Chapter 26: The Child with a Cardiovascular Disorder

a. Blood is circulated through the lungs again, causing pulmonary circulatory congestion. When PDA is present, oxygenated blood recycles through the lungs, overburdening the pulmonary circulation. Page 608-609

An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). What does the nurse understand regarding why dyspnea occurs? a. Blood is circulated through the lungs again, causing pulmonary circulatory congestion. b. Blood is shunted past the pulmonary circulation, causing pulmonary hypoxia. c. Blood is shunted past cardiac arteries, causing myocardial hypoxia. d. Blood is circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.

d. Vomiting Symptoms of digoxin toxicity include: nausea, vomiting, anorexia, irregularity in pulse rate and rhythm, and a sudden change in pulse. Page 612

An infant with congestive heart failure is receiving digoxin (Lanoxin). What does the nurse recognize as a sign of digoxin toxicity? a. Restlessness b. Decreased respiratory rate c. Increased urinary output d. Vomiting

Jones criteria The Jones criteria identify a cluster of symptoms and divide them into major criteria and minor criteria. The formula for making the diagnosis of rheumatic fever is to identify two major criteria in the patient, or one major and two minor criteria. Page 609

Because the diagnosis of rheumatic fever is difficult, an aid used to identify the presence of rheumatic fever is the _____________ _______________.

c. 5 years Children who recover from rheumatic fever should have a chemoprophylaxis protocol of penicillin G injections (about 200,000 units per dose) for a minimum of 5 years or up to the age of 18 to prevent further bouts of rheumatic fever. Page 615

How long should a 4-year-old child recovering from rheumatic fever need to receive monthly injections of penicillin G? a. 1 year b. 2 years c. 5 years d. 10 years

a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding e. Offering high-caloric formula ANS: A, B, C, E Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft, large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held. Page 612

How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the childs weakness and fatigue? (Select all that apply.) a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding d. Substituting glucose water for formula e. Offering high-caloric formula

height; weight Systemic blood pressure increases with age and is correlated with height and weight throughout childhood and adolescence. Significant hypertension is considered when measurements are persistently at or above the 95th percentile for the patients age and sex. Page 615

Systemic blood pressure increases with age and is correlated with _________ and _________throughout childhood and adolescence.

a. If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest. In the event of a paroxysmal hypercyanotic or tet spell, the infant should be placed in a knee-chest position. Page 610, Figure 26-3

The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions? a. If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest. b. If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body. c. If the baby turns blue, I will immediately put the baby upright in an infant seat. d. If the baby turns blue, I will put the baby in supine position with his head elevated.

pulse pressure The pulse pressure is the difference between the diastolic pressure and the systolic pressure. Page 608

The nurse explains that the difference between the systolic blood pressure reading and the diastolic blood pressure reading is called the __________ ___________.

a. Inflammation weakens blood vessels, leading to aneurysm. Inflammation of vessels weakens the walls of the vessels and often results in aneurysm. Page 617

The nurse is caring for a child with a diagnosis of Kawasaki disease. The childs parent asks the nurse, How does Kawasaki disease affect my childs heart and blood vessels? On what understanding is the nurses response based? a. Inflammation weakens blood vessels, leading to aneurysm. b. Increased lipid levels lead to the development of atherosclerosis. c. Untreated disease causes mitral valve stenosis. d. Altered blood flow increases cardiac workload with resulting heart failure.

c. Patient education The main focus of a hypertension-prevention program is patient education. Page 616

The nurse is planning a hypertension-prevention program. What should be the main focus of the nurse when presenting information? a. Pharmacological treatment b. Surgical interventions available c. Patient education d. Reduction of aerobic exercise

ventricular septal VSDs are the most common congenital heart defect. Page 615

The nurse takes into consideration that the most common congenital heart defect is the ____________ ____________ defect.

d. Clubbing occurs as a result of chronic hypoxia. Clubbing of the fingers develops in response to chronic hypoxia. Page 609-610

The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, Why do my childs fingertips look like that? On what understanding does the nurse base a response? a. Clubbing occurs as a result of untreated congestive heart failure. b. Clubbing occurs as a result of a left-to-right shunting of blood. c. Clubbing occurs as a result of decreased cardiac output. d. Clubbing occurs as a result of chronic hypoxia.

d. An atrial septal defect on the book it's a. PDA Because the right side of the heart must take over pumping blood to both the lungs and systemic circulation, the ductus arteriosus must remain open to shunt the oxygenated blood from the lungs. Page 610

Through what does the infant born with hypoplastic left heart syndrome acquire oxygenated blood? a. The patent ductus arteriosus b. A ventricular septal defect c. The closure of the foramen ovale d. An atrial septal defect

a. Hypertrophied right ventricle b. Patent ductus arteriosus d. Narrowing of pulmonary artery e. Dextroposition of aorta ANS: A, B, D, E, it should be A, C, D, E The four anomalies that comprise tetralogy of Fallot are hypertrophied right ventricle, patent ductus arteriosus, stenosis of pulmonary artery, and dextroposition of the aorta. Page 609

What are the four structural heart anomalies that make up the tetralogy of Fallot? (Select the four that apply.) a. Hypertrophied right ventricle b. Patent ductus arteriosus c. Ventral septal defect d. Narrowing of pulmonary artery e. Dextroposition of aorta

a. Spontaneous cyanosis b. Dyspnea c. Weakness e. Syncope ANS: A, B, C, E Indicators of a paroxysmal hypercyanotic episode or a tet episode are spontaneous cyanosis, dyspnea, weakness, and syncope. Page 609

What assessment(s) in a child with tetralogy of Fallot would indicate the child is experiencing a paroxysmal hypercyanotic episode? (Select all that apply.) a. Spontaneous cyanosis b. Dyspnea c. Weakness d. Dry cough e. Syncope

a. Blood to shunt left to right, causing increased pulmonary flow and no cyanosis Pulmonary blood flow is increased when a ventricular septal defect exists. The blood shifts from left to right because of the higher pressure in the left ventricle. This particular shift does not cause cyanosis. Page 608

What does the nurse explain that a ventricular septal defect will allow? a. Blood to shunt left to right, causing increased pulmonary flow and no cyanosis b. Blood to shunt right to left, causing decreased pulmonary flow and cyanosis c. No shunting because of high pressure in the left ventricle d. Increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume

d. Blood pressure lower in the legs than in the arms The characteristic symptoms of coarctation of the aorta are a marked difference in blood pressure and pulses between the upper and lower extremities. Pressure is increased proximal to the defect and decreased distal to the coarctation. Page 609

What finding would the nurse expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta? a. Blood pressure higher on the right side b. Blood pressure higher on the left side c. Blood pressure lower in the arms than in the legs d. Blood pressure lower in the legs than in the arms

c. They have little cholesterol. HDLs have low amounts of triglycerides, large amounts of proteins, low amount of cholesterol, and are excreted via the liver. They have no role in the production of steroids. Page 616

What is accurate about the characteristics of high-density lipoproteins (HDLs)? a. They have high amounts of triglycerides. b. They have only small amounts of protein. c. They have little cholesterol. d. They aid in steroid production.

d. A fat intake reduction of 25-35% of total calories For a child with increased cholesterol a fat reduction of 25-35% of total calories with less than 75 saturated fat and less than 200 mg of cholesterol per day is advised. Page 616

What should the school nurse recommend when encouraging a heart-healthy diet for a child with high cholesterol? a. A fat intake reduction of 5-10% of total calories b. A fat intake reduction of 10-15% of total calories c. A fat intake reduction of 15-20% of total calories d. A fat intake reduction of 25-35% of total calories

a. A loud, harsh murmur with a systolic thrill A loud, harsh murmur combined with a systolic thrill is characteristic of a ventricular septal defect. Page 608

Which assessment would lead the nurse to suspect that a newborn infant has a ventricular septal defect? a. A loud, harsh murmur with a systolic thrill b. Cyanosis when crying c. Blood pressure higher in the arms than in the legs d. A machinery-like murmur

b. He tires out during feedings. Fatigue during feeding or activity is common to most infants with congenital cardiac problems. Page 611-612

Which comment made by a parent of a 1-month-old would alert the nurse about the presence of a congenital heart defect? a. He is always hungry. b. He tires out during feedings. c. He is fussy for several hours every day. d. He sleeps all the time.

a. Atrial septal defects (ASDs) d. Patent ductus arteriosus e. Ventricular septal defects (VSDs) ANS: A, D, E The congenital heart defects that cause increased pulmonary blood flow are ASDs, VSDs, and patent ductus arteriosus. Page 610

Which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? (Select all that apply.) a. Atrial septal defects (ASDs) b. Tetralogy of Fallot c. Dextroposition of aorta d. Patent ductus arteriosus e. Ventricular septal defects (VSDs)

b. Withholding a dose if the apical heart rate is less than 100 beats/min As a rule, if the pulse rate of an infant is below 100 beats/min, the medication is withheld and the physician is notified. Page 612

Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant? a. Counting the apical rate for 30 seconds before administering the medication b. Withholding a dose if the apical heart rate is less than 100 beats/min c. Repeating a dose if the child vomits within 30 minutes of the previous dose d. Checking respiratory rate and blood pressure before each dose

Rheumatic fever (RF) Rheumatic fever (RF) is a systemic disease involving the joints, heart, central nervous system (CNS), skin, and subcutaneous tissues. It belongs to a group of disorders known as collagen diseases Page 613

________________ is a systemic disease involving the joints, heart, central nervous system (CNS), skin, and subcutaneous tissues. It belongs to a group of disorders known as collagen diseases.

Fetal circulation Fetal circulation is designed to serve the metabolic needs during intrauterine life and also to permit safe transition to life outside the womb. Page 614

________________________is designed to serve the metabolic needs during intrauterine life and also to permit safe transition to life outside the womb.

a. Heredity b. Stress d. Obesity e. Poor diet ANS: A, B, D, E Primary, or essential, hypertension implies that no known underlying disease is present. Nevertheless, heredity, obesity, stress, and a poor diet and exercise pattern can contribute to any type of hypertension. Page 607

A 16-year-old patient is diagnosed with primary hypertension. What risk factors does the nurse mention when providing education on this diagnosis to the patient and his family? (Select all that apply.) a. Heredity b. Stress c. Congenital defect d. Obesity e. Poor diet

b. Heart muscle and the mitral valve The tissues that cover the heart and heart valves are affected. The heart muscle may be involved and the mitral valve is frequently involved. Page 614

A child develops carditis from rheumatic fever. Which areas of the heart are affected by carditis? a. Coronary arteries b. Heart muscle and the mitral valve c. Aortic and pulmonic valves d. Contractility of the ventricles

b. Painful, tender joints and carditis The presence of two major Jones criteria would indicate a high probability of rheumatic fever. Page 614, Box 26-1

A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever? a. Subcutaneous nodules and fever b. Painful, tender joints and carditis c. Erythema marginatum and arthralgia d. Chorea and elevated sedimentation rate

c. Sydenhams chorea As the effects of rheumatic fever affect the central nervous system, the child may develop Sydenhams chorea, manifested by involuntary, purposeless movements of the limbs. Page 614

A child with rheumatic fever begins involuntary, purposeless movements of her limbs. What does the nurse recognize that this indicates? a. Seizure activity b. Hypoxia c. Sydenhams chorea d. Decreasing level of consciousness

a. Squatting increases the return of venous blood back to the heart. The squatting position allows the child to breathe more easily because systemic venous return is increased. Page 609

A father asks why his child with tetralogy of Fallot seems to favor a squatting position. What is the nurses best response? a. Squatting increases the return of venous blood back to the heart. b. Squatting decreases arterial blood flow away from the heart. c. Squatting is a common resting position when a child is tachycardic. d. Squatting increases the workload of the heart.

d. Echocardiogram Echocardiography is a noninvasive procedure that localizes murmurs and determines if theheart is structurally normal. Page 607, Table 26-7

A pediatric patient is scheduled for a noninvasive procedure to determine if his heart is structurally normal and to localize a murmur. What diagnostic test does the nurse anticipate? a. Barium swallow b. Chest x-ray c. Electrocardiogram d. Echocardiogram