preparing for a class about the structural and functional differences in the cardiovascular system of infants and children as compared to adults. What would the instructor include in the class discussion? a) The heart is about four times the birth size between the ages of 6 and 12 years. b) Blood pressure is initially high at birth but gradually decreases to adult levels. c) The heart's apex is higher in the chest in children younger than the age of 7 years. d) Left ventricular function predominates immediately after birth.

The heart's apex is higher in the chest in children younger than the age of 7 years.

A nursing instructor is preparing for a class about the structural and functional differences in the cardiovascular system of infants and children as compared to adults. Which of the following would the instructor include in the class discussion? a) The heart's apex is higher in the chest in children younger than the age of 7 years. b) Blood pressure is initially high at birth but gradually decreases to adult levels. c) The heart is about four times the birth size between the ages of 6 and 12 years. d) Left ventricular function predominates immediately after birth.

The heart's apex is higher in the chest in children younger than the age of 7 years. Correct Explanation: In infants and children younger than age 7 years, the heart lies more horizontally, resulting in the apex lying higher in the chest. Right ventricular function predominates at birth, and over the first few months of life, left ventricular function becomes dominant. A normal infant's blood pressure is about 80/40 mm Hg and increases over time to adult levels. Between the ages of 1 and 6 years, the heart is four times the birth size; between 6 and 12 years of age, the heart is 10 times its birth size.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. Which of the following would most likely explain this assessment finding? a) The spleen increases due to increased destruction of red blood cells. b) The liver increases due to cardiac medications. c) The spleen increases due to frequent infection. d) The liver increases in right-sided heart failure.

The liver increases in right-sided heart failure.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. Which of the following would most likely explain this assessment finding? a) The spleen increases due to frequent infection. b) The spleen increases due to increased destruction of red blood cells. c) The liver increases in right-sided heart failure. d) The liver increases due to cardiac medications.

The liver increases in right-sided heart failure. Explanation: The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding?

The liver size increases in right-sided heart failure. The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly

A nurse is interviewing a mother who is about to deliver her baby. Which of the following responses would alert the nurse for a higher potential for a heart defect in the infant? a) The mother has seizures, but did not take medication while pregnant. b) The mother states she slept all the time while pregnant. c) The mother states she took acetaminophen while pregnant. d) The mother states she has lupus.

The mother states she has lupus.

A nurse is interviewing a mother who is about to deliver her baby. Which response would alert the nurse for a higher potential for a heart defect in the infant?

The mother states she has lupus. Having lupus while pregnant could contribute to a congenital heart defect. Acetaminophen and sleeping do not have an effect on a child developing a heart defect. The seizure medication can have an impact on the child having a heart defect, but not necessarily a history of seizures in the mother.

A nurse is interviewing a mother who is about to deliver her baby. Which of the following responses would alert the nurse for a higher potential for a heart defect in the infant? a) The mother states she slept all the time while pregnant. b) The mother states she took acetaminophen while pregnant. c) The mother has seizures, but did not take medication while pregnant. d) The mother states she has lupus.

The mother states she has lupus. Correct Explanation: Having lupus while pregnant could contribute to a congenital heart defect. Acetaminophen and sleeping do not have an effect on a child developing a heart defect. The seizure medication can have an impact on the child having a heart defect, but not necessarily a history of seizures in the mother.

The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. Which of the following would be included in the intervention strategies? a) Blood pressures should be measured daily. b) The child should not be allowed to participate in sports. c) Beta blocker education should be given to the parents. d) The nurse would review the child's 24-hour diet recall.

The nurse would review the child's 24-hour diet recall.

The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. Which of the following would be included in the intervention strategies? a) The nurse would review the child's 24-hour diet recall. b) The child should not be allowed to participate in sports. c) Blood pressures should be measured daily. d) Beta blocker education should be given to the parents.

The nurse would review the child's 24-hour diet recall. Explanation: With a child in the 90th percentile for blood pressure, diet and physical activity should be the main focus. Blood pressures should be measured, but daily is not necessary. Children are not routinely put on beta blockers and the child should be allowed to participate in sports if monitored.

A parent asks if the reason her infant has a congenital heart defect is because of something she did while she was pregnant. What is the best response by the nurse? a) No, heart defects are mainly caused by genetic factors. b) The studies show it is impossible to know what causes heart defects. c) There are several reasons a baby can have a heart defect, let's talk about those causes. d) Yes, there is a chance you caused this defect.

There are several reasons a baby can have a heart defect, let's talk about those causes.

A parent asks if the reason her infant has a congenital heart defect is because of something she did while she was pregnant. What is the best response by the nurse?

There are several reasons a baby can have a heart defect, let's talk about those causes. Focus on the therapeutic communication in this situation, while still obtaining more information. This will help the nurse explore various options for the cause of the defect with the parent.

A parent asks if the reason her infant has a congenital heart defect is because of something she did while she was pregnant. What is the best response by the nurse? a) No, heart defects are mainly caused by genetic factors. b) The studies show it is impossible to know what causes heart defects. c) Yes, there is a chance you caused this defect. d) There are several reasons a baby can have a heart defect, let's talk about those causes.

There are several reasons a baby can have a heart defect, let's talk about those causes. Correct Explanation: Focus on the therapeutic communication in this situation, while still obtaining more information. This will help the nurse explore various options for the cause of the defect with the parent.

PEDS: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder 3

Ensembles d'études connexes

Chapter 3 quiz B

Biology 1361: Chapter 4

econ practice midterm #2

AP Psych Unit 10

Counseling

tik 185 klausimai

Success Peds - GI

BMED420 Midterm1

Chapter 16: the dirt on black market plants

NCLEX Style Questions for Exam 4

Chapter 28 - Microbial Ecology

CHEM 140 Final

asepsis and infection control prep u

DECA Hospitality and Tourism

Social Psych

ACC 111 - Ch 3

Audit Chapter 5

VA History Module 1

Med Surg exam #2 CHAPTERS 41, 42, 43, 44, 45

ENT200 Cengage Ch.4