Pediatrics Ch. 23
What is the priority nursing intervention for reducing the chance of perfusion problems after cardiac catheterization?
OChecking the pulses distal to the catheterization site
What should nurses stress when counseling parents regarding the home care of the child with a cardiac defect before corrective surgery?
The desirability of promoting normalcy within the limits of the child's condition
The patient has had a persistent fever for the last 5 days, inflammation of lips and conjunctiva, and reddening of the tongue. The patient also has cervical lymphadenopathy and erythema in the palms and soles. What diagnosis does the nurse expect to find in the medical record?
Kawasaki disease
While reviewing the laboratory reports of a patient, the nurse finds that the patient has a total cholesterol level of 220 mg/L and low-density lipoprotein (LDL) level of 140 mg/dL. Which instruction does the nurse give to the patient after reviewing his her prescription?
"Take the statin medications in the evening."
The nurse is assessing a patient with polycythemia and notices finger clubbing and cyanosis. Which medication would be beneficial to the patient in this situation?
Morphine
What does nursing care of the infant and child with congestive heart failure include?
Organizing activities to permit uninterrupted sleep
The nurse is reviewing the medical records of different patients with heart anomalies. Which patient requires a change in the treatment plan?
Patient D
Congenital heart defects have traditionally been divided into acyanotic and cyanotic defects. The nurse knows which information about this system in clinical practice?
Problematic because children with acyanotic heart defects may experience cyanosis
What care should the nurse take when obtaining a blood pressure measurement for a child with systemic.hypertension?
Quiet the child when the blood pressure is measured.
The nurse, preparing to give digoxin to a 9-month-old infant, checks the dosage and sees that 4 mL of the drug is to be drawn up. What is the most appropriate action by the nurse, drawing on knowledge of this medication and safe pediatric dosages?
Refrain from drawing up dose because there is an error in the dosage
What condition is defined as sepsis with organ dysfunction and hypotension?
Septic shock
The nurse is preparing to administer a potassium supplement as prescribed to a patient with congestive heart failure. Which medication in the patient's medication profile would make the nurse hold the dose and contact the primary health care provider for further guidance?
Spironolactone
What clinical manifestation should the nurse expect to find in a child with infective endocarditis?
Splinter hemorrhages under the nails
The nurse is caring for a child with an atrial septal defect. What clinical manifestation should the nurse expect to find in this child?
Systolic murmur with a fixed split second heart sound.
What is an early sign of congestive heart failure that the nurse should recognize?
Tachypnea
What clinical manifestations result from pulmonary congestion in children with congestive.heart failure?
Tachypnea, exercise intolerance, cyanosis
After cardiac catheterization of a child, which assessment finding is a cause of concern to the nurse?
The affected extremity feels cool when touched.
The nurse is assessing a child with septic shock. Which assessment finding does the nurse recognize as the first stage of septic shock?
The skin is warm to touch
What is considered a mixed cardiac defect?
Transposition of the great arteries
What is the primary therapy for secondary hypertension in children?
Treatment of the cause
Before discharge, what teaching should the nurse give to the parents of a child who has been implanted with a pacemaker? Select all that apply.
Understand the settings of the pacemaker inserted. Learn cardiopulmonary resuscitation (CPR). Ensure that the child wears a Medic-Alert device.
The nurse is caring for a child with heart failure. What teaching should the nurse give to the parents of the child about reducing the workload on the child's heart?
Use medication to safely sedate the child.
What nursing intervention is the most important in preventing complications of digoxin administration?
Checking the apical pulse for 60 seconds before administering the medication
The nurse should explain to the parents that their child is receiving furosemide for severe congestive heart failure because of which effect?
A diuretic
A nurse is caring for a child who has just undergone cardiac catheterization. What interventions should the nurse implement with this child? Select all that apply.
Keep the site clean and dry. Administer acetaminophen or ibuprofen to relieve the child's pain. Assess pulses, temperature, and color of extremities. Remove the pressure dressing the day after catheterization and cover the site with an adhesive bandage.
What position does the nurse caring for a young child with tetralogy of Fallot see the child assuming in an attempt to compensate for the congenital heart defect?
Knee-chest
What nursing interventions should the nurse perform when caring for an infant with hypoxemia? Select all that apply.
Administer morphine subcutaneously. Place the infant in a knee-chest position. Perform good hand washing during care.
What teaching should the nurse give to the principal caregiver of a child about the administration of digoxin? Select all that apply.
Administer the drug every 12 hours. Report frequent vomiting or poor feeding. Give water after administering the drug.
A child presents the emergency department with an urticarial rash and laryngeal edema. What do these clinical symptoms suggest?
Anaphylaxis
A diagnosis of rheumatic fever is being ruled out in a child. Which laboratory test is the most reliable?
Antistreptolysin-0 titer
Which heart defect causes narrowing of the aortic valve?
Aortic stenosis
What does the nurse recognize as an early clinical sign of compensated shock in a child?
Apprehension
Which sign does the nurse recognize as a clinical sign of compensated shock in a child?
Apprehension
What should the nurse recognize as an early clinical sign of compensated shock in a child?
Apprehensiveness
A patient has a blood pressure of 40 mm Hg at rest in the pulmonary arteries. The nurse also finds that the patient is not showing any response to vasodilator testing. Which treatment strategy may be beneficial for the patient?
Bosentan
In which procedure for cardiac diagnosis are radiopaque catheters placed in a peripheral blood vessel and.advanced into the heart to measure pressures and oxygen levels in heart chambers?
Cardiac catheterization
A nurse is preparing to administer digoxin to a 2-year-old child. What is the most appropriate action when the nurse is administering digoxin?
Checking the apical heart rate and holding the medication if the pulse is below 70 beats/min
Which term describes the thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia?
Clubbing
After a patient returns from cardiac catheterization the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). What is the most appropriate nursing intervention?
Documenting the findings and continuing to monitor the child
The nurse is assessing the chest tube drainage of a child in the postoperative period after cardiac What kind of drainage surgery. does the nurse consider as a life-threatening sign?
Drainage greater than 3 mL/kg/hr for more than 3 hours.
The nurse is caring for a child with Kawasaki disease (KD). To which intervention performed at the time of diagnosis does the nurse refer for evaluating long-term complications?
Echocardiogram
In what procedure are high-frequency sound waves directed through a transducer to produce an image of cardiac structures?
Echocardiography
The nurse is caring for a child with a bedside cardiac monitor for electrocardiogram (ECG). What intervention should the nurse perform for this child?
Ensure that the white electrode is on the right of the chest.
What postoperative care should the nurse include for a child immediately after surgery?
Ensure the child is warm immediately after surgery.
Which medications are diuretics that are used in the management of heart failure? Select all that apply.
Furosemide Chlorothiazide Spironolactone
What should the nurse teach the parents of a child who has a history of bacterial infective endocarditis (IE)?
Institute prophylactic antibiotic therapy.
What is a priority patient outcome for a child with congestive heart failure?
The child will not have distended neck veins.
The nurse is assessing the cholesterol levels of the patient and finds that the patient has low-density lipoprotein (LDL) levels of 140 mg/dL. What instruction would be most appropriate for the nurse to give to the patient?
"You should include olive oil and green vegetables in your diet."
Surgical repair for patent ductus arteriosus (PDA) is performed to prevent the complication of what?
A worsening of pulmonary vascular congestion
How should the nurse administer a digitalizing dosage to a child prescribed digoxin?
Administer divided doses intravenously over 24 hours.
What preprocedural interventions should the nurse implement for a child who is prescribed a cardiac catheterization? Select all that apply.
Assess for any symptoms of infection. Obtain history for any allergic reactions. Obtain an accurate height of the child.
Which congenital heart defect is described as the incomplete fusion of the endocardial cushions?
Atrioventricular canal defect
What is the major cause of death in the first year of life besides preterm birth?
Congenital heart defect
What clinical manifestation should the nurse expect to find during the assessment of an infant with coarctation of the aorta?
Cooler lower extremities
What is an important nursing responsibility when a dysrhythmia is suspected?
Counting the apical pulse for 1 full minute and comparing the rate with the radial pulse rate
When a dysrhythmia is suspected, what is the nurse's first action?
Counting the apical rate for 1 full minute and comparing it with the radial rate
A child with a severe peanut allergy accidentally ate a candy bar that contained peanuts. The child is now experiencing progressively worsening respiratory distress. What is the priority nursing intervention for this child?
Establishing an airway
What assessment findings help the nurse recognize and evaluate the presence of toxic shock syndrome (TSS) in a patient? Select all that apply.
It is indicated by Staphylococcus aureus in the blood culture. It causes desquamation of palms and soles. It is accompanied by elevated temperatures.
What is the name for defects in which blood exiting the heart meets an area of anatomic narrowing?.
Obstructive
What should the nurse teach the parents of a child with heart failure who has been prescribed furosemide?
Record output as soon as the drug is given.
What is an early sign of heart failure?
Resting tachypnea
