Wong: Chapter 27: The Child with Cardiovascular Dysfunction

a common finding on physical examination of the child with acute rheumatic heart disease is: a) a systolic murmur b) a pleural friction rub c) an ejection click d) a split S2

a) a systolic murmur

The standard treatment for kawasaki disease is: a) aspirin and immune globulin b) aspirin and cryoprecipitate c) meperidine hydrochloride and immune globulin d) meperidine hydrochloride and cryoprecipitate

a) aspirin and immune globulin

coarctation of the aorta should be suspected when: a) the blood pressure in the arms is different from the blood pressure in the legs b) the blood pressure in the right arm is different from the blood pressure in the left arm c) apical pulse is stronger than the radial pulse d) point of maximum impulse is shifted to the left

a) the blood pressure in the arms is different from the blood pressure in the legs

Acts directly on distal tubules and possibly proximal tubules to decrease sodium, water, potassium, chloride, and bicarbonate absorption; decreases urinary diluting capacity; may need to supplement potassium

Chlorothiazide

of the following descriptions, the heart sound that would be considered normal in a young child is: a) splitting of S1 b) splitting of S2 c) splitting of S3 d) splitting of S4

b) splitting of S2

In fetal circulation, the umbilical vein divides and sends blood directly to the inferior vena cava by way of the ductus venosus. This division occurs at the: a) heart b) lungs c) liver d) placenta

c) liver

which of the following is not a major manifesto of rheumatic fever? a) carditis b) chorea c) erythema marginatum d) uveitis e) polyarthritis

e) polyarthritis

Blocks reabsorption of sodium and water to produce diuresis

furosemide

A beta blocker; blocks a and B-adrenergic receptors, causing decreased heart rate, decreased blood pressure and vasodilation; used selectively in children; improves symptoms and left ventricular function

Carvedilol

children who have been treated for rheumatic fever: a) do not need additional prophylaxis against BE b) are immune to rheumatic fever for the rest of their lives c) will have transitory manifestations of chorea for the rest of their lives d) may need antibiotic therapy for years

d) may need antibiotic therapy for years

A clue in the mother's history that is important in the diagnosis of congenital heart disease is: a) rheumatoid arthritis b) rheumatic fever c) streptococcal infection d) rubella

d) rubella

Which should the nurse consider when preparing a school-age child and the family for heart surgery? A. Unfamiliar equipment should not be shown. B. Let child hear the sounds of an ECG monitor. C. Avoid mentioning postoperative discomfort and interventions. D. Explain that an endotracheal tube will not be needed if the surgery goes well.

B. Let child hear the sounds of an ECG monitor.

Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? A. Pulmonary congestion B. Congenital heart defect C. Heart failure D. Systemic venous congestion

C. Heart failure

The nurse is caring for a child after heart surgery. Which should the nurse do if evidence is found of cardiac tamponade? A. Increase analgesia. B. Apply warming blankets. C. Immediately report this to physician. D. Encourage child to cough, turn, and breathe deeply.

C. Immediately report this to physician.

Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure? A. Tachypnea B. Tachycardia C. Peripheral edema D. Pale, cool extremities

C. Peripheral edema

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? A. "You may need to increase the caloric density of your infant's formula." B. "You should feed your baby every 2 hours." C. "You may need to increase the amount of formula your infant eats with each feeding." D. "You should place a nasal oxygen cannula on your infant during and after each feeding."

A. "You may need to increase the caloric density of your infant's formula."

A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse be administering? A. Captopril (Capoten) B. Furosemide (Lasix) C. Spironolactone (Aldactone) D. Chlorothiazide (Diuril)

A. Captopril (Capoten)

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on which statement? A. Child needs opportunities to play with peers. B. Child needs to understand that peers' activities are too strenuous. C. Parents can meet all of the child's needs. D. Constant parental supervision is needed to avoid overexertion.

A. Child needs opportunities to play with peers.

The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for? A. Cardiac arrhythmia B. Hypostatic pneumonia C. Heart failure D. Rapidly increasing blood pressure

ANS: A Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)? A. It decreases edema. B. It decreases cardiac output. C. It increases heart size. D. It increases venous pressure.

ANS: A Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size and venous pressure are decreased by digoxin.

The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching? A. "I should avoid tub baths but may shower." B. "I have to stay on strict bed rest for 3 days." C. "I should remove the pressure dressing the day after the procedure." D. "I may attend school but should avoid exercise for several days."

ANS: B The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: A. directed at his parents because he is too young to understand. B. detailed in regard to the actual procedures so he will know what to expect. C. done several days before the procedure so that he will be prepared. D. adapted to his level of development so that he can understand.

ANS: D Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.

The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to: A. notify physician. B. apply new bandage with more pressure. C. place the child in Trendelenburg position. D. apply direct pressure above catheterization site.

ANS: D If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.

Which explanation regarding cardiac catheterization is appropriate for a preschool child? A. Postural drainage will be performed every 4 to 6 hours after the test. B. It is necessary to be completely "asleep" during the test. C. The test is short, usually taking less than 1 hour. D. When the procedure is done, you will have to keep your leg straight for at least 4 hours.

ANS: D The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.

Causes vasodilation that decreases pulmonary and systemic vascular resistance, decreased blood pressure, reduced after load, and decreased right and left atrial pressures.

Angiotensin-converting enzyme (ACE) inhibitor

An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. A. 60 B. 70 C. 90 D. 100

B. 70

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk? A. Minimize seizures. B. Prevent dehydration. C. Promote cardiac output. D. Reduce energy expenditure.

B. Prevent dehydration.

Which is the leading cause of death after heart transplantation? A. Infection B. Rejection C. Cardiomyopathy D. Heart failure

B. Rejection

The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? A. Seizures B. Vomiting C. Bradypnea D. Tachycardia

B. Vomiting

As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in: A. chlorides. B. potassium. C. sodium. D. vitamins.

B. potassium.

A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. A. 60 B. 70 C. 90 to 110 D. 110 to 120

C. 90 to 110

Which is an important nursing consideration when chest tubes will be removed from a child? A. Explain that it is not painful. B. Explain that only a Band-Aid will be needed. C. Administer analgesics before procedure. D. Expect bright red drainage for several hours after removal.

C. Administer analgesics before procedure.

Which is an important nursing consideration when suctioning a young child who has had heart surgery? A. Perform suctioning at least every hour. B. Suction for no longer than 30 seconds at a time. C. Administer supplemental oxygen before and after suctioning. D. Expect symptoms of respiratory distress when suctioning.

C. Administer supplemental oxygen before and after suctioning.

Nursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.) A. Allow ambulation as tolerated. B. Monitor vital signs every 2 hours. C. Assess the affected extremity for temperature and color. D. Check pulses above the catheterization site for equality and symmetry. E. Remove pressure dressing after 4 hours. F. Maintain a patent peripheral intravenous catheter until discharge.

C. Assess the affected extremity for temperature and color. F. Maintain a patent peripheral intravenous catheter until discharge.

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.) A. Thirst and diminished urinary output B. Irritability and apprehension C. Cool extremities and decreased skin turgor D. Confusion and somnolence E. Normal blood pressure and narrowing pulse pressure F. Tachypnea and poor capillary refill time

C. Cool extremities and decreased skin turgor D. Confusion and somnolence F. Tachypnea and poor capillary refill time

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) A. Warm flushed extremities B. Weight loss C. Decreased urinary output D. Sweating (inappropriate) E. Fatigue

C. Decreased urinary output D. Sweating (inappropriate) E. Fatigue

air embolism may form in the venous system, traveling directly to the brain in the child with: a) a right to left shunt b) a left to right shunt c) dehydration and hypoxemia d) hypernatremia and hypokalemia

a) a right to left shunt

In fetal circulation the majority of the oxygenated blood is pumped through the: a) foramen ovale b) lungs c) liver d) coronary sinus

a) foramen ovale

The parents of a young child with heart failure tell the nurse that they are "nervous" about giving digoxin (Lanoxin). The nurse's response should be based on which statement? A. It is a safe, frequently used drug. B. It is difficult to either overmedicate or undermedicate with digoxin. C. Parents lack the expertise necessary to administer digoxin. D. Parents must learn specific, important guidelines for administration of digoxin.

D. Parents must learn specific, important guidelines for administration of digoxin.

Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. Which action should the nurse take? A. Keep child warm with blankets. B. Apply a hypothermia blanket. C. Record temperature on nurses' notes. D. Report findings to physician.

D. Report findings to physician.

When discussing hyperlipidemia with a group of adolescents, the nurse should explain that cardiovascular disease can be prevented by high levels of: A. cholesterol. B. triglycerides. C. low-density lipoproteins (LDLs). D. high-density lipoproteins (HDLs).

D. high-density lipoproteins (HDLs).

Used because of its rapid onset and decreased risk for toxicity; increases the force of contraction (positive inotropic effect), decreases the heart rate (negative chronotropic effect), slows the conduction of impulses through the AV node (negative dromotropic effect), and indirectly enhances diuresis

Digoxin

tetrology of fallot consists of these defects: a) VSD b) ASD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aorta f) patent ductus arteriosus

a) VSD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aorta

When obtaining a history from the parents of an infant suspected of having altered cardiac function, the nurse would expect: a) specific concerns related to palpitations the infant is having b) feeding difficulty, sweating with activity, and poor weight gain c) specific concerns about the infant's shortness of breath d) concerns related to the infant's lack of crying

b) feeding difficulty, sweating with activity, and poor weight gain

the process of the formation of the heart's atrial septum results in a temporary flap called the a) truncus arteriosus b) foramen ovale c) sinus venosus d) ductus venosus

b) foramen ovale

In children, the usual approach to the left ventricle of the heart in a cardiac catheterization is through the: a) left side of the heart b) right side of the heart

b) right side of the heart

the peak age for the incidence of kawasaki disease is in the: a) infant age group b) toddler age group c) school age group d) adolescent age group

b) toddler age group

The standard pediatric ECG has: a) 6 leads b) 12 leads c) 15 leads d) 18 leads

c) 15 leads

which one of the following heart rates would be considered tachycardia in an infant? a) a resting hr of 120 bpm b) a crying hr of 200 bpm c) a resting hr of 170 bpm d) a crying hr of 180 bpm

c) a resting hr of 170 bpm

which one of the following defects has the best prognosis? a) tetrology of fallot b) ventricular septal defect c) atrial septal defect d) hypoplastic left heart syndrome

c) atrial septal defect

When children develop heart failure from a congenital heart defect, the failure is usually: a) right sided only b) left sided only c) both right and left sided

c) both right and left sided

The presence of poor ventricular function and atrial arrhythmia increases the risk for: a) infection b) CVA c) fever d) air embolism

c) fever

Because of the medication used for long term therapy, children with kawasaki disease are at increased risk for: a) chickenpox b) influenza c) reye syndrome d) myocardial infarction

c) reye syndrome

The diagnostic test that requires intravenous sedation and has been used increasingly in recent years to confirm the diagnosis of a congenital heart defect without a cardia catheterization is the: a) ECG b) echocardiogram c) transesophageal echocardiogram d) two-dimensional echocardiogram

c) transesophageal echocardiogram

which of the following defects has the worst prognosis? a) tetrology of fallot b) atrial ventricular canal defect c) transposition of the great vessels d) hypoplastic left heart syndrome

d) hypoplastic left heart syndrome

ACE inhibitors that are frequently used in pediatrics

lisinopril, catopril, enalapril

Blocks action of aldosterone to produce diuresis; allows retention of potassium

spironolactone