Classmate's CV Peds NCLEX ?'s

The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever. The nurse knows that which laboratory study would assist in confirming the diagnosis? A. Immunoglobulin B. Red blood cell count C. White blood cell count D. Anti-streptolysin O titer

D

While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding? A. Decreased platelet count B. Decreased ferritin level C. Respiratory alkalosis D. Polycythemia

D

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin (Lanoxin). Which statement by the parent indicates a need for further instruction? A. "If my child vomits after the medication administration, I will repeat the dose." B. "I will not mix the medication with food." C. "I will take my child's pulse before administering the medication." D. "If more than one dose is missed, I will call the provider."

A

A 3-year-old child diagnosed with congestive heart failure is receiving maintenance doses of digoxin and furosemide (Lasix). She is rubbing her eyes when she is looking at the lights in the room and her heart rate is 65 beats per minute. The nurse expects which laboratory finding? A. Hypokalemia B. Hypomagnesemia C. Hypocalcemia D. Hypophosphatemia

A

A family member, who is caring for a 2-year-old with Tetralogy of Fallot, asks you why the child will periodically squat when playing with other children. Your response is:* A. "Squatting helps to increase systemic vascular resistance, which will decrease the right to left shunt that is occurring in the ventricles and this helps increase oxygen levels." B. "Squatting helps to decrease systemic vascular resistance, which will decrease the left to right shunt that is occurring in the ventricles and this helps increase oxygen levels." C. "Squatting helps to decrease systemic vascular resistance, which will increase the right to left shunt that is occurring in the ventricles and this helps increase oxygen levels." D. "Squatting helps to normalize systemic vascular resistance, which will increase the left to right shunt that is occurring in the ventricles and this helps increase oxygen levels."

A

For the child with hypoplastic left heart syndrome, which medication may be given to keep the patent ductus arteriosus (PDA) open until surgery can be done? A. Prostaglandin E B. Indomethicin C. Ibuprofen D. Digoxin

A

Indomethacin is being given to an infant with a patent ductus arteriosus in an attempt to promote closure of the PDA. The nurse caring for this infant becomes concerned about adverse side effects when noticing: A. decreased urine output, decreased platelets, and abdominal distention. B. increased blood pressure, tachycardia, and decreased oxygen requirements. C. increased urine output, increased white blood cell count, and increased reticulocyte count. D. Jaundice, pallor, and a petechial rash

A

The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. The nurse can determine the father understood the teaching when he states, "If the baby turns blue, I will: A. Hold him against my shoulder with his knees bent up toward his chest." B. Lay him down on a firm surface with his hand lower than the rest of his body." C. Immediately put the baby upright in an infant seat." D. Put the baby in a supine position with his head elevated."

A

The nurse explains 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

A

You're working in the NICU and conducting a head to toe assessment on a newborn diagnosed with patent ductus arteriosus (PDA) which of the following can be expected finding(s) ? Select all that apply. A. Machinery murmur B. Widened pulse pressure C. Dyspnea D. Pruritus

A B C

The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess urine output? A. Inserting a foley catheter. B. Weighing the diapers. C. Comparing intake with output. D. Measuring the amount of water added to the formula.

B

The following are examples of acquired heart disease. Select all that apply. A. Infective endocarditis B. Coarctation of the aorta C. Rheumatic fever (RF) D. Cardiomyopathy E. Kawasaki disease (KD) F. Transposition of the great vessels

ACDE

Which are the most serious complications for a child with Kawasaki disease? Select all that apply. A. Coronary thrombosis B. Hypocoagulability C. Decreased sedimentation time (ESR) D. Coronary stenosis E. Coronary artery aneurysm F. Hypoplastic left heart syndrome

ADE

A child born with Trisomy 21 should be evaluated for which associated cardiac manifestation? A. Systemic hypertension B. Congenital heart defect C. Hyperlipidemia D. Cardiomyopathy

B

A toddler who has been hospitalized for vomiting due to gastroenteritis is sleeping and difficult to wake up. Assessment reveals vital signs of a regular heart rate of 230 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refill time of 3 seconds. Which dysrhythmia does the nurse suspect in this child? A. Rapid atrial flutter B. Supraventricular tachycardia C. Sinus bradycardia D. Rapid atrial fibrillation

B

The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement by the parents indicates a need for further instructions? A. "A balance of rest and exercise is important." B. "I can apply lotion or powder to the incision if it is itchy." C. "Activities in which my child could fall need to be avoided for 2-4 weeks." D. "We should avoid going to places like the mall or grocery stores for at least 2 weeks after surgery."

B

A newborn baby, who is diagnosed with transposition of the great arteries, is ordered by the physician to be started on an infusion of prostaglandin E (alprostadil). The purpose of this medication is to: A. Prevent the closure of the foramen ovale. B. Allow a continued connection between the aorta and pulmonary artery via the ductus arteriosus. C. Prevent the closure of the ductus venosus. D. Increase the blood flow to the pulmonary vein, which will increase oxygen levels.

B!! Rationale: Prostaglandin E (alprostadil) is an infusion that can be given to a baby with TGA. This will provide temporary relief from the TGA by keeping the ductus arteriosus open (normally this structure will close after birth). The ductus arteriosus will keep the connection between the aorta and pulmonary artery open, which will allow deoxygenated and oxygenated blood to mix and enter circulation. In TGA, oxygenated blood is not able to enter the systemic circulation, but if this structure is kept open it will allow this to occur.

1. On assessment of a child admitted with a diagnosis of Kawasaki Disease, the nurse expects to note which clinical manifestation of the acute phase of the disease? Pg 889 A. Cracked lips B. Normal appearance C. Conjunctival hyperemia D. Desquamation of the skin

C

A nurse is assessing a patient with severe aortic stenosis. Which of the following would be an expected assessment finding? A. Hypertension B. Bounding pulses C. Narrowed pulse pressure D. Dyspnea

C

The clinic nurse reviews the record of a child just seen by the health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? A. Pallor B. Hyperactivity C. Exercise intolerance D. Gastrointestinal disturbances

C

The nurse is caring for a child with Kawasaki disease. A student nurse who is on the unit asks if there are medications to treat the disease. The nurse's best response to the student nurse is: pg 889 A. Immunogloulin G and ACE inhibitors B. Immunoglobulin and heparin C. Immunoglobulin G and aspirin D. Immunoglobulin and ibuprofen

C

The nurse is educating a family on care for an infant with a ventricular septal defect. Which of the following statements indicates that the family understands the teaching? A. "If my baby seems distressed I should try to feed him." B. " It's normal and I should not be concerned if my baby has trouble gaining weight." C. "Feeding my baby at a 45 degree angle will be the most beneficial." D. "The best way to prevent infections in my baby is to frequently wipe down surfaces."

C

The nurse is monitoring an infant with a congenital heart disease closely for signs of heart failure. Which early sign should the nurse be most concerned about? A. Pallor B. Cough C. Tachycardia D. Slow and shallow breathing

C

Which statement by the mother of a child with rheumatic fever (RF) indicates that she has an understanding of prevention for her other children? A. "Whenever one of them gets a sore throat, I will give that child an antibiotic." B. "There is no treatment since it is viral and must run its course." C. "If their culture is positive for group A streptococcus, I will give them a full course of their antibiotic." D. "If their culture is positive for staphylococcus A, I will give them a full course of their antibiotic."

C

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which of the following early signs of HF? A. Pallor B. Cough C. Tachycardia D. Slow and shallow breathing

C Rationale: HF is the inability of the heart to pump a sufficient amount of blood to meet the needs of the body. Early signs of this include tachycardia, tachypnea, profuse scalp sweating, fatigue and irritability, sudden weight gain, and respiratory distress. A cough is not an early sign. Pallor may be noted, but it is also not an early sign.

The nurse is caring for a 5-year-old child that is 2 hours post-op from a cardiac catheterization. Which of the following nursing diagnoses is the priority for this child? A. Fluid volume: Imbalanced, Risk for, related to diuretic effect of contrast medium used in catheterization and NPO status B. Fear, related to separation from support system in a stressful situation C. Tissue Perfusion: Peripheral, Risk for Ineffective, related to mechanical reduction of arterial and venous blood flow to lower extremity D. Anxiety (Family), related to potentially serious diagnosis

C ABC's. Circulation (Tissue perfusion) would be the priority diagnosis for this post-op child.

A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? (Select all that apply.) A. Weak femoral pulses B. Cool skin of lower extremities C. Severe cyanosis D. Clubbing of the fingers E. Heart failure

Correct Answers: A, B, and E. A → narrowing of the lumen of the aorta results in obstruction of blood flow from the ventricle, resulting in weak or absent femoral pulses. B → narrowing of the lumen of the aorta results in obstruction of blood flow from the ventricle, resulting in cool skin of the lower extremities E → heart failure occurs when the heart is unable to meet the body's demands, and is a manifestation of coarctation of the aorta.

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

D

A child with rheumatic fever is being admitted to the pediatric floor. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? A. "Has your child complained of back pain?" B. "Has your child complained of headaches?" C. "Has your child had any nausea or vomiting?" D. "Did your child have a sore throat or fever within the last 2 months?"

D

A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen? A. During sleep B. When changing the infant's diapers C. When the mother is holding the infant D. When drawing blood for electrolyte level testing

D

A newborn is diagnosed with truncus arteriosus. You're educating the parents about this heart defect. Which statement by the mother demonstrates she understood the education provided about this condition? A. "My baby has narrowing in the pulmonary artery, and the aorta is arising out of the right ventricle rather than the left ventricle." B. "My baby's heart shares one artery that connects the right and left ventricles." C. "The left side of my baby's heart is not fully developed." D. "The natural structure in my baby's heart, the ductus arteriosus, has failed to close after birth leading to more blood flow to the lungs."

The answer is B. Truncus arteriosus is a congenital heart defect where there is ONE artery along with one truncal valve that connects the right and left ventricles. This structure will function to carry blood to both the lungs and body. In a normal heart, there should be TWO separate arteries (pulmonary artery and aorta) with their own valves (instead of one truncal valve). The pulmonary artery will carry blood from the right side of the heart to the lungs, and the aorta will carry blood from the left side of the heart to the body.