Peds Cardiac

The parents of a child with transposition of the great vessels ask the nurse why the child looks blue. Which response by the nurse is the most appropriate? A. "Her body gets blood that doesn't have much oxygen." B. "Her lungs are underdeveloped and underperfused." C. "She is not able to regulate her temperature and is cold." D. "This is very unusual for this condition, so I'll ask the doctor."

ANS: A In this condition, the aorta arises from the right side of the body, so systemic circulation consists of oxygen-poor blood. The other answers are not appropriate.

A nurse notes that a child's chart describes a heave. Which assessment should the nurse perform to correlate with this finding? A. Assess for nausea. B. Auscultate for heart sounds. C. Listen to lung sounds. D. Review the last ECG.

ANS: B A heave is an abnormal tremor that accompanies a vascular or cardiac murmur, so the nurse would listen to heart sounds. Lung sounds and ECGs are not directly related to a heave. Nausea is not related at all.

A child is hospitalized with heart failure and is receiving furosemide (Lasix). Which nursing action is the priority? A. Administer oxygen. B. Encourage rest. C. Provide meticulous skin care. D. Monitor brain natriuretic peptide.

ANS: A A child with heart failure receiving furosemide will have pulmonary congestion from fluid backup into the lungs. The nurse should provide oxygen as the priority action. The other actions are important for this child but do not take priority. Rest will help the body heal and reduce metabolic needs. Skin care is important for edematous tissues. Brain natriuretic peptide does help quantify fluid retention, but monitoring does not actively provide care for the child.

A nurse is monitoring a child after an interventional catheterization for PDA. Before the procedure, blood pressure was 98/42 mm Hg. After the procedure, blood pressure was 98/74 mm Hg. One hour later, the blood pressure is 96/34 mm Hg. What action by the nurse is best? A. Administer epinephrine (Adrenalin). B. Contact the provider. C. Document the findings. D. Give a rapid fluid bolus.

ANS: A After an interventional PDA repair, the child's pulse pressure should be normal (<40 mm Hg). Children with PDA usually have widened pulse pressure, which is normalized with correction. If the pulse pressure widens again the provider should be notified, as this may signal device embolization or dislodgment.

A 42-lb (19-kg) child is admitted for initial management of cardiomyopathy (CMP). The physician leaves orders for carvedilol (Coreg), 15 mg orally twice a day. What action by the nurse is most appropriate? A. Ask the provider to clarify the dose. B. Consult pharmacy about the drug choice. C. Give the medication as ordered. D. Withhold any antacids in this patient.

ANS: A Coreg is a beta blocker and is used in the treatment of CMP. The safe dose for this drug is 0.07 mg/kg, with a maximal dose of 0.5 mg/kg. The dose of 15 mg is far above the safe dose range. The nurse should consult the provider about the dose. Consulting pharmacy about the appropriateness of this drug is unnecessary. There is no contraindication to antacids.

A child has coarctation of the aorta (CoA). The parents report that the child is hesitant to participate in activities due to aching in his legs. Which information does the nurse provide? A. "Aching or pain is due to lower blood pressure in the legs." B. "Encourage activity so that collateral circulation develops." C. "Maybe he is getting to much blood pressure medication." D. "Your child needs to rest and limit participation in activities."

ANS: A In CoA, the blood pressure to the lower extremities is less than 10 mm Hg lower than the BP in the upper extremities. Normally, the lower extremity BP should be the same or higher. The lack of perfusion with oxygenated blood leads to pain or aching in the legs. The nurse provides accurate information about the condition. Developing collateral circulation is not a treatment methodology as you would see in peripheral arterial occlusions. The blood pressure is not lower due to medication; it is a manifestation of the condition. The child should participate as he is able and comfortable in order to maximize growth and development.

A nurse is teaching a community class on heart disease in children. Which information about prevention is most important for the nurse to share? A. Many conditions are genetic, and preventative gene therapy may become possible. B. Maintaining good control of diabetes and hypertension prevents most cases. C. Prevention is impossible because there are few known causes of heart disease. D. Taking 400 mg/day of folic acid will prevent most known cardiac diseases.

ANS: A Most cases of congenital cardiac disease have no known cause. The most accurate statement is that genetic causes of heart disease may be prevented with gene therapy in the future. Controlling chronic health conditions is important but not the most accurate answer. Prevention is not totally impossible. Folic acid is important but has the most impact on preventing neural tube defects.

Which information about exercise should the nurse give the parents of a child with heart failure? A. Encourage activity on the days when your child feels well. B. Exercise is not allowed in children who have heart failure. C. Physical activity often makes heart failure worse in children. D. Your child will not be able to participate in contact sports.

ANS: A Physical activity is beneficial to patients with heart failure, as it can strengthen the heart muscle, possibly preventing or reducing further exacerbations. However, when the child is not feeling well, he or she should not be pushed into vigorous activity. Even walking can be helpful. Without exercise, the symptoms will worsen. Too rigorous an activity may make symptoms worse. Participating in contact sports will probably not be allowed, but this information is too narrow in scope to be the best answer.

A child has significant polycythemia. When consulting with the health-care provider, which intervention does the nurse inquire about? A. Administering anticoagulants B. Implementing a fluid restriction C. Obtaining an oxygen saturation D. Starting cardiac rehabilitation

ANS: A Polycythemia (hemoglobin >15 g/dL) predisposes a child to thrombotic events, including stroke. The nurse would ask about an anticoagulant. A fluid restriction would "thicken" the blood even further, increasing the risk of thrombotic events. The nurse should be able to obtain an oxygen saturation as an independent nursing assessment. There is not enough information about the patient to recommend cardiac rehabilitation.

The mother of a toddler reports to the nurse that the child becomes cyanotic when he cries. Which question by the nurse is most important to ask the mother? A. "Does he squat while he cries?" B. "How long does the cyanosis last?" C. "Is he growing normally?" D. "What was his birth weight?"

ANS: A The mother is describing a "tet" spell, which is a hallmark sign of tetralogy of Fallot. A child with this condition becomes cyanotic when playing or crying and draws his or her legs up or squats. By doing this, the child lowers his or her pulmonary vascular resistance and relieves the cyanosis. The other questions are important, but will not give information specific to this condition.

A child is being released from the hospital after surgical correction of an atrioventricular canal defect (AVC). What referral by the nurse is most appropriate? A. Down syndrome support group B. Hospice services team C. Lions eye bank D. Transplant team

ANS: A Up to 75% of cases of AVC occur in children with Down syndrome, so this is the most appropriate referral if this is the case for this child. There is no information in the stem of the question to indicate that the child is terminally ill; the Lions eye bank is unrelated to this condition, and the child is probably not a candidate for a heart transplant because these defects can be repaired surgically.

The pediatric intensive care nurse assesses for the main complications following cardiac transplantation. Which complications is the nurse assessing for after cardiac transplantation? (Select all that apply.) A. Coronary artery disease B. Infection C. Post-transplant lymphoproliferative disorder D. Rejection E. Renal failure

ANS: A, B, C, D Coronary artery disease, infection, post-transplant lymphoproliferative disorder, and rejection are the main complications after cardiac transplantation. Renal failure may occur, but is not one of the major complications.

A pediatric nurse palpates a 2-year-old child's liver at 4 cm below the right costal margin. Which actions by the nurse are appropriate? (Select all that apply.) A. Assess work of breathing. B. Auscultate lung sounds. C. Calculate child's intake and output. D. Determine last bowel movement. E. Listen for heart murmur.

ANS: A, B, C, E An enlarged liver in a child can be indicative of heart failure or fluid overload from congenital heart defects. Assessing for respiratory distress, listening to heart and lung sounds, and calculating I&O will all give information related to cardiac function. Bowel movements are not related.

The faculty is discussing cardiac output with a student. Which components comprise the cardiac output? (Select all that apply.) A. Afterload B. Contractility C. Heart rate D. Hemoglobin E. Stroke volume

ANS: A, B, C, E Cardiac output is the product of stroke volume and heart rate (CO = SV ´ HR). Afterload and contractility are components of stroke volume. Hemoglobin is not related to cardiac output but does impact tissue oxygenation.

A nursing faculty member is explaining the three different types of cardiomyopathy (CMP) to students. Which information does the faculty member include in this discussion? (Select all that apply.) A. Dilated CMP is often caused by infection. B. Dilated CMP is the least common form. C. Hypertrophic CMP is usually familial. D. Hypertrophic CMP involves poor filling. E. Restrictive CMP is the most common type.

ANS: A, C, D Dilated CMP is caused by toxic agents, often from infections, chemotherapy, immunological defects, or nutritional disorders. It is the most common form of CMP. Hypertrophic CMP is usually a familial disorder and involves a hyperdynamic ventricle that fills poorly because of thickening. Restrictive CMP is the least common type of CMP.

The student studying pediatric cardiac disorders learns that which anomalies comprise the disorder tetralogy of Fallot? (Select all that apply.) A. An overriding aorta B. Atrial septal defect (ASD) C. Hypertrophic right ventricle D. Pulmonary stenosis or atresia E. Ventricular septal defect (VSD)

ANS: A, C, D, E The four defects seen in tetralogy of Fallot are VSD, an overriding aorta, pulmonary stenosis or atresia, and hypertrophic right ventricle. An ASD is not part of the condition.

The pediatric nurse explains to the student that which valves are known as semilunar valves? (Select all that apply.) A. Aortic B. Bicuspid C. Mitral D. Pulmonary E. Tricuspid

ANS: A, D The aortic and pulmonary valves are known as semilunar valves because each of their cusps looks like a half-moon. The mitral and tricuspid valves are atrioventricular valves. A bicuspid valve simply has two cusps.

At a well-child visit, the nurse notes a 4-year-old child to be in the 95th percentile for weight. Which screening measure is most important for the nurse include in this visit? A. Body mass index (BMI) B. Cholesterol panel C. Congenital heart disease D. None; child is too young

ANS: B After the age of 2 years, children who meet certain criteria should be screened for hypercholesterolemia-hyperlipidemia. Criteria include a child who is at the 85% percentile or greater for weight. A BMI can be calculated from the height and weight, but does not screen for other diseases. Congenital heart disease is not related to a heavy weight.

A child is scheduled for open heart surgery. Which nursing action is the priority? A. Complete the preoperative checklist. B. Ensure informed consent is on the chart. C. Show the parents the intensive care unit. D. Teach the family about the surgery.

ANS: B All actions are important for the child undergoing open heart surgery. However, the priority for any surgical patient is to ensure complete informed consent is on the chart.

A school-age child is brought to the clinic by a parent who reports that the child becomes short of breath with activity. Which assessment finding would the nurse correlate with this condition? A. Bulging fontanels B. Elevated brain natriuretic peptide C. Peripheral edema D. Weight loss

ANS: B Brain natriuretic peptide (BNP) is a measure of fluid overload, often seen in heart failure. An elevation in the laboratory value indicates that the child is retaining fluids. Bulging fontanels would not be seen in this age group. Children do not have peripheral edema, as is common in adults. Weight gain, not loss, would occur with fluid retention.

A child has been diagnosed with an atrioventricular canal defect (AVC). While awaiting surgical correction, which teaching takes priority? A. Care of tubes and drains postoperatively B. Feeding the child frequent, small amounts C. Monitoring weight gain and urine output D. Returning for all scheduled appointments

ANS: B Children with uncorrected AVC have shortness of breath, leading to feeding problems. The parents should be taught to feed the child small amounts frequently to limit dyspnea that may accompany feeding. The child will not go home with drains and tubes postoperatively. Monitoring weight gain and urine output is important for all children with cardiac defects. Returning for appointments is important for all children.

A child has truncus arteriosus with hypotension and poor perfusion. Which medication does the nurse prepare to administer? A. Amiodarone (Cordarone) B. Clopidogrel (Plavix) C. Dopamine (Intropin) D. Isoproterenol (Isuprel)

ANS: B Drugs used in this condition include preload- and afterload-reducing agents and positive inotropes. Dopamine is a positive inotrope. The other drugs would not be appropriate.

A 12-year-old child has been diagnosed with long QT syndrome. Which teaching by the nurse is most important? A. No driving until rhythm disturbances are controlled for 6 months. B. Parents and siblings of the child need to be tested for the disorder. C. The child cannot participate in any contact sports for a year. D. Watch the child for symptoms of heart failure or infection.

ANS: B Parents and siblings need to be tested for long QT syndrome as soon as possible. It is true the child has driving restrictions until the rhythm is controlled for 6 months, but for a 12-year old, this is not priority information. Sports may be curtailed until the rhythm is controlled, but there is no specific restriction that lasts for 1 year. Heart failure and infection are not related.

A student nurse asks the faculty why a child with patent ductus arteriosus (PDA) is taking a nonsteroidal anti-inflammatory drug (NSAID). Which response by the faculty is the most appropriate? A. Decreases venous stasis, lowering risks of clotting B. Inhibits prostaglandin, which helps close the PDA C. Provides long-lasting pain and inflammation control D. Reduces swelling around the PDA, making surgery easier

ANS: B Prostaglandin helps keep the PDA open, so an NSAID that inhibits prostaglandin synthesis will help close the opening. This is especially beneficial for premature infants. It is not used for venous stasis, pain relief, or swelling.

A new nurse is taking a child's blood pressure. What action would cause an experienced nurse to intervene? A. Allows the child to get familiar with equipment B. Chooses a cuff that covers 65% of the child's arm C. Has a parent stay with the child to calm him or her D. Uses an automatic cuff if the heart rate is normal

ANS: B The appropriate-sized cuff is important for accuracy. The cuff should be long enough to cover 80-100% of the child's arm. A cuff that is too small will give a falsely high reading. The other actions are appropriate.

A nurse is concerned that a child may have renal failure after open heart surgery. Which laboratory value does the nurse assess as the priority to determine the child's kidney function? A. Blood urea nitrogen (BUN) B. Serum creatinine C. Hemoglobin D. Urine pH

ANS: B The diagnostic laboratory value most specific for kidney function is the creatinine, so this is the laboratory value the nurse assesses. BUN also indicates kidney function, but alterations in BUN can be due to many causes other than kidney problems. The hemoglobin and urine pH do not give information about the function of the kidneys.

A nurse is assessing patients for the presence of patent ductus arteriosus (PDA). Which patient should the nurse assess first? A. 1-year old, history of frequent colds B. 4-year old, blood pressure of 102/36 mm Hg C. Infant with history of poor feeding D. Toddler with murmur at right sternal border

ANS: B This child has a wide pulse pressure, which is a sign of PDA. The nurse would assess this child first. Frequent colds and poor feeding can be seen in PDA, but they are vague symptoms and could be related to a number of other conditions. The murmur of a PDA is heard best at the left subclavicular margin.

A child has a large ventricular septal defect (VSD) with left-to-right shunting. Which information about VSDs does the faculty member explain to the nursing student? (Select all that apply.) A. The child will have obvious cyanosis. B. A harsh, pansystolic murmur is heard. C. This is the most common congenital heart defect. D. Some VSDs can close spontaneously. E. Transcatheter closure is common.

ANS: B, C, D A VSD is the most common congenital heart defect and is one of the mildest forms. The murmur of a VSD is harsh, pansystolic, and heard best at the lower left sternal border. Some VSDs can close spontaneously; those that need invasive closure must be surgically repaired. Presently, transcatheter closure is not available.

Which is the average oxygen saturation of blood in the right atrium? A. 25% B. 50% C. 70% D. 98%

ANS: C The right atrium is the collecting chamber that receives blood from the entire body except for the lungs. The oxygen saturation of this blood is approximately 70%.

A nurse is teaching a group of parents about bacterial endocarditis (BE) and follow-up care. Which parents should be instructed to obtain prophylactic antibiotics prior to dental cleaning? (Select all that apply.) A. Child after complete repair via catheter for 1 year B. Child after transplant, no residual defect, for 6 months C. Child with congenital repair with residual defect, for life D. Child with one prior episode of bacterial endocarditis E. Child with prosthetic mitral valve for the first 6 months

ANS: B, C, D Guidelines for who needs prophylaxis prior to invasive procedures were updated in 2007. They include children post-cardiac transplantation who do not have residual valve problems for 6 months post-transplant, any child with a residual defect after a surgical repair for the remainder of his or her life, and children who have already had one (or more) episode of BE. Prophylaxis after complete repairs is for 6 months. Prophylaxis after valve replacement is lifelong.

The student is learning about atrioventricular canal defects (AVCs). Which information stated by the student reflects appropriate understanding of the disease process? (Select all that apply.) A. Cyanosis is the cardinal manifestation. B. It often occurs in children with Down syndrome. C. Prostaglandin is administered preoperatively. D. The tricuspid and mitral valves form one opening. E. It will usually close on its own without surgery.

ANS: B, D An AVC is formed during fetal endocardial development. The tricuspid and mitral valves come together and form one large opening, through which blood is mixed. Because the shunt is left to right, there is no cyanosis. This disorder is often seen in children with Down syndrome and must be repaired surgically for the child to live a normal life. Prostaglandin is used to maintain a patent ductus arteriosus, not for AVCs.

An infant is discharged after open heart surgery. The infant is going home on oxygen and with multiple medications. Which instruction by the nurse is the priority? A. "Be sure to keep all postoperative appointments." B. "Do not allow anyone to pick up or hold the baby." C. "If your baby is irritable, check oxygen saturation." D. "Monitor the incision for redness or warmth."

ANS: C A child going home on oxygen will have an oximeter. This child's parents need to be educated on signs of heart failure (including decreased oxygenation), including irritability in a small child. They should be told to check the oxygen saturation when irritability is seen. Keeping appointments and monitoring a surgical incision are appropriate instructions for any postoperative patient. The baby can be picked up and held but must be cradled and not picked up under the arms until the sternum has healed.

A 10-year-old child is being discharged after surgical repair of a total anomalous pulmonary venous return defect (TAPVR). Which referral made by the nurse is most appropriate for this child? A. Hospice team B. Occupational therapy C. School nurse D. Visiting nurse

ANS: C After a TAPVR repair, most children go on to live full and normal lives. Because this child will return to school, communication with the school nurse is appropriate. Hospice, visiting nurses, and occupational therapy are not warranted.

A child is being discharged after a pacemaker insertion. Which teaching point by the nurse takes priority? A. Any prescribed activity restrictions B. Need for a healthy balanced diet C. Schedule for pacemaker testing D. Signs of wound site infection

ANS: C All options are important for the postoperative child who had a pacemaker insertion. However, the instruction that is specific to this operation is the schedule for follow-up pacemaker function testing, which will be lifelong.

A nurse is concerned that a child with pulmonary hypertension (PA) is developing heart failure. Which manifestation would the nurse assess for first? A. Cough B. Dyspnea C. Extremity edema D. Tachycardia

ANS: C As the pressure in the lungs increases in the child with PA, the right ventricle hypertrophies and will eventually fail. Manifestations of right-sided failure include peripheral edema. Lung manifestations are seen in left-sided heart failure. Tachycardia is nonspecific. Although both sides of the heart can eventually fail, the first signs and symptoms will be of right-sided failure.

A nurse notes that a child has clubbed fingernails. Which laboratory finding would the nurse correlate with this assessment? A. Hemoglobin: 16 g/dL B. PaCO2: 43 mm Hg C. PaO2: 72 mm Hg D. White blood count: 8,500 mm3

ANS: C Clubbing of the fingernails is associated with chronically low oxygenation. A PaO2 of 72 mm Hg is low. The other values are normal.

A child hospitalized with heart failure has extremely high blood pressure. Which medication does the nurse prepare to administer? A. Digoxin (Lanoxin) B. Dobutamine (Dobutrex) C. Enalapril (Vasotec) D. Hydrochlorothiazide (Aquazide)

ANS: C Enalapril is a calcium-channel blocker that reduces systemic vascular resistance, or afterload. Digoxin and dobutamine are positive inotropic agents. Hydrochlorothiazide is a diuretic.

A child hospitalized with heart failure has manifestations related to increased preload. Which drug does the nurse prepare to administer? A. Digoxin (Lanoxin) B. Dopamine (Intropin) C. Furosemide (Lasix) D. Metoprolol (Toprol)

ANS: C Furosemide is a diuretic, used to rid the body of excess fluid, and it is excess fluid that leads to increased preload. Digoxin is often used in heart failure for its positive inotropic actions. Dopamine increases contractility. Metoprolol is a beta blocker, and its major effect is blocking sympathetic nervous system activity.

A 3-year-old child is 4 hours post-cardiac catheterization via the right femoral artery. Which assessment finding should the nurse report to the provider? A. Crying, complaining of pain at site B. Restless, tries to get up repeatedly C. Right pedal pulse weaker than left D. Wants to be held by a parent

ANS: C Pedal pulses should be equal (or unchanged) after a cardiac catheterization. If a pedal pulse on the insertion side is weaker, arterial flow to the extremity may have been disrupted, and this should be reported. Pain is expected and is treated with acetaminophen. A 3-year-old would be expected to want to get up and not lie still and might want to be held. Sedation might be required to maintain bedrest with the affected leg kept straight.

What has the greatest influence on preload? A. Blood pressure B. Contractility C. Fluid volume D. Heart rate

ANS: C Preload is equivalent to venous blood return to the atria and end diastolic volumes of the heart. This is directly influenced by fluid volume. Heart rate and contractility have some influence, but they are not the major determinants of preload. Blood pressure is not a direct influence on preload.

Which artery carries deoxygenated blood? A. Aorta B. Inferior vena cava C. Pulmonary artery D. Subclavian artery

ANS: C The pulmonary artery is the only artery in the body to carry deoxygenated blood. It is an artery because it carries blood away from the heart.

A student nurse records a systolic blood pressure of 106 mm Hg for a 4-year-old child. Which response by the registered nurse is best? A. Ask the student if this is a normal finding. B. Have the student repeat the blood pressure. C. Refer the family to a health-care provider. D. Tell the student to document the results.

ANS: C This blood pressure is in the 95th percentile for age. For screening purposes, a blood pressure greater than 20 mm Hg above normal for the child's age is considered a red flag for hypertension, and the child should be referred to a health-care provider. The other options are all appropriate but are not as important as referring the child for further workup.

A nurse is assessing a school-age child admitted with new heart murmur, arthritis-type symptoms, erythema marginatum, and fever. When taking the child's history, which question is most likely to provide important information? A. "Did your child have any vaccinations recently?" B. "Has your child been exposed to contagious illnesses?" C. "Has your child had a sore throat in the last 2 to 3 weeks?" D. "Is there a family history of autoimmune disorders?"

ANS: C This child is displaying manifestations of rheumatic fever, which typically arises after an episode of acute pharyngitis. The nurse should ask about recent sore throats. The other questions are not as likely to provide vital information.

A child is prescribed warfarin (Coumadin). Which laboratory values does the nurse monitor? (Select all that apply.) A. Electrolytes B. Hematocrit (Hct) C. International normalized ratio (INR) D. Partial thromboplastin time (PTT) E. Prothrombin time (PT)

ANS: C, D Coumadin is monitored using the PT and INR. Electrolytes and hematocrit are important laboratory values but are not specific for this drug. The PTT is used to monitor heparin therapy.

An infant has critical aortic stenosis. The physician orders several medications for the infant. Which prescribed medications would the nurse question for this infant? (Select all that apply.) A. Bumetanide (Bumex) B. Diltiazem (Cardizem) C. Enoxaparin (Lovenox) D. Epinephrine (Adrenalin) E. Furosemide (Lasix)

ANS: C, D In cases of critical aortic stenosis, medications include preload- and afterload-reducing agents, including bumetanine, diltiazem, and furosemide. Enoxaparin is a low-molecular-weight heparin. Epinephrine will raise heart rate and blood pressure and would cause this child's condition to worsen.

An infant has been diagnosed with pulmonic stenosis. Which manifestations does the nurse document as normal findings for this condition? (Select all that apply.) A. Cough B. Dyspnea C. Enlarged liver D. Puffy eyelids E. Retractions

ANS: C, D Right-sided heart failure occurs with pulmonic stenosis. Manifestations include hepatomegaly (enlarged liver) and puffy eyelids. Cough and dyspnea are more likely due to left-sided heart failure. Retractions can occur with respiratory distress despite the cause.

A nurse is admitting a child scheduled for a Fontan repair. Which condition does the nurse understand the child to have? A. Aortic stenosis B. Patent ductus arteriosus C. Pulmonary regurgitation D. Tricuspid atresia

ANS: D A child scheduled for a Fontan repair has tricuspid atresia.

A child has been admitted with Kawasaki disease and is started on aspirin and warfarin (Coumadin). For which nursing diagnosis does the nurse plan interventions as the priority? A. Acute pain related to mouth redness and cracked lips B. Altered body image related to peeling skin rash C. Altered nutrition: less than body requirements D. Risk for bleeding related to medication effects

ANS: D Actual nursing diagnoses take priority over "risk for" diagnoses when the actual diagnoses exist. There is no information in the stem to show that the child has impaired mucous membranes leading to pain, an altered body image related to rash, or altered nutrition, although all of these are possible for this child. Risk for injury is the priority because the child is taking two medications that alter coagulation, and for patient safety, this is a critical diagnosis.

A child is in the pediatric intensive care unit 2 hours after a surgical repair of an atrial septal defect (ASD). Postoperative nursing actions include which of the following? A. Administer pain medication. B. Maintain venous access. C. Monitor chest tube drainage. D. The nurse will take all of these actions.

ANS: D All actions are important for the child postoperatively following an ASD repair. This child will be on a mechanical ventilator, so airway is the priority. The nurse will suction secretions as needed to maintain a patent airway.

A 5-year-old child is being discharged after valve replacement surgery. Which discharge information specific to this child does the nurse provide? A. "Be sure to keep all follow-up appointments." B. "Encourage your child to eat a healthy diet." C. "Monitor the chest incision for redness or heat." D. "This valve will need replacement in about 5 years."

ANS: D All options are appropriate for any child with a heart condition or after surgery. The option most specific to this child's condition is informing the parents that as the child grows, the valve will need to be replaced about once every 5 years.

The parents of a child born with severe hypoplastic left heart syndrome ask the nurse about treatment options. Which option is inconsistent with the nurse's knowledge about this condition? A. "Palliative or end-of-life care is one possibility." B. "She can be listed for a cardiac transplant." C. "Surgical correction involves several procedures." D. "We can give a series of dopamine (Intropin) infusions."

ANS: D Although dopamine is a positive inotrope, serial infusions are not used for this condition. The other statements relay possible treatment decision points for this child.

A child diagnosed with a heart murmur is scheduled for an echocardiogram. Which information about this diagnostic test does the nurse provide to the family? A. Allows visualization of the heart's electrical activity B. Gives direct pressure measurements across valves C. Provides more specific information than other tests D. Shows the location and size of a heart defect

ANS: D An echocardiogram is a noninvasive test that can show the size and location of a heart defect. An electrocardiogram (ECG) provides visualization of the heart's electrical activity. Direct pressure measurements are obtained with cardiac catheterization. More specific information can be obtained about heart defects via a magnetic resonance angiogram or computed tomographic angiogram.

A child has had a closure device inserted in interventional radiology for an atrial septal defect (ASD). Two hours later the child is pale, tachycardic, and hypotensive. Which action by the nurse takes priority? A. Administer a beta blocker to slow the heart rate down. B. Document findings then notify the health-care provider. C. Increase the rate of the IV fluid administration. D. Prepare the child to return to interventional radiology.

ANS: D Complications from insertion of closure devices include bleeding, cardiac tamponade, or migration of the device. The provider needs to be notified stat, and the child prepared to return to the interventional radiology suite. A beta blocker is inappropriate in this setting. The nurse should notify the provider and obtain orders prior to changing IV fluid rates. Documentation needs to be thorough, but should wait until after the provider is notified.

The nurse is teaching the parents of a child who had a surgical correction of a congenital heart defect about subacute bacterial endocarditis (SBE). Which recommendation regarding antibiotic administration prior to dental cleanings is the most appropriate? A. All children with congenital heart defects need SBE prophylaxis. B. Chronic SBE prophylaxis is recommended for most similar children. C. Risks for SBE are very high but easily prevented with antibiotics. D. The provider must weigh the risk-to-benefit ratio for SBE prophylaxis.

ANS: D In 2007 the American Heart Association made major changes to the guidelines for prophylaxis needed for patients who have known cardiac disease. The provider needs to weigh the risk-to-benefit ratio, as prophylaxis will only prevent a few cases of SBE and the risk of antibiotic resistance is high. When used, SBE prophylaxis is usually a one-time dose. The actual risk of SBE from dental procedures is less than that from toothbrushing.

A student nurse is caring for a child several hours after open heart surgery. Which action by the student requires intervention by the registered nurse? A. Administers pain medication based on assessment of nonverbal signs of pain B. Groups nursing care tasks to allow for uninterrupted periods of rest and sleep C. Monitors hourly output from child's indwelling urinary catheter and chest tube D. Prepares to administer medication through the central venous pressure line

ANS: D The central venous pressure line is used to measure right atrial pressure. It is not used for medication administration. The RN should intervene when the student prepares to give medication through this line. The other actions are appropriate.

A child has been admitted for suspected bacterial endocarditis. What action takes priority? A. Administering antibiotics B. Education on valve replacement C. Giving an antipyretic D. Obtaining blood cultures

ANS: D The priority action is to obtain blood cultures, either drawn by the nurse or laboratory. Antibiotics are not started until these are collected. If the child is febrile, an antipyretic is appropriate, but it is not the priority. Education on valve replacement is not warranted until later in the course of the disease if it is needed.

A child is suspected of having neurally mediated syncope. Which diagnostic test does the nurse prepare the child for? A. Cerebral angiogram B. Coronary angiogram C. Echocardiogram D. Tilt table test

ANS: D The tilt table test is specific for neurally mediated syncope.

The nurse is assigned to four patients on the pediatric progressive care unit. After receiving shift report, which patient should the nurse see first? A. Blood pressure of 88/56 mm Hg in 4-year-old child with heart failure B. Child crying inconsolably after his parents went home C. Pain 5/10 in a child 2 days after cardiac surgery D. Temperature 104.6°F (40.3°C) 3 days after dental visit

ANS: D This child likely has infective endocarditis or bacterial endocarditis. Any high fever after an invasive procedure or dental cleaning needs to be investigated for this possibility. The blood pressure of 88/56 mm Hg is at about the 50% percentile for a 4-year-old and would be considered adequate. Pain is an expected finding after surgery and needs to be treated, but not as the priority. The crying child could be comforted by a nursing assistant, child-life specialist, social worker, or even a volunteer until the nurse can see the child.