Davis Pediatric Success Chapter 5 Cardiovascular Disorders

The RN is providing care for a 10-day-old diagnosed with coarctation of the aorta and recognized which assessment is supportive of this diagnosis.

-Decreased blood pressure in the lower extremities -Elevated blood pressure in the upper extremities *Pressure overload causes left ventricular hypertrophy & hypertension in the upper part of the body, including the brain *The narrowing alters the blood flow above and below the narrow area *This will cause all at the top half of the body to be exaggerated & all at the bottom half of the body to be diminished as it relates to blood flow

The RN is caring for an infant diagnosed with an atrial septal defect and recognizes which clinical manifestation is a presentation of this diagnosis

-Diaphoresis with feeding -Mid-systolic murmur *Many defects between 3mm & 8mm close spontaneously by age 3 *Larger defects require surgery

What are the guidelines from the Jones Criteria

-Elevated ESR -Elevated CRP -Positive throat culture -Elevated Streptococcal Antibody titer *Think about the purpose of each test and expected value in a client with rheumatic fever

While caring for a 14 month old diagnosed with Kawasaki Disease, the RN knows which clinical manifestation confirms this diagnoses?

-Fever unresponsive to antipyretics -Cervical lymphadenopathy -Reddened skin rash with peeling -Strawberry tongue and red, cracked lips

Realizing that congestive HF is a complication for the child diagnosed with Kawasaki disease the RN will notify the HCP immediately for which assessment finding?

-Gallop rhythm -Respiratory distress -Decreased urine output -Tachycardia

The RN is caring for a newborn diagnosed with aortic stenosis and expects which clinical manifestation?

-Hypotension -Poor Feeding -Heart murmur

Untreated Coarctation of Aorta can lead to?

-Left ventricular hypertrophy -Hypertension -Heart Failure Ruptured aorta -Aortic aneurysm -Stroke *It is advised to perform the surgery within the first two years of life *The sooner the problem is corrected the better the prognosis for the child

The RN is providing education to the mother of a 5-month-old diagnosed with a congenial heart defect and explains to the mother that her son is at risk of developing which complication?

-Normal heart function stopping (Heart Failure) -Not enough oxygen in the blood (Hypoxemia) *Think about the action of the heart and what happens when there's a defect *Think failure and hypoxemia *Poor pumping and Poor oxygenation

Prior to the initiation of IVIG, the RN will implement which assessment interventions?

-Obtain a full set of vitals -Verify patency of intravenous line -Verify patient identifiers for accuracy *The administration of IVIG should follow the same guidelines as for administration of blood products *Monitor for allergic reactions, monitor cardiac status and monitor for extravasation

Which assessment intervention will the RN implement in the preparation of the 4-month-old patient with a cardiac catheterization?

-Obtain accurate assessments of the height and weight (essential for drug dosage & for cath selection) -Collect hx of allergies and last oral intake (important d/t contrast iodine) -Assess the groin and perineal area for signs of skin irritation (procedure may be cx d/t diaper rash) -Document the posterior tibial and dorsalis pedis pulses bilaterally *Think about what you would need to know about this patient to maintain safety during the procedure

While providing care for a 1 month old newborn, which clinical presentation observed by the RN supports the possible diagnosis of tetralogy of fallot

-Oxygen saturation of 80% -Cyanosis while crying -Dyspnea with feeding *Neonates with severe right ventricular outflow obstruction have severe cyanosis and dyspnea during feeding, leading to poor weight gain

Tet spells require immediate intervention which include

-Place the infant with knees to chest or the child in a squatting position -Establish a quiet environment -Administer oxygen

While caring for a 5-week-old infant diagnosed with a ventricular septal defect the RN recognizes which clinical manifestations support this diagnosis.

-Poor weight gain -Fatigue after feeding -Grunting during feeding -Loud systolic murmur -Respiratory distress *abnormal opening between the Rt & Lt ventricles *many will close spontaneously during the first year of life *remember the specific murmur with VSD has a loud systolic

While caring for an 11-month-old with heart failure as a result of a congenital heart defect, the RN will implement which intervention?

-Position the infant elevated while sleeping and upright when feeding -Monitor oxygen saturation and administer oxygen as indicated -Monitor BP and HR before and after administration Think about what will improve the infants daily living

During the review of lab test results obtained from a 6 year old patient, the RN knows which lab finding verifies the diagnoses of rheumatic fever?

-Positive throat culture for strep -Elevated antistreptolysin O' titer *The diagnosis is based on a set of guidelines from the Jones criteria

During the postoperative care of a 6-month-old infant following surgery to repair tetralogy of Fallot, what presentation observed by the RN is an indicator of HF?

-Puffiness of the eyes -Coolness of extremities -Fewer wet diapers *Patient should be on endocarditis prophylaxis preoperatively and 6 months after surgery

The RN educates the mother of a 2-year-old diagnosed with Kawasaki to seek medical attention if she observes which symptom in her son d/t the risk of a myocardial infarction

-Restlessness -Abdominal pain -Inconsolable crying -Very pale skin color *Most serious complication of Kawasaki Disease is the potential for a myocardial infarction and aneurysm formation *Remember that with small children the presentation of a MI may be subtle. So the symptoms will not necessarily be cardiac in nature, but instead be something unusual for this two year old

While caring for a 6-year-old in the ER, the RN is aware of which health event occurs before the development of rheumatic fever.

-Scarlet fever -Strep throat *Remember rheumatic fever occurs after an infection with group A B-hemolytic streptococci

When discussing the diagnosis of tetralogy of fallot with a grad student, the RN reviews which defect as part of TOF?

-Ventricular septal defect -Pulmonic stenosis -Overriding aorta -Right ventricular hypertrophy *Remember Pulmonic Stenosis Right Ventricular Hypertrophy Overriding Aorta Ventricular Septal Defect

The RN is providing care for a 1-year-old with a congenital heart defect and recognizes which clinical presentation for heart failure.

-Wet-sounding cough -Skin cool and mottled -Sweating when walking *The child is easily fatigued, has poor exercise tolerance and is often irritable *Decreased cardiac output results in poor perfusion and is manifested by cold extremities, weak pulses, slow CRP, low BP, and mottled skin *Systemic venous congestion results in peripheral edema, distended neck and peripheral veins, and hepatomegaly

The RN is providing home care instructions to the mother of a 4yr old post-cardiac catheterization and will include which education point?

-Your child needs to be observed for any signs of infection, so monitor the site -Your child has a dressing over the puncture site that you will remove tomorrow, 24 hrs after the procedure Education for the patent should include: -What to monitor for (redness, swelling, drainage, and bleeding -How to manage pain (acetaminophen or ibuprofen) -Catheter site should be clean and dry (tub baths should be avoided) -No strenuous exercise for several days

Cardiac catheterization provides what type of information

-oxygen saturation in the blood -Pressure changes in the heart -Cardiac output -Anatomic abnormalities

A 16-year-old being treated for hypertension has a history of asthma. Which drug class should be avoided in treating this client ' s hypertension? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

1 Beta blockers are not generally used in clients with asthma and hypertension because of concern the beta agonist will cause severe asthma attacks.

Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)? 1. Chickenpox or influenza. 2. E. coli or Staphylococcus . 3. Candida or Streptococcus A. 4. Streptococcus A or staphylococcus.

1 Both chickenpox and infl uenza are viral in nature, so consider stopping the aspirin because of the danger of Reye syndrome.

A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy.

1 CHD is found often in children with Down syndrome.

The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness? 1. Kawasaki disease (KD). 2. Rheumatic fever (RF). 3. Malignant hypertension. 4. Atrial fibrillation.

2 Chorea can be a manifestation of RF, with a higher incidence in females.

The mother of a toddler reports that the child ' s father has just had a myocardial infarction (MI). Because of this information, the nurse recommends the child have a(n): 1. Electrocardiogram. 2. Lipid profi le. 3. Echocardiogram. 4. Cardiac catheterization.

2 Current recommendations are for a lipid profi le in children over 2 years with a fi rst- or second-degree relative with stroke (CVA), myocardial infarction, angina, or sudden cardiac death. Also screen if parent, sibling, or grandparent has cholesterol of 240 mg/dL or greater.

A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using fi rm nipples with small openings to slow feedings.

1 Formula can be supplemented with extra calories, either from a commercial supplement, such as Polycose, or from corn syrup. Calories in formula could increase from 20 kcal/oz to 30 kcal/oz or more.

The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse ' s response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen (Motrin).

1 High-dose immunoglobulin G and salicylate (aspirin) therapy for inflammation are the current treatment for KD.

Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.

1 The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fi ngers is a result of the polycythemia and hypoxemia.

A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin (Lanoxin) and furosemide (Lasix). She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.

1 The rubbing of the child ' s eyes may mean that she is seeing halos around the lights, indicating digoxin (Lanoxin) toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide (Lasix) can increase the risk for digoxin toxicity.

The school nurse has been following a child who comes to the offi ce frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS).

2 In the older child, COA causes dizziness, headache, fainting, elevated blood pressure, and bounding radial pulses.

Aspirin has been ordered for the child with rheumatic fever (RF) in order to: 1. Keep the patent ductus arteriosus (PDA) open. 2. Reduce joint infl ammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis.

2 Joint inflammation is experienced in RF; aspirin therapy helps with infl ammation and pain.

Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin (Lanoxin) and furosemide (Lasix). The child no longer has retractions, lungs are clear, and HR is 96 beats per minute while the child sleeps. The nurse is confi dent that the child has diuresed successfully and has good renal perfusion when the nurse notes the child ' s urine output is: 1. 0.5 cc/kg/hr. 2. 1 cc/kg/hr. 3. 30 cc/hr. 4. 1 oz/hr.

2 Normal pediatric urine output is 1 cc/kg/ hr.

While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood fl ow, the nurse would expect which laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left.

2 Polycythemia is the result of the body attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood cells to carry the oxygen.

A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of which drug? 1. Calcium channel blocker. 2. Beta blocker. 3. ACE inhibiter. 4. ARB.

2 The beta blocker not only affects the heart and lungs but also blocks the beta sites in the liver, reducing the amount of glycogen available for use, causing hypoglycemia. The lower HR and BP also suggest ingestion of a cardiac medication.

While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other fi ndings are a wide pulse pressure, periods of apnea, increased Pa CO 2 , and decreased P O 2 . The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. Patent ductus arteriosus (PDA). 3. Ventricular septal defect (VSD). 4. Bronchopulmonary dysplasia

2 The main identifi er in the stem is the machine-like murmur, which is the hallmark of a PDA.

In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).

3 With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lower-than-expected BP and weak pulses in the lower extremities.

A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is _____________________.

Rheumatic fever (RF). To make the diagnosis of RF, major and minor criteria are used. Major criteria include carditis, subcutaneous nodules, erythema marginatum, chorea, and arthritis. Minor criteria include fever and previous history of RF.

While caring for an infant diagnosed with Tetralogy of Fallot, the RN identifies a hypercyanotic spell and implements which intervention?

-Administer oxygen therapy -Swaddle the infant closely -Provide the infant a pacifier

While assessing a 3-year-old diagnosed with a congenital heart defect, the RN is aware that which presentation will support the presence of hypoxemia.

-An abnormally large amount of red blood cells (polycythemia) in the circulating system -Thickening and flattening of the tips of the fingers & toes

The RN caring for 6-year-old with a diagnosis of rheumatic fever is aware that clinical manifestations are observed in which areas of the body?

-Cardiac -Skin -Joint -Central Nervous System *Inflammatory hemorrhagic bullous lesions, called Aschoff bodies, are formed which cause swelling, fragmentation, and alterations in the connective tissue *Aschoff bodies are found in virtually all patients with clinical rheumatic activity these lesions are found in the heart, blood vessels, brain and serous surfaces of the joints and pleura

While caring for a 10-year-old, which diagnostic test does the RN anticipate the HCP will order to verify the presence of Coarctation of the aorta?

-Chest X-Ray - will show a shadow -Echocardiogram - will show left ventricular hypertrophy *Think about a diagnostic test that shows the problem *Other physical assessments that are supported is a blood pressure reading in all four extremities & palpation of femoral pulses *The presence of a coarctation alters fetal circulation by shifting a higher proportion of flow through the right ventricle *Neonates & infants with severe coarctation usually have right ventricular hypertrophy rather than left ventricular hypertrophy

What are the two main presentations with Tetralogy of Fallot?

-Cyanosis -Hypoxia

Which client could require feeding by gavage? Select all that apply. 1. Infant with congestive heart failure (CHF). 2. Infant with signifi cant pulmonary stenosis. 3. Toddler with repair of transposition of the great vessels. 4. Toddler with Kawasaki disease (KD) in the acute phase. 5. School-age child with rheumatic fever (RF) and chorea.

1, 2 1. The child may experience increased cardiac demand while feeding. Feedings by gavage eliminate that work and still provide high-calorie intake for growth. 2. The child with signifi cant pulmonary stenosis will tire easily, especially during a feeding, and may need to be gavage-fed.

Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.

1, 2, 3 1. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to infl ammation. 2. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to infl ammation. 3. Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to infl ammation.

Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. Cerebrovascular accident (CVA). 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

1, 2, 3, 4, 6 1. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke (CVA). 2. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke (CVA). 3. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke (CVA). 4. Developmental delays can be caused by multiple hospitalizations and surgeries. The child usually catches up to the appropriate level. 6. Brain damage can be caused by hypoxia, blood clots, and stroke (CVA).

Tetralogy of Fallot (TOF) involves which defects? Select all that apply. 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA).

1, 2, 4, 6 1. TOF is a congenital defect with a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 4. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 6. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta.

What can an electrocardiogram (ECG) detect? Select all that apply. 1. Ischemia. 2. Injury. 3. Cardiac output (CO). 4. Dysrhythmias. 5. Systemic vascular resistance (SVR). 6. Occlusion pressure. 7. Conduction delay.

1, 2, 4, 7, 1. An electrocardiogram can indicate ischemia of the heart muscle. 2. An electrocardiogram can indicate injury to the heart muscle 4. An electrocardiogram can show dysrhythmias. 7. An electrocardiogram does show conduction delays.

Which of the following are examples of acquired heart disease? Select all that apply. 1. Infective endocarditis. 2. Hypoplastic left heart syndrome. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). 6. Transposition of the great vessels.

1, 3, 4, 5 1. Infective endocarditis is an example of an acquired heart problem. 3. RF is an acquired heart problem. 4. Cardiomyopathy is an acquired heart problem. 5. KD is an acquired heart problem.

A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should fi rst assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

2 Checking for pulses, especially in the canulated extremity, would assure perfusion to that extremity and is the priority post procedure.

Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fi sts. 6. Change bed linens only when necessary. 7. Organize nursing activities.

1, 4, 5, 6, 7 1. Rocking by the parents will comfort the infant and decrease demands. 4. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. 5. An infant sucking the fi sts could indicate hunger. 6. Change bed linens only when necessary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the child.

An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff? 1. Soy. 2. Latex. 3. Penicillin. 4. Dairy.

2 Children with spina bifida (myelomeningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy.

Which finding might delay a cardiac catheterization procedure on a 1-year-old? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

2 A child with severe diaper rash has potential for infection if the interventionist makes the standard groin approach.

A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has: 1. Ventricular septal defect (VSD). 2. Aortic stenosis (AS). 3. Mitral valve prolapse. 4. Tricuspid atresia.

2 AS can progress, and the child can develop exercise intolerance that can be better when resting.

BP screenings to detect end-organ damage should be done routinely beginning at what age? 1. Birth. 2. 3 years. 3. 8 years. 4. 13 years.

2 Age 3 years is the recommended age to establish a baseline BP in a normal, healthy child.

What associated manifestation might the nurse occasionally fi nd in a child diagnosed with Wilms tumor? 1. Atrial fi brillation. 2. Hypertension. 3. Endocarditis. 4. Hyperlipidemia.

2 Because Wilms tumor sits on the kidney, it can be associated with secondary hypertension. It does not affect or cause the other conditions.

The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse ' s best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby ' s defect is small and will likely close on its own by 1 year of age." 3. "It is common for health-care providers to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."

2 Usually a VSD will close on its own within the fi rst year of life.

The Norwood procedure is used to correct: 1. Transposition of the great vessels. 2. Hypoplastic left heart syndrome. 3. Tetralogy of Fallot (TOF). 4. Patent ductus arteriosus (PDA).

2. The Norwood procedure is specifi c to hypoplastic left heart syndrome.

What should the nurse assess prior to administering digoxin (Lanoxin)? 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

2. The apical pulse rate is assessed because digoxin (Lanoxin) decreases the HR; if the HR is <60, digoxin should not be administered.

During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.

3 The toddler will naturally assume this position to decrease preload by occluding venous fl ow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood fl ow

Which drug should not be used to control secondary hypertension in a sexually active adolescent female who uses intermittent birth control? 1. Beta blockers. 2. Calcium channel blockers. 3. ACE inhibitors. 4. Diuretics.

3 ACE inhibitors and angiotensin II receptor blockers can cause birth defects. The others are not teratogenic.

Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her infl ammation."

3 Children can be irritable for 2 months after the symptoms of the disease start.

A heart transplant may be indicated for a child with severe heart failure and: 1. Patent ductus arteriosus (PDA). 2. Ventricular septal defect (VSD). 3. Hypoplastic left heart syndrome. 4. Pulmonic stenosis (PS).

3 Hypoplastic left heart syndrome is treated by the Norwood procedure, or heart transplant.

Which medication should the nurse give to an infant diagnosed with transposition of the great vessels? 1. Ibuprofen (Motrin). 2. Betamethasone. 3. Prostaglandin E. 4. Indomethacin (Indocin).

3 Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery

Which statement by the mother of a child with rheumatic fever (RF) shows an understanding of prevention for her other children? 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A Streptococcus , I will give them their antibiotic." 4. "If their culture is positive for Staphylococcus A, I will give them their antibiotic."

3 RF is caused by a streptococcal infection, not by Staphylococcus .

The most common cardiac dysrhythmia in the pediatric population is: 1. Ventricular tachycardia. 2. Sinus bradycardia. 3. Supraventricular tachycardia. 4. First-degree heart block.

3 Supraventricular tachycardia is most common in children.

On examination, a nurse hears a murmur at the left sternal border (LSB) in a child with diarrhea and fever. The parent asks why the health-care provider never said anything about the murmur. The nurse explains: 1. "The health-care provider is not a cardiologist." 2. "Murmurs are diffi cult to detect, especially in children." 3. "The fever increased the intensity of the murmur." 4. "We need to refer the child to an interventional cardiologist."

3 The increased CO of the fever increases the intensity of the murmur, making it easier to hear.

Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant? 1. Promoting fl uid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

3 The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so that fl uid in the lungs can go to the base of the lungs, allowing better expansion.

Congenital heart defects (CHDs) are classifi ed by which of the following? Select all that apply. 1. Cyanotic defect. 2. Acyanotic defect. 3. Defects with increased pulmonary blood fl ow. 4. Defects with decreased pulmonary blood fl ow. 5. Mixed defects. 6. Obstructive defects. 7. Pansystolic murmurs.

3, 4, 5, 6 3. Heart defects are now classifi ed as defects with increased or decreased pulmonary blood fl ow, mixed, obstructive, or acquired. 4. Heart defects are now classifi ed as defects with increased or decreased pulmonary blood fl ow, mixed, obstructive or acquired. 5. Heart defects are now classifi ed as defects with increased or decreased pulmonary blood fl ow mixed, obstructive, or acquired. 6. Heart defects are now classifi ed as defects with increased or decreased pulmonary blood fl ow, mixed, obstructive, or acquired.

Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? Select all that apply. 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him his ordered anti-infl ammatory medication for pain and infl ammation." 4. "I will apply cold packs to his swollen joints to reduce pain." 5. "I will take my child every month to the health-care provider ' s offi ce for his penicillin shot."

3, 5 3. Anti-inflammatory medications are the drugs of choice for treatment of RF because RF is a systemic inflammatory 5. The parent will take the child to the clinic monthly for a penicillin injection to prevent recurrent strep infections.

Which assessments indicate that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)? Select all that apply. 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr. 5. Playing basketball with other children his age.

3, 5 3. The 50th percentile height and weight for age shows good growth, indicating good nutrition and perfusion. 5. Playing basketball with children his age indicates he is following the prescribed treatment and responding well to it.

The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse ' s fi rst action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

4 Applying direct pressure 1 inch above the puncture site will localize pressure over the vessel site.

Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin (Lanoxin) indicates the need for further education? 1. "I will give the medication at regular 12-hour intervals." 2. "If he vomits, I will not give a make-up dose." 3. "If I miss a dose, I will not give an extra dose." 4. "I will mix the digoxin in some formula to make it taste better."

4 If the medication is mixed in his formula, and he refuses to drink the entire amount, the dose will be inadequate.

A toddler who has been hospitalized for vomiting because of gastroenteritis is sleeping and diffi cult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refi ll of 3 seconds. Which dysrhythmia does the nurse suspect in this child? 1. Rapid pulmonary fl utter. 2. Sinus bradycardia. 3. Rapid atrial fi brillation. 4. Supraventricular tachycardia.

4 SVT is often above 200 and a result of dehydration, which a vomiting child could have. The rapid rate causes a low CO, resulting in low BP and prolonged capillary refi ll.

During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse ' s fi rst action should be to: 1. Lay the child fl at to promote hemostasis. 2. Lay the child fl at with legs elevated to increase blood fl ow to the heart. 3. Sit the child on the parent ' s lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.

4 The increase in the SVR would increase afterload and increase blood return to the pulmonary artery.

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: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

4 Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life.

Which vaccines must be delayed for 11 months after the administration of gamma globulin? Select all that apply. 1. Diphtheria, tetanus, and pertussis. 2. Hepatitis B. 3. Inactivated polio virus. 4. Measles, mumps, and rubella. 5. Varicella.

4, 5 4. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months. 5. The body might not produce the appropriate number of antibodies following gamma globulin infusion, so live virus vaccines should be delayed for 11 months.

After a diagnosis of a pulmonic stenosis, the RN will anticipate the HCP order the newborn be prepared for what procedure for initial treatment?

Balloon dilation *The initial treatment intervention for either aortic or pulmonic stenosis involves a balloon dilation of the valve, this is performed during a cardiac catheterization

While assessing the cardiac catheterization site post-procedure of a 4-month-old infant, the RN assesses a bloody, saturation dressing and applies what priority intervention?

Apply direct continuous pressure 1 inch above the puncture site *Hemorrhage is a specific risk of cardiac catheterization

When caring for an infant diagnosed with Down's Syndrome, the RN notes cyanosis that increased with crying and recognizes that this clinical presentation is an indicator of what congenital heart defect?

Atrioventricular canal defect *Incomplete fusion of the endocardial cushions, which allows blood to flow between all four chambers of the heart *It is the most common cardiac defect in children diagnosed with Down's Syndrome *Four-Corners Down Under!!!

The nurse is caring for a 9-month-old who was born with a congenital heart defect (CHD). Assessment reveals a HR of 160, capillary refi ll of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _____________________.

Congestive heart failure (CHF).

The _____________________ serves as the septal opening between the atria of the fetal heart.

Foramen ovale.

The RN is providing discharge instructions to the mother of a 18-month-old diagnosed with Kawasaki disease and identifies the need to reinforce teaching based on what statement by the mother

If my son is exposed to chicken pox, I will stop his aspirin dose for 10 days and then restart if he does not get sick. *The parents need accurate information about the usual course of Kawasaki and how to care for their child *Tell parents to discontinue aspirin if the child is exposed to influenza and chicken pox because of aspirin's possible association with Reye Syndrome

Kawasaki disease

Involves widespread inflammation of the small and medium blood vessels with the coronary arteries being the most susceptible to damage *The acute phase begins with an abrupt onset of a high fever that is unresponsive to antibiotics and antipyretics *Over time the bulbar conjunctiva of the eyes become reddened *Inflammation of the pharynx and the oral membranes develops

A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has _____________________.

Kawasaki disease (KD).

Patent ductus arteriosus causes what type of shunt? _____________________

Left to right. Blood fl ows from the higher-pressure aorta to the lower-pressure pulmonary artery, resulting in a left to right shunt.

A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The fl ow of blood through the heart is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the fl ow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood fl ow with the extra blood.

The flow of blood through the heart with an atrial septal defect (ASD) is _____________________.

Left to right. The pressures in the left side of the heart are greater, causing the fl ow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood fl ow with the extra blood.

The RN is caring for a 1-week newborn diagnosed with a patent ductus arteriosus and anticipates the presence of what sound with the murmur?

Machinery like murmur sound *Patent ductus results in a left-to-right shunt *machinery like murmur sound is d/t a widened pulse pressure and bounding pulses result from runoff of blood from the aorta to the pulmonary artery

Tet Spells

Occurs when a child or infant becomes cyanotic and hypoxic when the oxygen requirements exceed the blood supply, this occurs during: -Crying -When waking up -After feeding

The RN identifies the need for further education based on the mother's statement regarding the valvotomy procedure scheduled to treat her toddler that is diagnosed with aortic stenosis

Once this procedure is done, he will be cured & will not need further surgeries or treatments *for the patient with aortic or pulmonic stenosis in which balloon dilation is unsuccessful, a valvotomy is performed, which is to release scar tissue within the valve and as the child grows the valve wil become stenosed again

A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

Patent ductus arteriosus (PDA).

Indomethacin (Indocin) may be given to close which congenital heart defect (CHD) in newborns? _____________________

Patent ductus arteriosus (PDA).

For the child with hypoplastic left heart syndrome, which drug may be given to allow the patent ductus arteriosus (PDA) to remain open until surgery? _____________________

Prostaglandin E.

What is the earliest sign of heart failure in peds?

Tachycardia

A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called _____________________.

Tetralogy of Fallot (TOF). "Tet" spells are characteristic of TOF.

The RN is maintaining observations of the 4-month-old infant after a cardiac catheterization through the right femoral vessel and becomes concerned about what assessment?

The cardiac monitor shows sinus rhythm with a heart rate of 66 bpm *Think about what is not expected for a 4 month old also think about what assessment indicates an unexpected finding after a cardiac catheterization

What statement by the RN is the best response to the mother of a 10-day-old asking for an explanation of her son's diagnosis of Coarctation of the aorta.

This defect causes a narrowing of the aorta that causes a difference in blood flow to the upper and lower parts of your sons body *Remember with coarctation there is a narrowing

What information statement will the RN provide to the parent's of a 4 month old prior to a cardiac catheterization?

This procedure is invasive, provides much-needed information about your child's heart, and does have some risks, but these risks are rare