Pediatrics Test 2- Cardiac Disorders

Which is the acceptable mg/dL level, or below this level, low-density lipoprotein (LDL) cholesterol level for a child from a family with heart disease? _____ Record your answer as a whole number.

ANS: 110 The low-density lipoproteins (LDLs) contain low concentrations of triglycerides, high levels of cholesterol, and moderate levels of protein. LDL is the major carrier of cholesterol to the cells. Cells use cholesterol for synthesis of membranes and steroid production. Elevated circulating LDL is a strong risk factor in cardiovascular disease. For children from families with a history of heart disease, the LDL should be <110.

What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)? A.Assess the parents' anxiety level and readiness to learn B.Gather literature for the parents C.Secure a quiet place for teaching D.Discuss the plan with the nursing team

ANS: A Any effort to organize the right environment, plan, or literature is of no use if the parents are not ready to learn or have high anxiety. Decreasing their level of anxiety is often needed before new information can be processed. A baseline assessment of prior knowledge should be taken into consideration before developing any teaching plan. Locating a quiet place for meeting with parents is appropriate; however, an assessment should be done before any teaching is done. Discussing a teaching plan with the nursing team is appropriate after an assessment of the parents' knowledge and readiness.

What is an expected assessment finding in a child with coarctation of the aorta? A.Orthostatic hypotension B.Systolic hypertension in the lower extremities C.Blood pressure higher on the left side of the body D.Disparity in blood pressure between the upper and lower extremities

ANS: D The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities. Orthostatic hypotension is not present with coarctation of the aorta. Systolic hypertension may be detected in the upper extremities. The left arm may not accurately reflect systolic hypertension because the left subclavian artery can be involved in the coarctation.

Surgical closure of the ductus arteriosus would bring about what desired effect? A.Stop the loss of unoxygenated blood to the systemic circulation. B.Decrease the edema in legs and feet. c. Increase the oxygenation of blood .d. Prevent the return of oxygenated blood to the lungs

ANS: D The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary artery. The aorta carries oxygenated blood to the systemic circulation. Because of the higher pressure in the aorta, blood is shunted into the pulmonary artery and the pulmonary circulation. Edema in the legs and feet is usually a sign of heart failure. This repair would not directly affect the edema. Increasing the oxygenation of blood would not interfere with the return of oxygenated blood to the lungs.

A nurse is assessing a 2-month-old infant who has a ventricular septal defect. Which of the following findings should the nurse report to the provider? A. Weight gain of 1.8 kg (4 Ib) B. Heart rate of 125/min C. Soft, flat fontanel D. Systemic murmur

Correct Answer: A. Weight gain of 1.8 kg (4 (b) A4 lb weight gain indicates increased fluid and worsening of the child's heart failure; therefore, the nurse should report this finding to the provider. Incorrect Answers: B. A heart rate of 125/min is an expected finding in a 2-month-old infant. C. A soft, flat fontanel is an expected finding in a 2-month-old infant. D. A systemic murmur is an expected finding in an infant who has a ventricular septal defect.

A nurse is caring for a 3-year-old child who has a cyanotic cardiac defect. The child cries when her parents leave the room, worsening her cyanosis and dyspnea. Into which of the following positions should the nurse place the child to improve these manifestations? A. Orthopneic B. Knee-chest c. sims' D. Semi-Fowler's

Correct Answer: B. Knee-chest The knee-chest position, which is similar to squatting, facilitates the oxygenation of the lungs. The nurse should assist the child into this position to facilitate breathing.

A nurse is assessing a 6-month-old infant following a cardiac catheterization. Which of the following findings should the nurse report to the provider? A. Temperature 37.5°C (99.5°F) B. Apical pulse rate 140/min C. BP 86/40 mmHg )D. Respiratory rate 32/min

Correct Answer: C. BP 86/40 mmHg A BP of 86/40 mmHg is indicative of hypotension and bleeding in a 6-month-old infant and should be immediately reported to the provider. Incorrect Answers: A. This temperature is within the expected reference range for a 6-month-old infant. B. This apical pulse level is within the expected reference range for a 6-month-old infant. D. This respiratory rate is within the expected reference range for a 6-month-old infant.

A nurse is reviewing the morning laboratory results of an infant who is receiving digoxin and furosemide for the treatment of heart failure. Which of the following findings should the nurse report to the provider? A. Sodium 140 mEq/L B. Calcium 10.2 mg/dL c. Chloride 100 mEq/L D. Potassium 3.2 mEg/L

Correct Answer: D. Potassium 3.2 mEg/L The nurse should identify that a potassium level of 3.2 mEq/L is below the expected reference range of 4.1 to 5.3 mEq/L for an infant. Therefore, the nurse should report this finding to the provider. Incorrect Answers: A. The nurse should identify that a sodium level of 140 mEq/L is within the expected reference range of 134 to 150 mEq/Lfor an infant. B. The nurse should identify that a calcium level of 10.2 mg/dL is within the expected reference range of 8.8 to 10.8 mg/dL for an infant. C. The nurse should identify that a chloride level of 100 mEq/L is within the expected reference range of 90 to 110 mEq/L for an infant.

A nurse is caring for a child who has suspected nephrotic syndrome. Which of the following laboratory values should the nurse expect? A. Platelets 120,000/mm^3 B. Serum sodium 160 mEq/L C. Hgb9g/dL D. Serum cholesterol 700 mg/dL

Correct Answer: D. Serum cholesterol 700 mg/dL A serum cholesterol level of 700 mg/dL is above the expected reference range. A child who has nephrotic syndrome will have high serum cholesterol findings because of the increase in plasma lipids. Incorrect Answers: A. A platelet count of 120,000/mm^3 is below the expected reference range. Children with nephrotic syndrome have an increased platelet count because of hemoconcentration. B. A serum sodium level of 160 mEq/L is above the expected reference range. Children who have nephrotic syndrome have a serum sodium level that is lower than expected because of hemoconcentration. C. A hemoglobin level of 9 g/dL is below the expected reference range. Children who have nephrotic syndrome will have hemoglobin levels that are within the expected reference range or elevated.

A nurse is planning care for an infant who has heart failure. Which of the following interventions should the nurse include in the plan to meet the nutritional needs of the infant? (Select all that apply.) A. Offer the infant a feeding every 2 hr B. Allow 30 min to complete each feeding C. Gradually increase the caloric density of the formula D. Position the infant semi-upright during feedings E. Provide gavage feeding if respiratory rate exceeds 80/min

Correct Answers: B. Allow 30 min to complete each feeding C. Gradually increase the caloric density of the formula D. Position the infant semi-upright during feedings E. Provide gavage feeding if respiratory rate exceeds 80/min The nurse should allow 30 minutes for each feeding. This length of feeding allows adequate intake without causing the infant to get overl fatigued or to lose needed rest time before the next feeding. The nurse should plan to provide the infant with a formula that has increase caloric density. An infant who has heart failure has an increased metabolic rate due to impaired cardiac function. Adding expressed breas milk or enteral nutrition formula or oil to the formula provides the infant with increased calories in a decreased volume of feeding. The ni should gradually increase the caloric density of the feeding by 2 kcal/oz/day to promote infant tolerance and decrease the risk of diarrhea The nurse should plan to hold the infant in a semi-upright position during feedings to promote maximum chest expansion and decrease t risk of respiratory distress. The nurse should plan to withhold oral feedings and provide gavage feedings if the infant shows indications of stress or fatigue. An infant who has a respiratory rate of 80/min to 100/min has tachypnea, which is an indicator of infant stress.

Which complication should the nurse asses for when caring for a child post cardiac catheterization? A.Cardiac arrhythmia B.Hypostatic pneumonia C.Congestive heart failure D.Rapidly increasing blood pressure

ANS: A Because a catheter is introduced into the heart, a risk exists of catheter-induced arrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, congestive heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

Which drug is an angiotensin-converting enzyme (ACE) inhibitor? a. Captopril b. Furosemide c. Spironolactone d. Chlorothiazide

ANS: A Capoten is an ACE inhibitor. Lasix is a loop diuretic. Aldactone blocks the action of aldosterone. Diuril works on the distal tubules.

What beneficial effect is achieved by administering digoxin? A.Decreases edema B.Decreases cardiac output C.Increases heart size D.Increases venous pressure

ANS: A Digoxin has a rapid onset and is useful in increasing cardiac output, decreasing venous pressure, and as a result decreasing edema. Heart size is decreased by digoxin

Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure? A.Weigh the infant every day on the same scale at the same time. B.Notify the physician when weight gain exceeds more than 20 g/day. C.Put the infant in a car seat to minimize movement. D.Administer digoxin as ordered by the physician.

ANS: A Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency. An excessive weight gain for an infant is an increase of more than 50 g/day. With fluid volume excess, skin will be edematous. The infant's position should be changed frequently to prevent undesirable pooling of fluid in certain areas. Digoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid.

What term is used to describe the painful, tender, pea-sized nodules that may appear on the pads of the fingers or toes in cases of bacterial endocarditis? A.Osler's nodes B.Janeway lesions C.Subcutaneous nodules D.Aschoff's nodules

ANS: A Osler's nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis. Subcutaneous nodules are nontender swellings located over bony prominences, commonly found in rheumatic fever. Aschoff's nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.

What is a major clinical manifestation of rheumatic fever? A.Polyarthritis B.Osler's nodes C.Janeway spots D.Splinter hemorrhages of distal third of nails

ANS: A Polyarthritis is swollen, hot, red, and painful joints. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. Osler's nodes, Janeway spots, and splinter hemorrhages are characteristic of infective endocarditis.

A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality? a. Polycythemia b. Infection c. Dehydration d. Anemia

ANS: A Polycythemia is a compensatory response to chronic hypoxia. The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood. Infection is not a clinical consequence of cyanosis. Although dehydration can occur in cyanotic heart disease, it is not a compensatory mechanism for chronic hypoxia. It is not a clinical consequence of cyanosis. Anemia may develop as a result of increased blood viscosity. Anemia is not a clinical consequence of cyanosis.

Which structural defects constitute tetralogy of Fallot? A.Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy B.Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy C.Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy D.Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular .hypertrophy

ANS: A Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not aortic stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy, is present in tetralogy of Fallot. There is a ventricular septal defect, not an atrial septal defect, and overriding aorta, not aortic hypertrophy, is present.

Parents of a 3-year-old child diagnosed with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on what knowledge? A.The child needs opportunities to play with peers. B.The child needs to understand that peers' activities are too strenuous. C.Parents can meet all the child's needs. D.Constant parental supervision is needed to avoid overexertion.

ANS: A The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace and regulate their activities. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence.

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? A.Administering penicillin B.Avoiding salicylates (aspirin) C.Imposing strict bed rest for 4 to 6 weeks D.Administering corticosteroids if chorea develops

ANS: A The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice. Salicylates can be used to control the inflammatory process, especially in the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile stage, but it does not need to be strict. The chorea is transient and will resolve without treatment.

In which situation is there the newborn infant will have a congenital heart defect (CHD)? A.Trisomy 21 detected on amniocentesis B.Family history of myocardial infarction C.Father has type 1 diabetes mellitus D.Older sibling born with Turner's syndrome

ANS: A The incidence of congenital heart disease is approximately 50% in children with trisomy 21 (Down syndrome). A family history of congenital heart disease, not acquired heart disease, increases the risk of giving birth to a child with CHD. Infants born to mothers who are insulin dependent have an increased risk of CHD. Infants identified as having certain genetic defects, such as Turner's syndrome, have a higher incidence of CHD.

The nurse is caring for an infant diagnosed with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands? A.Organize nursing activities to allow for uninterrupted sleep B.Allow the infant to sleep through feedings during the night C.Wait for the infant to cry to show definite signs of hunger D.Discourage parents from rocking the infant

ANS: A The infant requires rest and conservation of energy for feeding. Every effort is made to organize nursing activities to allow for uninterrupted periods of sleep. Whenever possible, parents are encouraged to stay with their infant to provide the holding, rocking, and cuddling that help children sleep more soundly. To minimize disturbing the infant, changing bed linens and complete bathing are done only when necessary. Feeding is planned to accommodate the infant's sleep and wake patterns. The child is fed at the first sign of hunger, such as when sucking on fists, rather than waiting until he or she cries for a bottle because the stress of crying exhausts the limited energy supply. Because infants with CHD tire easily and may sleep through feedings, smaller feedings every 3 hours may be helpful.

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? A."You may need to increase the caloric density of your infant's formula." B."You should feed your baby every 2 hours." C."You may need to increase the amount of formula your infant eats with each feeding." D."You should place a nasal oxygen cannula on your infant during and after each feeding."

ANS: A The metabolic rate of infants with heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue. Infants with heart failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest, and a 4-hour schedule is too long. Fluids must be carefully monitored because of the heart failure. Infants do not require supplemental oxygen with feedings.

What is one of the most frequent causes of hypovolemic shock in children? a. Myocardial infarction B.Blood loss C.Anaphylaxis D.Congenital heart disease

ANS: B Blood loss and extracellular fluid loss are two of the most frequent causes of hypovolemic shock in children. Myocardial infarction is rare in a child; if it occurred, the resulting shock would be cardiogenic, not hypovolemic. Anaphylaxis results in distributive shock from extreme allergy or hypersensitivity to a foreign substance. Congenital heart disease tends to contribute to hypervolemia, not hypovolemia.

As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in what electrolyte? a. Chlorides b. Potassium c. Sodium d. Zinc

ANS: B Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with potassium.

The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching? A."I should avoid tub baths but may shower." B."I have to stay on strict bed rest for 3 days." C."I should remove the pressure dressing the day after the procedure." D."I may attend school but should avoid exercise for several days."

ANS: B Encourage rest and quiet activities for the first 3 days and avoid strenuous exercise. The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean.

What is the initial goal for the treatment of secondary hypertension? A.Weight control and diet B.Treating the underlying disease C.Administration of digoxin D.Administration of -adrenergic receptor blockers

ANS: B Identification of the underlying disease should be the first step in treating secondary hypertension. Weight control and diet are nonpharmacologic treatments for primary hypertension. Digoxin is indicated in the treatment of congestive heart failure. -Adrenergic receptor blockers are indicated in the treatment of primary hypertension.

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents (strokes) exists. An important objective to decrease this risk is to achieve what result? A.Minimize seizures B.Prevent dehydration C.Promote cardiac output D.Reduce energy expenditure

ANS: B In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

Which clinical changes occur as a result of septic shock? A.Hypothermia B.Increased cardiac output C.Vasoconstriction D.Angioneurotic edema

ANS: B Increased cardiac output, which results in warm, flushed skin, is one of the manifestations of septic shock. Fever and chills are characteristic of septic shock. Vasodilation is more common in septic shock. Angioneurotic edema occurs as a manifestation in anaphylactic shock.

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? A.Atrial septal defect B.Tetralogy of Fallot C.Ventricular septal defect D.Patent ductus arteriosus

ANS: B Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the interventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) A.Warm flushed extremities B.Weight loss C.Decreased urinary output D.Sweating (inappropriate) E.Anorexia

ANS: C, D, E The signs and symptoms of heart failure include decreased urinary output, sweating, and poor feeding. Other signs include pale, cool extremities, not warm and flushed, and weight gain, not weight loss.

What should the nurse consider when preparing a school-age child and the family for heart surgery? A.Not showing unfamiliar equipment B.Letting child hear the sounds of an electrocardiograph monitor C.Avoiding mentioning postoperative discomfort and interventions d. Explaining that an endotracheal tube will not be needed if the surgery goes well

ANS: B The child and family should be exposed to the sights and sounds of the intensive care unit. All positive, nonfrightening aspects of the environment are emphasized. The child should be shown unfamiliar equipment, and its use should be demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous lines, incision, and endotracheal tube.

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect? A.Pulmonary stenosis B.Patent ductus arteriosus C.Ventricular septal defect D.Coarctation of the aorta

ANS: B The classic murmur associated with patent ductus arteriosus is a machinery-like one that can be heard throughout both systole and diastole. A systolic ejection murmur that may be accompanied by a palpable thrill is a manifestation of pulmonary stenosis. The characteristic murmur associated with ventricular septal defect is a loud, harsh, holosystolic murmur. A systolic murmur that is accompanied by an ejection click may be heard on auscultation when coarctation of the aorta is present.

An 8-month-old infant becomes hypercyanotic while blood is being drawn. What should be the nurse's first action? a. Assess for neurologic defects B.Place the child in the knee-chest position C.Begin cardiopulmonary resuscitation D.Prepare the family for imminent death

ANS: B The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. The child should be assessed for airway, breathing, and circulation. Often calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell; cardiopulmonary resuscitation is not necessary, and death is unlikely.

What is the primary nursing intervention necessary to prevent bacterial endocarditis? A.Institute measures to prevent dental procedures. B.Counsel parents of high risk children about prophylactic antibiotics. C.Observe children for complications such as embolism and heart failure. D.Encourage restricted mobility in susceptible children.

ANS: B The objective of nursing care is to counsel the parents of high risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition. Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary. Observing for complications and encouraging restricted mobility in susceptible children should be done, but maintaining good oral health and using prophylactic antibiotics are most important.

What is the leading cause of death after heart transplantation? A.Infection B.Rejection C.Cardiomyopathy D.Congestive heart failure

ANS: B The posttransplantation course is complex. The leading cause of death after cardiac transplantation is rejection. Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection. one of the indications for cardiac transplant. Congestive heart failure is not a leading cause of death.

What is a common sign of digoxin toxicity? a. Seizures b. Vomiting c. Bradypnea d. Tachycardia

ANS: B Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower heart rate, not respiratory rate.

An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during a routine blood draw. Which interventions should the nurse implement? Place in order from the highest-priority intervention to the lowest-priority intervention. A.Administer 100% oxygen by blow-by B.Place infant in knee-chest position c. Remain calm d. Give morphine subcutaneously or by an existing intravenous line First priority Second priority Third priority Fourth priority

ANS: BADC Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in infants with tetralogy of Fallot, may occur in any child whose heart defect includes obstruction to pulmonary blood flow and communication between the ventricles. The infant becomes acutely cyanotic and hyperpneic because sudden infundibular spasm decreases pulmonary blood flow and increases right-to-left shunting. Because profound hypoxemia causes cerebral hypoxia, hypercyanotic spells require prompt assessment and treatment to prevent brain damage or possibly death. The infant should first be placed in the knee-chest position to reduce blood returning to the heart. Next, 100% oxygen is given to alleviate the hypoxemia. Morphine is next administered to reduce infundibular spasms. Last, the nurse should remain calm.

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, what medication should the nurse prepare for immediate administration? A.Diphenhydramine B.Dopamine C.Epinephrine D.Calcium chloride

ANS: C After the first priority of establishing an airway, epinephrine is the drug of choice. Diphenhydramine is not a strong enough antihistamine for this severe a reaction. Dopamine and calcium chloride are not appropriate drugs for this type of reaction.

A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response? A."You will be able to hold your child during the procedure." B."Your child can be active during the procedure, but can't sit in your lap." C."Your child must lie quietly; sometimes a mild sedative is administered before the procedure." D."The procedure is invasive so your child will be restrained during the echocardiogram."

ANS: C Although an echocardiogram is noninvasive, painless, and associated with no known side effects, it can be stressful for children. The child must lie quietly in the standard echocardiographic positions; crying, nursing, being held, or sitting up often leads to diagnostic errors or omissions. Therefore, infants and young children may need a mild sedative; older children benefit from psychologic preparation for the test. The distraction of a video or movie is often helpful.

Which defect results in increased pulmonary blood flow? A.Pulmonic stenosis B.Tricuspid atresia C.Atrial septal defect D.Transposition of the great arteries

ANS: C Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. Pulmonic stenosis is an obstruction to blood flowing from the ventricles. Tricuspid atresia results in decreased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

A nurse is teaching an adolescent about essential hypertension. The nurse knows that which of the following is correct? A.Primary hypertension should be treated with diuretics as soon as it is detected. B.Congenital heart defects are the most common cause of primary hypertension. C.Primary hypertension may be treated with weight reduction. D.Primary hypertension is not affected by exercise.

ANS: C Essential hypertension in children may be treated with weight reduction and exercise programs. If ineffective, pharmacologic intervention may be needed. Primary hypertension is considered an inherited disorder.

The nurse is caring for a child after heart surgery. What intervention should the nurse implement immediately if evidence is found of cardiac tamponade? A..Increase analgesia B. Apply warming blankets c. Immediately report this to the physician d. Encourage the child to cough, turn, and breathe deeply

ANS: C If evidence is noted of cardiac tamponade (blood or fluid in the pericardial space constricting the heart), the physician is notified immediately of this life-threatening complication. Increasing analgesia may be done before the physician drains the fluid, but the physician must be notified. Warming blankets are not indicated at this time. Encouraging the child to cough, turn, and breathe deeply should be deferred until after the evaluation by the physician.

What is an important nursing consideration when suctioning a young child who has had heart surgery? A.Perform suctioning at least every hour. B.Suction for no longer than 30 seconds at a time. C.Administer supplemental oxygen before and after suctioning. D.Expect symptoms of respiratory distress when suctioning.

ANS: C If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are to be avoided by using the appropriate technique.

What intervention should be implemented prior to the removal of a child's chest tubes? A.Explain that it is not painful. B.Explain that only a Band-Aid will be needed. C.Administer analgesics before the procedure. D.Educate the patient to expect bright red drainage for several hours after removal.

ANS: C It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing intravenous line. It is not a pain-free procedure. A sharp, momentary pain is felt, and this should not be misrepresented to the child. A petroleum gauze/airtight dressing is needed. Little or no drainage should be found on removal.

Which action by the school nurse is important in the prevention of rheumatic fever? A.Encourage routine cholesterol screenings. B.Conduct routine blood pressure screenings. C.Refer children with sore throats for throat cultures. D.Recommend salicylates instead of acetaminophen for minor discomforts.

ANS: C Nurses have a role in prevention—primarily in screening school-age children for sore throats caused by group A -hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A -hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye's syndrome after viral illnesses.

Which term is used to describe a clinical manifestation of the systemic venous congestion that can occur with congestive heart failure? A.Tachypnea B.Tachycardia C.Peripheral edema D.Pale, cool extremities

ANS: C Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool extremities are clinical manifestations of impaired myocardial function.

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? A.Pulmonary congestion B.Congenital heart defect C.Heart failure D.Systemic venous congestion

ANS: C The definition of heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body. Pulmonary congestion is an excessive accumulation of fluid in the lungs. Congenital heart defect is a malformation of the heart present at birth. Systemic venous congestion is an excessive accumulation of fluid in the systemic vasculature.

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what conditions occur? (Select all that apply.) A.Respiratory rate of 36 breaths/minute at rest B.Appetite slowly increasing C.Temperature above 37.7° C (100° F) D.New, frequent coughing E.Turning blue or bluer than normal

ANS: C, D, E The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C (100° F); new, frequent coughing; and any episodes of the infant turning blue or bluer than normal. A respiratory rate of 36 breaths/minute at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly.

Which clinical manifestations would the nurse expect to see as shock progresses in a child and decompensated develops? (Select all that apply.) A.Thirst and diminished urinary output B.Irritability and apprehension C.Cool extremities and decreased skin turgor D.Confusion and somnolence E.Normal blood pressure and narrowing pulse pressure F.Tachypnea and poor capillary refill time

ANS: C, D, F Cool extremities, decreased skin turgor, confusion, somnolence, tachypnea, and poor capillary refill time are beginning signs of decompensated shock.

Nursing interventions for the child after a cardiac catheterization include which of the following? (Select all that apply.) A.Allow ambulation as tolerated. B.Monitor vital signs every 2 hours. C.Assess the affected extremity for temperature and color. D.Check pulses above the catheterization site for equality and symmetry. E.Remove pressure dressing after 4 hours. F.Maintain a patent peripheral intravenous catheter until discharge.

ANS: C, F The extremity that was used for access for the cardiac catheterization must be checked for temperature and color. Coolness and blanching may indicate arterial occlusion. The child should have a patent peripheral intravenous line to ensure adequate hydration. Allowing ambulation, monitoring vital signs every 2 hours, checking pulses, and removing the pressure dressing after 4 hours are interventions that do not apply to a child after a cardiac catheterization.

What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy? A.Neurogenic shock B.Cardiogenic shock C.Hypovolemic shock D.Anaphylactic shock

ANS: D Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Neurogenic shock results from loss of neuronal control, such as the interruption of neuronal transmission that occurs from a spinal cord injury. Cardiogenic shock is decreased cardiac output. Hypovolemic shock is a reduction in the size of the vascular compartment, decreasing blood pressure, and low central venous pressure.

What is a common, serious complication of rheumatic fever? A.Seizures B.Cardiac arrhythmias C.Pulmonary hypertension D.Cardiac valve damage

ANS: D Cardiac valve damage is the most significant complication of rheumatic fever. Seizures, cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic fever.

The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on knowing what information? A.It is a safe, frequently used drug. B.It is difficult to either overmedicate or undermedicate with digoxin. C.Parents lack the expertise necessary to administer digoxin. D.Parents must learn specific, important guidelines for administration of digoxin.

ANS: D Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and monitor for side effects. Digoxin is a frequently used drug, but it has a narrow therapeutic range. Very small amounts of the liquid are given to infants, which makes it easy to overmedicate or undermedicate. Parents may lack the necessary expertise to administer the drug at first, but with discharge preparation they should be prepared to administer the drug safely.

When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what substance are thought to protect against cardiovascular disease? A.Cholesterol B.Triglycerides C.Low-density lipoproteins (LDLs) D.High-density lipoproteins (HDLs)

ANS: D HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high levels of proteins. It is thought that HDLs protect against cardiovascular disease. Cholesterol, triglycerides, and LDLs do not protect against cardiovascular disease.

When caring for the child with Kawasaki disease, the nurse should understand that principle of care? A.The child's fever is usually responsive to antibiotics within 48 hours. B.The principal area of involvement is the joints. C.Aspirin is contraindicated. D.Therapeutic management includes administration of gamma globulin and aspirin.

ANS: D High-dose intravenous gamma globulin and aspirin therapy are indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. The fever of Kawasaki disease is unresponsive to antibiotics and antipyretics. Involvement of mucous membranes and conjunctiva, changes in the extremities, and cardiac involvement are seen.

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. What is the most appropriate initial nursing action? A.Notify the physician. B.Apply a new bandage with more pressure. C.Place the child in the Trendelenburg position. D.Apply direct pressure above the catheterization site.

ANS: D If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying the physician and applying a new bandage with more pressure can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. The Trendelenburg position would not be helpful; it would increase the drainage from the lower extremities.

Seventy-two hours after cardiac surgery, a young child has a temperature of 37.7° C (101° F). The nurse should initially implement which intervention? A.Keep the child warm with blankets B.Apply a hypothermia blanket C.Record the temperature on nurses' notes D.Report findings to physician

ANS: D In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or an elevated temperature continues after this period, it is most likely a sign of an infection and immediate investigation is indicated. Blankets should be removed from the child to keep the temperature from increasing. A hypothermia blanket is not indicated for this level of temperature. The temperature should be recorded, but the physician must be notified for evaluation.

José is 4 year old. Preoperative teaching for a 4-year-old child scheduled for a cardiac catheterization should be done with what primary consideration in mind? A.Directed at his parents because he is too young to understand. B.Detailed in regard to the actual procedures so he will know what to expect. C.Done several days before the procedure so that he will be prepared. D.Adapted to his level of development so that he can understand.

ANS: D Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. This age-group does not understand in-depth descriptions. Preschoolers should be prepared close to the time of the cardiac catheterization.

What is the most common causative agent of bacterial endocarditis? A.Staphylococcus albus B.Streptococcus hemolyticus C.Staphylococcus albicans D.Streptococcus viridans

ANS: D Staphylococcus viridans is the most common causative agent in bacterial (infective) endocarditis. Staphylococcus albus, Streptococcus hemolyticus, and Staphylococcus albicans are not common causative agents.

Which postoperative intervention should be questioned for a child after a cardiac catheterization? A.Continue intravenous (IV) fluids until the infant is tolerating oral fluids. B.Check the dressing for bleeding. C.Assess peripheral circulation on the affected extremity. D.Keep the affected leg flexed and elevated.

ANS: D The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure. IV fluid administration continues until the child is taking and retaining adequate amounts of oral fluids. The insertion site dressing should be observed frequently for bleeding. The nurse should also look under the child to check for pooled blood. Peripheral perfusion is monitored after catheterization. Distal pulses should be palpable, although they may be weaker than in the contralateral extremity.

A nurse is assessing a school-aged child after a ventriculoperitoneal (VP) shunt replacement. Which of the following findings indicates a complication of this procedure? A. Abdominal distention B. Unequal peripheral pulses c. Pinpoint pupils D. Frontal bossing

Correct Answer: A. Abdominal distention A VP shunt allows excess cerebrospinal fluid from the ventricles to drain into the peritoneal cavity and be reabsorbed. Abdominal distention can indicate the presence of peritonitis due to the draining cerebral spinal fluid or a postoperative ileus.

A nurse is assessing a 6-month-old infant who had a cardiac catheterization with right femoral entry to diagnose a possible congenital heart defect. Which of the following findings should the nurse report to the provider? A. Cool toes on the right foot B. Weak pedal pulses on both feet c. Positive Babinski reflex on both feet D. Erythema on the right foot

Correct Answer: A. Cool toes on the right foot A Lab Values The nurse should monitor the temperature of the infant's right extremity and should report any indication of coolness distal to the entry site to the provider because this can indicate an obstruction of an artery. Incorrect Answers: B. The nurse should monitor the infant's pedal pulses for bilateral symmetry and equal strength. The nurse should expect the pedal pulse distal to the entry site to be weak after the procedure; however, it should gradually increase in strength C. The nurse should expect infants to have à positive Babinski reflex until about 12 months of age D. The nurse should monitor the color of the infant's right extremity and should report any indication of pallor or blanching to the provider because this can indicate an perfusion issue

A nurse is caring for an infant who has tetralogy of Fallot and is experiencing a hypercyanotic episode. Which of the following actions should the nurse take? A. Place the infant in a knee-chest position B. Initiate a fluid restriction C. Provide oxygen by nasal cannula D. Administer acetaminophen

Correct Answer: A. Place the infant in a knee-chest position The nurse should place the infant in a knee-chest position during a hypercyanotic episode. This position reduces the return of desaturated blood from the legs through the venous system and promotes the diversion of blood into the pulmonary artery. Incorrect Answers: B. The nurse should provide IV fluids as needed to treat the hypercyanotic episode. C. The nurse should apply a face mask to the infant and deliver 100% oxygen to treat the hypercyanotic episode. D. The nurse should expect to administer morphine to treat the hypercyanotic episode.

A nurse is caring for a 4-month-old infant who has tetralogy of Fallot and experiences a hypercyanotic spell. Which of the following actions should the nurse take? A. Place the infant in knee-chest position B. Begin CPR C. Prepare to intubate the infant D. Administer IV adenosine

Correct Answer: A. Place the infant in knee-chest position The nurse should identify that a hypercyanotic spell occurs when a vascular spasm reduces pulmonary blood flow and forces blood to shunt from the right ventricle to the left ventricle through the ventricular septal defect. The nurse should place the infant in a knee-chest position to increase systemic vascular resistance, which will help force more blood through the pulmonary artery

A nurse in a provider's office receives a phone call from the guardian of an infant who just vomited after the administration of digoxin. Which of the following actions should the nurse take first? A. Tell the guardian that a repeat dose of medication should not be given B. Verify the prescribed medication regimen c. Determine if the infant has been exposed to others who are ill D. Ask the guardian about the infant's urinary output

Correct Answer: A. Tell the guardian that a repeat dose of medication should not be given The greatest risk to this infant is an injury from digoxin toxicity. Therefore, the priority action for the nurse to take is to instruct the guardian not to administer another dose of medication. The nurse should follow-up with the guardian frequently to determine if the child has further episodes of vomiting. If so, the nurse should notify the provider immediately because vomiting is a possible indication of digoxin toxicity. Incorrect Answers: B. The nurse should verify the prescribed digoxin regimen and the accuracy of home administration. However, there is another action the nurse should take first. C. The nurse should attempt to identify possible causes of the infant's vomiting. However, there is another action the nurse should take first. D. The nurse should determine if the infant's urinary output is adequate to evaluate the effectiveness of the digoxin in managing the infant's heart failure. However, there is another action the nurse should take first.

A nurse is providing teaching to the parent of an infant who has heart failure and a new prescription for digoxin elixir. Which of the following pieces of information should the nurse include? A. Withhold the medication if the infant's heart rate is less than 110/min B. Mix the medication in 120 mL (4 oz) of infant formula c. Expect the infant to vomit frequently while taking this medication D. Double the dose if the infant has increased edema

Correct Answer: A. Withhold the medication if the infant's heart rate is less than 110/min The parent should withhold the medication and notify the provider if the infant's heart rate is less than 110/min. Incorrect Answers: B. The parent should not mix the medication with any liquids, including formula. C. The parent should notify the provider if the infant vomits frequently because this can be a manifestation of medication toxicity. D. The parent should not double the dose of medication for any reason because this could cause toxicity. MacBook

A nurse is assessing a school-aged child who is 30 minutes postoperative following a cardiac catheterization using the left femoral artery. Which of the following findings should the nurse identify as the priority to report to the provider? A. The child rouses to verbal stimuli B. The pulse strength of the child's left popliteal artery site is decreased C. The child's respiratory rate is 20/min D. The child rates his pain at the catheter insertion site at a 7 on a scale of O to 10

Correct Answer: B. The pulse strength of the child's left popliteal artery site is decreased When using the greatest risk framework, the nurse should identify that the greatest risk to the child is a decrease or loss of circulation below the catheter insertion site. This can indicate hemorrhage or a thrombus at the site and can result in neurovascular impairment.

A nurse is providing preoperative education for an 8-year-old child prior to cardiac surgery. Which of the following actions should the nurse take? A. Provide education for the child immediately before the surgery. B. Plan a teaching session that will last no longer than 60 min. C. Use a doll with tubes and an incision to explain the surgery. D. Discuss methods to cover the scar once healing has occurred.

Correct Answer: C. Use a doll with tubes and an incision to explain the surgiry. Play involving visual and interactive approaches is appropriate for a school-age child's level of understanding. Incorrect Answers: A. School-age children should have preoperative teaching up to 1 day before the procedure to allow the child time to process the information and form questions. B. Teaching sessions should last no longer than 20 minutes for a school-age child. D. Concerns about changes to body image and the presence of a scar are important to adolescents rather than school-age children.

A nurse is planning preoperative teaching for a school-age child who is scheduled for cardiac surgery. Which of the following actions should the nurse plan to take when teaching the child? A. Limit teaching sessions to 10 min B. Use simple, concrete terms when giving explanations C. Use photographs to help explain the procedure D. Conduct the teaching session 2 days before the procedure

Correct Answer: C. Use photographs to help explain the procedure The nurse should recognize the school-age child's increased language ability and desire for knowledge. The nurse should use photographs and simple diagrams to explain the procedure in an interesting and concrete way that the child can understand. Incorrect Answers: A. The nurse should limit teaching sessions to 10 to 15 minutes for a preschooler but can extend sessions for a school-age child to about 20 minutes. B. The nurse should use correct medical terminology when providing preoperative teaching for this child. D. The nurse should schedule preoperative teaching sessions for a school-age child no more than 1 day prior to the procedure.

A nurse is caring for a child who has tetralogy of Fallot. Which of the following laboratory values should the nurse expect to find? A. Platelet count of 20.000/mm^3 B. WBC 4,000/mm^3 C. Thyroid stimulating hormone 7.0 microunits/mL D. RBC 6.8 million/uL

Correct Answer: D. RBC 6.8 million/uL A child who has tetralogy of Fallot experiences cyanosis; therefore, the body responds by increasing RB production (polycythemia) in an attempt to supply oxygen to all body parts.

A nurse is planning care for an infant who has heart failure. Which of the following interventions should the nurse include in the plan to meet the nutritional needs of the infant? (Select all that apply.) A. Offer the infant a feeding every 2 hr B. Allow 30 min to complete each feeding C. Gradually increase the caloric density of the formula D. Position the infant semi-upright during feedings E. Provide gavage feeding if respiratory rate exceeds 80/min

Correct Answers: B. Allow 30 min to complete each feeding C. Gradually increase the caloric density of the formula D. Position the infant semi-upright during feedings E. Provide gavage feeding if respiratory rate exceeds 80/min The nurse should allow 30 minutes for each feeding. This length of feeding allows adequate intake without causing the infant to get overly fatigued or to lose needed rest time before the next feeding. The nurse should plan to provide the infant with a formula that has increased caloric density. An infant who has heart failure has an increased metabolic rate due to impaired cardiac function. Adding expressed breast milk or enteral nutrition formula or oil to the formula provides the infant with increased calories in a decreased volume of feeding. The nurse should gradually increase the caloric density of the feeding by 2 kcal/oz/day to promote infant tolerance and decrease the risk of diarrhea. The nurse should plan to hold the infant in a semi-upright position during feedings to promote maximum chest expansion and decrease the risk of respiratory distress. The nurse should plan to withhold oral feedings and provide gavage feedings if the infant shows indications of stress or fatigue. An infant who has a respiratory rate of 80/min to 100/min has tachypnea, which is an indicator of infant stress.