Chapter 26- Caring for a Child with Cardiovascular Conditions

A child has been admitted with Kawasaki disease and is started on aspirin and warfarin (Coumadin). For which nursing diagnosis does the nurse plan interventions as the priority? A. Acute pain related to mouth redness and cracked lips B. Altered body image related to peeling skin rash C. Altered nutrition: less than body requirements D. Risk for bleeding related to medication effects

D. Risk for bleeding related to medication effects

A nurse is admitting a child scheduled for a Fontan repair. Which condition does the nurse understand the child to have? A. Aortic stenosis B. Patent ductus arteriosus C. Pulmonary regurgitation D. Tricuspid atresia

D. Tricuspid atresia

The parents of a child born with severe hypoplastic left heart syndrome ask the nurse about treatment options. Which option is inconsistent with the nurses knowledge about this condition? A. Palliative or end-of-life care is one possibility. B. She can be listed for a cardiac transplant. C. Surgical correction involves several procedures. D. We can give a series of dopamine (Intropin) infusions.

D. We can give a series of dopamine (Intropin) infusions

A pediatric nurse palpates a 2-year-old childs liver at 4 cm below the right costal margin. Which actions by the nurse are appropriate? (Select all that apply.) A. Assess work of breathing. B. Auscultate lung sounds. C. Calculate childs intake and output. D. Determine last bowel movement. E. Listen for heart murmur.

A, B, C, D

The pediatric intensive care nurse assesses for the main complications following cardiac transplantation. Which complications is the nurse assessing for after cardiac transplantation? (Select all that apply.) A. Coronary artery disease B. Infection C. Post-transplant lymphoproliferative disorder D. Rejection E. Renal failure

A, B, C, D

The faculty is discussing cardiac output with a student. Which components comprise the cardiac output? (Select all that apply.) A. Afterload B. Contractility C. Heart rate D. Hemoglobin E. Stroke volume

A, B, C, E

A nursing faculty member is explaining the three different types of cardiomyopathy (CMP) to students. Which information does the faculty member include in this discussion? (Select all that apply.) A. Dilated CMP is often caused by infection. B. Dilated CMP is the least common form. C. Hypertrophic CMP is usually familial. D. Hypertrophic CMP involves poor filling. E. Restrictive CMP is the most common type.

A, C, D

The student studying pediatric cardiac disorders learns that which anomalies comprise the disorder tetralogy of Fallot? (Select all that apply.) A. An overriding aorta B. Atrial septal defect (ASD) C. Hypertrophic right ventricle D. Pulmonary stenosis or atresia E. Ventricular septal defect (VSD)

A, C, D, E

The pediatric nurse explains to the student that which valves are known as semilunar valves? (Select all that apply.) A. Aortic B. Bicuspid C. Mitral D. Pulmonary E. Tricuspid

A, D

A child has coarctation of the aorta (CoA). The parents report that the child is hesitant to participate in activities due to aching in his legs. Which information does the nurse provide? A. Aching or pain is due to lower blood pressure in the legs. B. Encourage activity so that collateral circulation develops. C. Maybe he is getting to much blood pressure medication. D. Your child needs to rest and limit participation in activities.

A. Aching or pain is due to lower blood pressure in the legs.

A nurse is monitoring a child after an interventional catheterization for PDA. Before the procedure, blood pressure was 98/42 mm Hg. After the procedure, blood pressure was 98/74 mm Hg. One hour later, the blood pressure is 96/34 mm Hg. What action by the nurse is best? A. Administer epinephrine (Adrenalin). B. Contact the provider. C. Document the findings. D. Give a rapid fluid bolus.

A. Administer epinephrine

A child is hospitalized with heart failure and is receiving furosemide (Lasix). Which nursing action is the priority? A. Administer oxygen. B. Encourage rest. C. Provide meticulous skin care. D. Monitor brain natriuretic peptide.

A. Administer oxygen

A child has significant polycythemia. When consulting with the health-care provider, which intervention does the nurse inquire about? A. Administering anticoagulants B. Implementing a fluid restriction C. Obtaining an oxygen saturation D. Starting cardiac rehabilitation

A. Administering anticoagulants

A 42-lb (19-kg) child is admitted for initial management of cardiomyopathy (CMP). The physician leaves orders for carvedilol (Coreg), 15 mg orally twice a day. What action by the nurse is most appropriate? A. Ask the provider to clarify the dose. B. Consult pharmacy about the drug choice. C. Give the medication as ordered. D. Withhold any antacids in this patient.

A. Ask the provider to clarify the dose

The mother of a toddler reports to the nurse that the child becomes cyanotic when he cries. Which question by the nurse is most important to ask the mother? A. Does he squat while he cries? B. How long does the cyanosis last? C. Is he growing normally? D. What was his birth weight?

A. Does he squat while he cries?

A child is being released from the hospital after surgical correction of an atrioventricular canal defect (AVC). What referral by the nurse is most appropriate? A. Down syndrome support group B. Hospice services team C. Lions eye bank D. Transplant team

A. Down syndrome support group

Which information about exercise should the nurse give the parents of a child with heart failure? A. Encourage activity on the days when your child feels well. B. Exercise is not allowed in children who have heart failure. C. Physical activity often makes heart failure worse in children. D. Your child will not be able to participate in contact sports.

A. Encourage activity on the days when your child feels well.

The parents of a child with transposition of the great vessels ask the nurse why the child looks blue. Which response by the nurse is the most appropriate? A. Her body gets blood that doesn't have much oxygen. B. Her lungs are underdeveloped and underperfused. C. She is not able to regulate her temperature and is cold. D. This is very unusual for this condition, so Ill ask the doctor.

A. Her body gets blood that doesn't have much oxygen

A nurse is teaching a community class on heart disease in children. Which information about prevention is most important for the nurse to share? A. Many conditions are genetic, and preventative gene therapy may become possible. B. Maintaining good control of diabetes and hypertension prevents most cases. C. Prevention is impossible because there are few known causes of heart disease. D. Taking 400 mg/day of folic acid will prevent most known cardiac diseases.

A. Many conditions are genetic, and preventative gene therapy may become possible.

A student nurse records a systolic blood pressure of 106 mm Hg for a 4-year-old child. Which response by the registered nurse is best? A. Ask the student if this is a normal finding. B. Have the student repeat the blood pressure. C. Refer the family to a health-care provider. D. Tell the student to document the results.

C. Refer the family to a health care provider

A 3-year-old child is 4 hours postcardiac catheterization via the right femoral artery. Which assessment finding should the nurse report to the provider? A. Crying, complaining of pain at site B. Restless, tries to get up repeatedly C. Right pedal pulse weaker than left D. Wants to be held by a parent

C. Right pedal pulse weaker than left

A child has a large ventricular septal defect (VSD) with left-to-right shunting. Which information about VSDs does the faculty member explain to the nursing student? (Select all that apply.) A. The child will have obvious cyanosis. B. A harsh, pansystolic murmur is heard. C. This is the most common congenital heart defect. D. Some VSDs can close spontaneously. E. Transcatheter closure is common.

B, C, D

A nurse is teaching a group of parents about bacterial endocarditis (BE) and follow-up care. Which parents should be instructed to obtain prophylactic antibiotics prior to dental cleaning? (Select all that apply.) A. Child after complete repair via catheter for 1 year B. Child after transplant, no residual defect, for 6 months C. Child with congenital repair with residual defect, for life D. Child with one prior episode of bacterial endocarditis E. Child with prosthetic mitral valve for the first 6 months

B, C, D

The student is learning about atrioventricular canal defects (AVCs). Which information stated by the student reflects appropriate understanding of the disease process? (Select all that apply.) A. Cyanosis is the cardinal manifestation. B. It often occurs in children with Down syndrome. C. Prostaglandin is administered preoperatively. D. The tricuspid and mitral valves form one opening. E. It will usually close on its own without surgery.

B, D

A nurse is assessing patients for the presence of patent ductus arteriosus (PDA). Which patient should the nurse assess first? A. 1-year old, history of frequent colds B. 4-year old, blood pressure of 102/36 mm Hg C. Infant with history of poor feeding D. Toddler with murmur at right sternal border

B. 4- year old, blood pressure of 102/36 mm Hg

A nurse notes that a childs chart describes a heave. Which assessment should the nurse perform to correlate with this finding? A. Assess for nausea. B. Auscultate for heart sounds. C. Listen to lung sounds. D. Review the last ECG.

B. Auscultate for heart sounds

At a well-child visit, the nurse notes a 4-year-old child to be in the 95th percentile for weight. Which screening measure is most important for the nurse include in this visit? A. Body mass index (BMI) B. Cholesterol panel C. Congenital heart disease D. None; child is too young

B. Cholesterol panel

A new nurse is taking a childs blood pressure. What action would cause an experienced nurse to intervene? A. Allows the child to get familiar with equipment B. Chooses a cuff that covers 65% of the childs arm C. Has a parent stay with the child to calm him or her D. Uses an automatic cuff if the heart rate is normal

B. Chooses a cuff that covers 65% of the child's arm

A child has truncus arteriosus with hypotension and poor perfusion. Which medication does the nurse prepare to administer? A. Amiodarone (Cordarone) B. Clopidogrel (Plavix) C. Dopamine (Intropin) D. Isoproterenol (Isuprel)

B. Clopidogrel (Plavix)

A school-age child is brought to the clinic by a parent who reports that the child becomes short of breath with activity. Which assessment finding would the nurse correlate with this condition? A. Bulging fontanels B. Elevated brain natriuretic peptide C. Peripheral edema D. Weight loss

B. Elevated brain natriuretic peptide

A child is scheduled for open heart surgery. Which nursing action is the priority? A. Complete the preoperative checklist. B. Ensure informed consent is on the chart. C. Show the parents the intensive care unit. D. Teach the family about the surgery.

B. Ensure informed consent is on the chart

A child has been diagnosed with an atrioventricular canal defect (AVC). While awaiting surgical correction, which teaching takes priority? A. Care of tubes and drains postoperatively B. Feeding the child frequent, small amounts C. Monitoring weight gain and urine output D. Returning for all scheduled appointments

B. Feeding the child frequent, small amounts

A student nurse asks the faculty why a child with patent ductus arteriosus (PDA) is taking a nonsteroidal anti-inflammatory drug (NSAID). Which response by the faculty is the most appropriate? A. Decreases venous stasis, lowering risks of clotting B. Inhibits prostaglandin, which helps close the PDA C. Provides long-lasting pain and inflammation control D. Reduces swelling around the PDA, making surgery easier

B. Inhibits prostaglandin, which helps close the PDA

A 12-year-old child has been diagnosed with long QT syndrome. Which teaching by the nurse is most important? A. No driving until rhythm disturbances are controlled for 6 months. B. Parents and siblings of the child need to be tested for the disorder. C. The child cannot participate in any contact sports for a year. D. Watch the child for symptoms of heart failure or infection.

B. Parents and siblings of the child need to be tested for the disorder.

A nurse is concerned that a child may have renal failure after open heart surgery. Which laboratory value does the nurse assess as the priority to determine the childs kidney function? A. Blood urea nitrogen (BUN) B. Serum creatinine C. Hemoglobin D. Urine pH

B. Serum creatinine

A child is prescribed warfarin (Coumadin). Which laboratory values does the nurse monitor? (Select all that apply.) A. Electrolytes B. Hematocrit (Hct) C. International normalized ratio (INR) D. Partial thromboplastin time (PTT) E. Prothrombin time (PT)

C, D

An infant has been diagnosed with pulmonic stenosis. Which manifestations does the nurse document as normal findings for this condition? (Select all that apply.) A. Cough B. Dyspnea C. Enlarged liver D. Puffy eyelids E. Retractions

C, D

An infant has critical aortic stenosis. The physician orders several medications for the infant. Which prescribed medications would the nurse question for this infant? (Select all that apply.) A. Bumetanide (Bumex) B. Diltiazem (Cardizem) C. Enoxaparin (Lovenox) D. Epinephrine (Adrenalin) E. Furosemide (Lasix)

C, D

Which is the average oxygen saturation of blood in the right atrium? A. 25% B. 50% C. 70% D. 98%

C. 70%

A student nurse is caring for a child several hours after open heart surgery. Which action by the student requires intervention by the registered nurse? A. Administers pain medication based on assessment of nonverbal signs of pain B. Groups nursing care tasks to allow for uninterrupted periods of rest and sleep C. Monitors hourly output from childs indwelling urinary catheter and chest tube D. Prepares to administer medication through the central venous pressure line

D. Prepares to administer medication through the central venous pressure line

A child hospitalized with heart failure has extremely high blood pressure. Which medication does the nurse prepare to administer? A. Digoxin (Lanoxin) B. Dobutamine (Dobutrex) C. Enalapril (Vasotec) D. Hydrochlorothiazide (Aquazide)

C. Enalapril (Vasotec)

A nurse is concerned that a child with pulmonary hypertension (PA) is developing heart failure. Which manifestation would the nurse assess for first? A. Cough B. Dyspnea C. Extremity edema D. Tachycardia

C. Extremity edema

What has the greatest influence on preload? A. Blood pressure B. Contractility C. Fluid volume D. Heart rate

C. Fluid volume

A child hospitalized with heart failure has manifestations related to increased preload. Which drug does the nurse prepare to administer? A. Digoxin (Lanoxin) B. Dopamine (Intropin) C. Furosemide (Lasix) D. Metoprolol (Toprol)

C. Furosemide (Lasix)

A nurse is assessing a school-age child admitted with new heart murmur, arthritis-type symptoms, erythema marginatum, and fever. When taking the childs history, which question is most likely to provide important information? A. Did your child have any vaccinations recently? B. Has your child been exposed to contagious illnesses? C. Has your child had a sore throat in the last 2 to 3 weeks? D. Is there a family history of autoimmune disorders?

C. Has your child had a sore throat in the last 2 to 3 weeks?

An infant is discharged after open heart surgery. The infant is going home on oxygen and with multiple medications. Which instruction by the nurse is the priority? A. Be sure to keep all postoperative appointments. B. Do not allow anyone to pick up or hold the baby. C. If your baby is irritable, check oxygen saturation. D. Monitor the incision for redness or warmth.

C. If your baby is irritable, check oxygen saturation

A nurse notes that a child has clubbed fingernails. Which laboratory finding would the nurse correlate with this assessment? A. Hemoglobin: 16 g/dL B. PaCO2: 43 mm Hg C. PaO2: 72 mm Hg D. White blood count: 8,500 mm3

C. PaO2 72 mm Hg

Which artery carries deoxygenated blood? A. Aorta B. Inferior vena cava C. Pulmonary artery D. Subclavian artery

C. Pulmonary artery

A child is being discharged after a pacemaker insertion. Which teaching point by the nurse takes priority? A. Any prescribed activity restrictions B. Need for a healthy balanced diet C. Schedule for pacemaker testing D. Signs of wound site infection

C. Schedule for pacemaker testing

A 10-year-old child is being discharged after surgical repair of a total anomalous pulmonary venous return defect (TAPVR). Which referral made by the nurse is most appropriate for this child? A. Hospice team B. Occupational therapy C. School nurse D. Visiting nurse

C. School nurse

A child has been admitted for suspected bacterial endocarditis. What action takes priority? A. Administering antibiotics B. Education on valve replacement C. Giving an antipyretic D. Obtaining blood cultures

D. Obtaining blood cultures

A child has had a closure device inserted in interventional radiology for an atrial septal defect (ASD). Two hours later the child is pale, tachycardic, and hypotensive. Which action by the nurse takes priority? A. Administer a beta blocker to slow the heart rate down. B. Document findings then notify the health-care provider. C. Increase the rate of the IV fluid administration. D. Prepare the child to return to interventional radiology.

D. Prepare the child to return to interventional radiology

A child diagnosed with a heart murmur is scheduled for an echocardiogram. Which information about this diagnostic test does the nurse provide to the family? A. Allows visualization of the hearts electrical activity B. Gives direct pressure measurements across valves C. Provides more specific information than other tests D. Shows the location and size of a heart defect

D. Shows the location and size of a heart defect

The nurse is assigned to four patients on the pediatric progressive care unit. After receiving shift report, which patient should the nurse see first? A. Blood pressure of 88/56 mm Hg in 4-year-old child with heart failure B. Child crying inconsolably after his parents went home C. Pain 5/10 in a child 2 days after cardiac surgery D. Temperature 104.6F (40.3C) 3 days after dental visit

D. Temperature 104.6 3 days after dental visit

A child is in the pediatric intensive care unit 2 hours after a surgical repair of an atrial septal defect (ASD). Postoperative nursing actions include which of the following? A. Administer pain medication. B. Maintain venous access. C. Monitor chest tube drainage. D. The nurse will take all of these actions.

D. The nurse will take all of these actions.

The nurse is teaching the parents of a child who had a surgical correction of a congenital heart defect about subacute bacterial endocarditis (SBE). Which recommendation regarding antibiotic administration prior to dental cleanings is the most appropriate? A. All children with congenital heart defects need SBE prophylaxis. B. Chronic SBE prophylaxis is recommended for most similar children. C. Risks for SBE are very high but easily prevented with antibiotics. D. The provider must weigh the risk-to-benefit ratio for SBE prophylaxis.

D. The provider must weigh the risk to benefit ratio for SBE prophylaxis

A 5-year-old child is being discharged after valve replacement surgery. Which discharge information specific to this child does the nurse provide? A. Be sure to keep all follow-up appointments. B. Encourage your child to eat a healthy diet. C. Monitor the chest incision for redness or heat. D. This valve will need replacement in about 5 years.

D. This valve will need replacement in about 5 years

A child is suspected of having neurally mediated syncope. Which diagnostic test does the nurse prepare the child for? A. Cerebral angiogram B. Coronary angiogram C. Echocardiogram D. Tilt table test

D. Tilt table test