Peds Practice: Ch 41 Cardiovascular Disorder

A nurse is caring for a child that just had open-heart surgery and the parents are asking why there are wires coming out of the chest of the infant. What is the best response by the nurse? The wires are left in the heart one month after surgery for potential arrhythmias. These wires are connected to the heart and will detect if your child's heart gets out of rhythm. The wires will administer ongoing electrical shocks to the heart to maintain rhythm. The wires are measuring the fluid level in the heart.

These wires are connected to the heart and will detect if your child's heart gets out of rhythm.

Parents are told their infant has a hypoplastic left heart. What is the type of education that would be included for this family? This is a problem where the left side of the heart did not develop properly. This is a problem where the right side of the heart did not develop properly. The infant will have immediate surgery to completely correct the heart defect. There are no surgeries that can help the child live with this heart defect.

This is a problem where the left side of the heart did not develop properly.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? This test can only determine the size of the heart. This is a test that will check the electrical impulses in the heart. This is a test that will check how blood is flowing through the heart. This test is an invasive test that will measure the blockage in the heart.

This is a test that will check how blood is flowing through the heart.

A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education? An IV for fluids will be started immediately. Your child may need multiple surgeries to correct this defect. This is caused by an opening that usually closes by 1 week of age. This type of defect is caused by having a genetic predisposition for it.

This is caused by an opening that usually closes by 1 week of age.

A mother asks why her infant with a cyanotic heart defect turns blue. What is the best response by the nurse? This is a sign of heart failure. This is due to a decreased amount of oxygen to the peripheral tissue. This is considered a medical emergency and needs immediate surgery. This is due to the lack of oxygen to the brain.

This is due to a decreased amount of oxygen to the peripheral tissue.

A parent is told their infant has a heart defect with a left to right shunt. What is the best way for the nurse to explain this type of shunting to the parent? This type of shunting causes a decrease of blood to the lungs. This type of shunting causes an increase of blood to the lungs. This type of shunting causes an increase of blood to the systemic circulation. This type of shunting causes a decrease of blood to the brain.

This type of shunting causes an increase of blood to the lungs.

The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy the process of digitalization is done for which of the following reasons?

To build the blood levels to a therapeutic level

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which of the following reactions? Stomach upset Wheezing Nausea with diarrhea Abdominal distress

Wheezing

The nurse is caring for a 3 month old with history of congenital heart disease. The infant is brought to the emergency department with nausea and vomiting for 3 days. Admission labs confirm dehydration. The nurse realizes that the dehydrated infant is at risk for: jaundice. seizure activity. tachycardia. a cerebrovascular accident.

a cerebrovascular accident.

Infants with congenital heart disease should not be allowed to become dehydrated because this makes them prone to a) tachycardia!! b) cerebrovascular accident!! c) jaundice!! d) seizures!!

cerebrovascular accident!!

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the: child will have to remain NPO for 6 to 8 hours after the procedure to prevent vomiting. procedure is noninvasive and not frightening for children. child will require a general anesthetic and needs to be prepared for this. child will return with a bulky pressure dressing over the catheter insertion area.

child will return with a bulky pressure dressing over the catheter insertion area.

A nurse auscultates a child with atrial septal defect (ASD). What sounds would you hear? A. loud systolic murmur B. machinery-type murmur C. high pitched click D. fixed, split-second heart sound

fixed, split second heart sound

A nurse auscultates a child with truncus arteriosus (TGA). What sounds would you hear? A. loud second heart sound B. machinery-type murmur C. high pitched click D. fixed, split-second heart sound

fixed, split-second heart sound

Clinical Manifestations of Atrioventicular Canal Defect

frequent respiratory infections

A nurse auscultates a child with pulmonary stenosis. What sounds would you hear? A. loud systolic murmur in back of left axilla B. machinery-type murmur C. high pitched click D. fixed, split-second heart sound

high pitched click

A nurse auscultates a child with transposition of great arteries (TGA). What sounds would you hear? A. loud second heart sound B. machinery-type murmur C. high pitched click D. fixed, split-second heart sound

loud second heart sound

A nurse auscultates a child with a ventricular septal defect (VSD). What sounds would you hear? A. loud systolic murmur B. machinery-type murmur C. high pitched click D. fixed, split-second heart sound

loud systolic murmur

A nurse auscultates a child with atrioventricular canal defect. What sounds would you hear? A. loud systolic murmur B. machinery-type murmur C. high pitched click D. fixed, split-second heart sound

loud systolic murmur

A nurse auscultates a child with Coarctation of aorta. What sounds would you hear? A. loud systolic murmur in back of left axilla B. machinery-type murmur C. high pitched click D. fixed, split-second heart sound

loud systolic murmur in back of left axilla

A nurse auscultates a child with a patent ductus arteriosis (PDA). What sounds would you hear? A. loud systolic murmur B. machinery-type murmur C. high pitched click D. fixed, split-second heart sound

machinery-type murmur

The nurse would teach the mother of a boy with tetralogy of Fallot that if the child suddenly becomes cyanotic and dyspneic, the mother should: a. have him lie supine with the head turned to one side. b. have him lie prone, being sure he can breathe easily. c. place him in a semi-Fowler's position in an infant seat. d. place him in a knee-chest position.

place him in a knee-chest position.

The nurse is caring for a newborn who is scheduled for cardiac surgery to correct a diagnosed defect. Which statements by the mother demonstrate understanding of the situation? Select all that apply. "I'm sure it is likely that my baby will be in intensive care after surgery. I believe I can pump so he can still receive my milk." "I know my child uses up a lot of energy feeding but it doesn't seem to cause distress when I breast feed." "Since having the surgery my baby sometimes nurses for almost an hour." "I have read that human milk fortifier can be added to my breast milk for additional calorie needs if necessary." "I hope my baby doesn't have to have feeding through a feeding tube after surgery, but I know that is a possibility."

• "I know my child uses up a lot of energy feeding but it doesn't seem to cause distress when I breast feed." • "I'm sure it is likely that my baby will be in intensive care after surgery. I believe I can pump so he can still receive my milk." • "I hope my baby doesn't have to have feeding through a feeding tube after surgery, but I know that is a possibility." • "I have read that human milk fortifier can be added to my breast milk for additional calorie needs if necessary." Explanation: Children with congenital heart defects typically have increased nutritional needs due to the increased energy expenditure associated with increased cardiac and respiratory workloads. Most infants do well with breast feeding as long as feeding does not last for periods of more than about 20 minutes. Gavage is sometimes necessary postoperatively, and this can be accomplished with pumped breast milk, as well as human milk fortifier when necessary for calorie needs.

The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements? Select all that apply. A. "Our child will be so excited to get back to soccer league in a few days." B. "We will be sure to not allow our child to ride a bicycle for at least 2 weeks." C. "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed." D. "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." E. "It's wonderful that our child will never have an abnormal heart rhythm again."

• "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed." • "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." • "We will be sure to not allow our child to ride a bicycle for at least 2 weeks."

The nurse is assessing a child with aortic stenosis. Which findings would the nurse most likely assess? Select all that apply. Blood pressure in arms significantly higher than in legs Thrill palpated at base of heart Moderately loud systolic murmur at the base of the heart Dizziness with prolonged standing Chest pain with activity

• Dizziness with prolonged standing • Chest pain with activity • Thrill palpated at base of heart Explanation: Assessment findings associated with aortic stenosis include angina or chest pain with activity, dizziness with prolonged standing, and a thrill palpated at the base of the heart. A moderately loud systolic murmur at the base of the heart and blood pressure that is significantly higher in the arms than in the legs, possibly 20 mm Hg or higher, suggests coarctation of the aorta.

The physician suspects a 13-month-old may have a ventricular septal defect based on the signs and symptoms displayed. The parents ask the nurse what tests the physician may order to determine if their child has this diagnosis. The nurse is correct when telling the parents that common diagnostic testing for this disorder includes which tests? Cardiac catheterization CT scan Echocardiogram PET scan MRI

• MRI • Echocardiogram • Cardiac catheterization Explanation: An abnormal opening between the right and left ventricles in ventricular septal defect. Magnetic resonance imaging (MRI) or echocardiogram with color flow Doppler may reveal the opening as well as the extent of left-to-right shunting. These studies also may identify right ventricular hypertrophy and dilation of the pulmonary artery resulting from the increased blood flow. Cardiac catheterization may be used to evaluate the extent of blood flow being pumped to the pulmonary circulation and to evaluate hemodynamic pressures.

The nurse is caring for a child who is preparing to undergo an exercise stress test. Which interventions will be included in the care? Assess blood glucose level prior to the start of the test and one hour after. Remind child to verbalize any feelings of discomfort during the test. Monitor vital signs at completion of the test. Monitor vital signs prior to the start of the test. Complete EKG one hour after test is completed.

• Monitor vital signs prior to the start of the test. • Remind child to verbalize any feelings of discomfort during the test. • Monitor vital signs at completion of the test. Explanation: The exercise stress test monitors heart rate, blood pressure, ECG, and oxygen consumption at rest and during exercise. Vital signs are taken prior to, during and after the test period. An EKG is taken prior to the test. Serum glucose levels are not associated with this test.

The nurse is caring for a child who has been experiencing hypercyanotic episodes. Which treatments will be effective in managing them? Select all that apply. Apply a cool cloth the child's forehead. Provide supplemental oxygen. Administer Demerol as prescribed. Reduce intravenous fluids. Assist the child to a knee chest position.

• Provide supplemental oxygen. • Assist the child to a knee chest position.

A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series of laboratory tests have been ordered. Which findings are consistent with this disease? Select all that apply. - Reduced white blood cell count - Negative C reactive protein levels - Reduced hemoglobin levels - Reduced platelet levels - Elevated erythrocyte sedimentation rate (ESR)

• Reduced hemoglobin levels • Elevated erythrocyte sedimentation rate (ESR) Explanation: Kawasaki disease is an acute systemic vasculitis occurring mostly in children 6 months to 5 years of age. It is the leading cause of acquired heart disease among children. The CBC count may reveal mild to moderate anemia, an elevated white blood cell count during the acute phase, and significant thrombocytosis (elevated platelet count [500,000 to 1 million]) in the later phase. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level are elevated.

A child has been prescribed spironolactone. Which laboratory values should be reviewed when following up on this medication? Select all that apply. a. Serum sodium levels b. Serum chloride levels c. Serum magnesium levels d. Serum potassium levels

• Serum sodium levels • Serum potassium levels

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply. Bradycardia Tiring easily when eating Shortness of breath when playing Hypertension Crackles on lung auscultation

• Shortness of breath when playing • Crackles on lung auscultation • Tiring easily when eating

A child is suspected of having tricuspid atresia. Which findings are consistent with this disorder? Select all that apply. Bilateral crackles in lung fields Bradypnea Tachypnea Peripheral cyanosis in the first few hours after birth Weak infant sucking

• Tachypnea • Weak infant sucking • Bilateral crackles in lung fields Explanation: Tricuspid atresia is a congenital heart defect in which the valve between the right atrium and right ventricle fails to develop. As a result, there is no opening to allow blood to flow from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs. Related findings include tachypnea, respiratory crackles or wheezes, and diminished sucking reflex. Peripheral cyanosis in the immediate hours after birth is a normal finding for many infants and is not specific to this disorder.

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? Select all that apply. 4-month-old child with an apical heart rate of 102 beats per minute 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning 12-year-old child whose digoxin level was 0.9 ng/ mL on a blood draw this morning 16-year-old child with a heart rate of 54 beats per minute

• The 16-year-old child has a heart rate of 54 beats per minute • The 5-year-old child has developed vomiting, diarrhea and is difficult to arouse • The 2-year-old child has a digoxin level of 2.4 ng/mL from a blood draw this morning

The child has returned to the nurse's unit following a cardiac catheterization. The insertion site is located at the right groin. Peripheral pulses were easily palpated in bilateral lower extremities prior to the procedure. Which finding should be reported to the child's physician? A. The child is reporting nausea. B. The right groin is soft without edema. C. The child has a temperature of 102.4° F (39.1° C). D. The child has a runny nose. E. The child's right foot is cool with a pulse assessed only with the use of a Doppler.

• The child has a temperature of 102.4° F (39.1° C). • The child is reporting nausea. • The child's right foot is cool with a pulse assessed only with the use of a Doppler. Explanation: The following information should be reported to the physician following a cardiac catheterization because they are indicative of possible complications: Negative changes to the child's peripheral vascular circulatory status (cool foot with poor pulse), a fever over 100.4° F (37.8° C), and nausea or vomiting.

The young child had a chest tube placed during cardiac surgery. Which findings may indicate the development of cardiac tamponade? Select all that apply. - The child's heart rate has increased from 88 beats per minute to 126 beats per minute. - The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube. - The child is resting quietly. - The child's apical heart rate is strong and easily auscultated. - The child's right atrial filling pressure has decreased.

• The child's heart rate has increased from 88 beats per minute to 126 beats per minute. • The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube. Explanation: Abrupt cessation of chest tube output and an increased heart rate are indicators that the child may have developed cardiac tamponade. The child's right atrial filling pressure will increase. The child may be anxious and their apical heart rate may be faint and difficult to auscultate.

A healthcare provider and other health team members are discussing congenital heart disorders which increase pulmonary blood flow. Which disorders are topics for this discussion? Select all that apply. Ventricular septal defect Coarctation of the aorta Atrioventricular canal defect Pulmonary stenosis Patent ductus arteriosus

• Ventricular septal defect • Patent ductus arteriosus • Atrioventricular canal defect

A child is having surgery for a congenital heart defect. The parent asks about their 1-year-old's growth and developmental delays and what they can expect after surgery. What is the best response by the nurse? a) "This was caused by the lack of oxygen and it is usually permanent." b) "As long as you decrease external stimuli, the child should catch up." c) "You can expect to continue to see delays." d) "After surgery, most children will catch up."

"After surgery, most children will catch up."

A group of nurses is reviewing the cardiovascular system and its function. Which statement by one of the nurses demonstrates an understanding of a child's cardiovascular system? "Between the ages of 5 and 6, the child's left ventricle grows to about two times the size of the right." "The child's heart doesn't mature and function like an adult's until between 8 and 10 years of age." "At birth, the infant's right and left ventricle are about the same size." "The heart rate of the child decreases whenever the child experiences a fever."

"At birth, the infant's right and left ventricle are about the same size."

The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse? "It is a difficult process to understand. Rest assured that we are doing everything in your child's best interest." "We have standardized care plans for children with congenital heart defects and this nursing diagnosis is on the care plan." "The heart is a pump and it isn't pumping effectively." "Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs."

"Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs."

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure? "He seems to have a normal appetite." "He gets sweaty when he eats." "He does not seem sick." "He does not seem short of breath."

"He gets sweaty when he eats."

The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells? "He walks very quickly and never stops moving." "He likes to stop and squat wherever he walks." "He takes one nap a day and is fairly active." "He does not seem to have difficulty breathing."

"He likes to stop and squat wherever he walks."

A nurse is taking the history of a 4-year-old boy who will undergo a cardiac catheterization. Which statement by his mother may necessitate rescheduling of the procedure? "He is not taking any medication." "He is allergic to iodine and shellfish." "He seems listless and slightly warm." "He is very scared and nervous about the procedure."

"He seems listless and slightly warm."

The nurse is assessing the past medical history of an infant with a suspected cardiovascular disorder. Which response by the mother warrants further investigation? "I had the flu during my last trimester." "His Apgar score was an 8." "I am on a low dose of steroids." "I was really nauseous throughout my whole pregnancy."

"I am on a low dose of steroids"

The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond? "Are you sure you are making nutrient dense foods?" "Maybe your child doesn't really like the foods your making. This could lead to not gaining sufficient weight." "It's hard to get your child to eat enough at this age to maintain their weight since they are expending so much energy with the heart condition." "It's great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain."

"It's great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain."

A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can to reduce the risk of this type of condition occurring in her baby. Which of the following should the nurse mention to this patient?

"Make sure you are fully immunized."

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education? "The medication indomethacin is used to try to close the hole." "Surgery is usually performed in the first two months of life for this." "The medication prostaglandin E1 is used to try to close the hole." "Most infants do not need surgical repair for this."

"Most infants do not need surgical repair for this."

A child will be undergoing a Holter monitor test. Which statement by the mother indicates the need for further instruction? "This test will monitor my child for about 24 hours." "We do not need to alter our activities during the testing period." "Wearing a snug shirt the day of the test will be helpful." "My child cannot have any thing to eat or drink after midnight the day of the test."

"My child cannot have anything to eat or drink after midnight the day of the test."

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching? "Strenuous activity should be limited for the next 3 days." "We need to watch for changes in skin color or difficulty breathing." "We need to avoid a tub bath for the next 3 days." "The feeling of the heart skipping a beat is common."

"The feeling of the heart skipping a beat is common."

The parents of a 2-year-old newly diagnosed with tricuspid atresia ask the nurse, "I don't understand why our child's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is most likely to be understood by the parents? "The number of red blood cells has significantly increased from the heart defect, resulting in the cells pooling in the fingertips." "Chronic hypoxia from your child's heart defect causes effects in various parts of the body, including the fingers." "This is a common complication of tricuspid atresia. Unfortunately there is nothing we can do to treat it." "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes."

"The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." Explanation: Clubbing (which is what the parents are describing) of fingertips or toes can occur from the chronic hypoxia that occurs with disorders with decreased pulmonary blood flow, such as tricuspid atresia. Using the term "low oxygen levels in the blood" rather than "chronic hypoxia" is a better way to explain what is happening to the parents. Red blood cell pooling is not the cause of clubbing. Although clubbing is a possible result of tricuspid atresia, telling the parents this is a "common complication" does not address the parent's concerns.

The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents ask the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the the nurse? "Oxygen isn't always the best treatment for your child's condition. Surgery is necessary." "I can only place oxygen on your child if the doctor orders oxygen." "This is something we should talk with the physician about. Maybe it would help your baby." "While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help."

"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help."

An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize? "You get some medicine that will make you sleepy." "You need to lie very still during this test." "You'll have to wear the monitor for 24 hours." "You need to report any symptoms you are having during the test."

"You need to report any symptoms you are having during the test."

The nurse is caring for a pediatric c;ient diagnosed with tetralogy of Fallot. After speaking with the physician, the parents state to the nurse, "The doctor said something about our child having too many red blood cells. We don't understand how that could happen?" What is the best response by the nurse? "The doctor was talking about polycythemia. It's common with this type of heart disorder." "I'm not really sure what red blood cells have to do with the heart defect your child has. We should ask your doctor." "It is a very complicated process. Since your child has tetralogy of Fallot, their body is overtaxed with everything it does. The amount of red blood cells being produced is just one more thing the heart has to deal with." "Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder."

"Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder."

A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which statement should the nurse make to the girl's mother in response to these findings? Not say anything, as the girl has an insignificant heart murmur and there is no reason to alarm the mother or her. "Your daughter has an innocent heart murmur, which is nothing to worry about." "Your daughter has an organic heart murmur, which indicates that she has some degree of heart disease. The doctor will provide a referral to a good cardiologist." "Your daughter has a functional heart murmur; I recommend that you limit her physical activity so that her heart rate is not elevated for long periods of time."

"Your daughter has an innocent heart murmur, which is nothing to worry about."

You take an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant? a) 80 beats per minute b) 150 beats per minute c) 60 beats per minute d) 100 beats per minute

100 beats per minute

The nurse is conducting a physical examination of an infant with a suspected cardiovascular disorder. Which assessment finding is suggestive of sudden ventricular distention? Decreased blood pressure Heart murmur Cool, clammy, pale extremities Accentuated third heart sound

Accentuated third heart sound

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant? Administer oxygen. Administer antidiuretic. Restrict fluids. Provide large, less frequent feedings.

Administer oxygen.

The nurse is caring for a 10-year-old girl with a suspected heart dysrhythmia. The nurse would expect to prepare the child for which test to identify and quantitate the dysrhythmia? Arteriogram Ambulatory electrocardiographic monitoring Echocardiogram Chest radiograph

Ambulatory electrocardiographic monitoring

The nurse is caring for a 10-year-old boy following a cardiac catheterization. Four hours after the procedure, the nurse notes some minor bleeding at the site. Which action would be most appropriate? Change the dressing. Contact the physician. Apply pressure 1 inch above the site. Ensure that the child's leg is kept straight.

Apply pressure 1 inch above the site.

Coarctation of the aorta demonstrates few symptoms in newborns. Which of the following is an important assessment to make on all newborns to help reveal this condition? Observing for excessive crying Assessing for the presence of femoral pulses Recording an upper extremity blood pressure Auscultating for a cardiac murmur

Assessing for the presence of femoral pulses

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection? Apply EMLA cream to the catheter insertion site Record pedal pulses Keep the child NPO for 2 to 4 hours before the procedure Avoid drawing a blood specimen from the right femoral vein before the procedure

Avoid drawing a blood specimen from the right femoral vein before the procedure

What information would be included in the care plan of an infant in heart failure? A. Maintain child in the supine position. B. Administer digoxin even if the infant is vomiting. C. Encourage larger, less frequent feedings. D. Begin formulas with increased calories.

Begin formulas with increased calories.

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note? Appropriate mastery of developmental milestones Pitting periorbital edema Bounding pulse Preference to resting on the right side

Bounding pulse

When caring for a child that has just had a cardiac catheterization, what is a sign of hypotension? Decreased heart rate and dizziness Syncope and tachypnea Cold, clammy skin and increased heart rate Diaphoresis and tachycardia

Cold clammy skin and increased heart rate

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?

Digoxin

The nurse is administering medications to the child with congestive heart failure. Large doses of which of the following medications are used initially in the treatment of CHF to attain a therapeutic level? a) Ferrous sulfate b) Furosemide (Lasix) c) Albuterol sulfate d) Digoxin (Lanoxin)

Digoxin (Lanoxin)

The care provider has ordered the drug furosemide (Lasix) to treat a child diagnosed with congestive heart failure. The nurse knows that this drug will be used to:

Eliminate excess fluids

The nurse is collecting data on a 5 year old child admitted with the diagnosis of congestive heart failure. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Failure to gain weight b) Jerking movements of the arms and legs c) Scissoring of the legs with toes pointed down d) Clubbing of the fingers

Failure to gain weight

Tetralogy of Fallot consists of the following four anomalies: aortic stenosis, atrial septal defect, dextroposition (overriding) of the aorta, and hypertrophy of the left ventricle. True False

False

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting? Feeding problems Bradypnea Bradycardia Yellowish color

Feeding problems

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: narrow pulse. bounding pulse. hepatomegaly. femoral pulse weaker than brachial pulse.

Femoral pulse weaker than brachial pulse

The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder? A. Cardiomyopathy B. Infective endocarditis C. Heart failure D. Kawasaki Disease

Heart failure

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. What should the nurse mention in explaining how this diagnostic test works? A. High-frequency sound waves are directed toward the heart B. X-rays are directed toward the heart C. A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video D. A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy

High-frequency sound waves are directed toward the heart

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. Which of the following should the nurse mention in explaining how this diagnostic test works? High-frequency sound waves are directed toward the heart A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video X-rays are directed toward the heart

High-frequency sound waves are directed toward the heart

On assessment immediately following cardiac surgery, which condition would the nurse expect to find in an infant? Hyperexcitability Hypothermia Hypertension Hypovolemia

Hypothermia

A nurse is reviewing blood work on a patient with a cyanotic heart defect. Which of the following results would most likely be seen in a patient experiencing polycythemia? a. Increased RBC b. Increased WBC c. Decreased WBC d. Decreased RBC

Increased RBC

An 8-month-old has a ventricular septal defect. Which nursing diagnosis would best apply? Impaired gas exchange related to a right-to-left shunt Impaired skin integrity related to poor peripheral circulation Ineffective airway clearance related to altered pulmonary status Ineffective tissue perfusion related to inefficiency of the heart as a pump

Ineffective tissue perfusion related to inefficiency of the heart as a pump

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. The nurse should tell the mother which of the following? a) Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions b) Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization c) Surgical closure by ductal ligation d) No treatment is necessary, as the defect will resolve spontaneously

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse? a. This image will clarify the structures within the heart. b. It will show if blood is being shunted. c. It will determine if the heart is enlarged. d. It will determine disturbances in heart conduction.

It will determine if the heart is enlarged.

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Which of the following findings would the nurse expect to note? Lower extremities Face Presacral region Hands

Lower extremities

When caring for a child with Kawasaki Disease, the nurse would know that: management includes administration of aspirin and IVIG. steroid creams are used for the hand peeling. joint pain is a permanent problem. antibiotics should be administered exactly every 8 hours by IV.

Management includes administration of aspirin and IVIG.

The nurse is conducting a physical examination of a 7-year-old girl prior to a cardiac catheterization. The nurse knows to pay particular attention to assessing the child's pedal pulses. How can the nurse best facilitate their assessment after the procedure? Mark the child's pedal pulses with an indelible marker, then document. Assess the location and quality of the child's peripheral pulses. Mark the location of the child's peripheral pulses with an indelible marker. Document the location and quality of the child's pedal pulses.

Mark the child's pedal pulses with an indelible marker, then document

A nurse is administering digoxin to a 3-year-old. What would be a reason to hold the dose of digoxin? Hypertension Nausea and vomiting Fever and tinnitus Ataxia

Nausea and vomiting

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. Which of the following would be the priority nursing intervention? Administer epinephrine. Elevate the head of the bed. Observe vitals every two hours. Notify the doctor immediately.

Notify the doctor immediately.

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of which of the following as the major mechanism involved? Mixing of well-oxygenated and poorly oxygenated blood Narrowing of the major vessel Obstruction of blood flow to the lungs Increased pulmonary blood flow

Obstruction of blood flow to the lungs

A client's newborn is diagnosed with tetralogy of Fallot. When explaining this condition to the client, which defect would the nurse's description include? Atrial septal defect Left ventricular hypertrophy Stenosis of the aorta Overriding of the aorta

Overriding of the aorta

When educating the family of an ill infant with an atrioventricular canal defect/septal defect, what information would be included in the education if the doctor is planning on performing palliative care until the infant is healthier? VSD patching surgery should be performed immediately. The medication indomethacin is used to try to close the hole. Most infants do not need surgical repair for this if palliative procedures are performed. Palliative pulmonary artery banding should help the infant grow.

Palliative pulmonary artery banding should help the infant grow.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? a. Low blood pressure and decreased heart rate b. Decreased heart rate and impalpable pulse c. Irritability and dry mucous membranes d. Peeling hands and feet and fever

Peeling hands and feet and fever

A child is diagnosed with tetralogy of Fallot and during a temper tantrum turns blue. Which of the following would the nurse do first? a. Assess for an irregular heart rate. b. Assess for an increased respiratory rate. c. Place child in the knee-to-chest position. d. Explain to the child the need to calm down since it is affecting the heart.

Place child in the knee-to-chest position.

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. Which of the following should the nurse instruct the parents to do in the event that the child becomes cyanotic? Administer prescribed amoxicillin Administer low-dose aspirin Perform hands-on CPR Place him in a knee-chest position

Place him in a knee-chest position

The nurse is caring for a 6-year-old with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority? Use a calm, comforting approach. Provide supplemental oxygen. Administer propranolol (0.1 mg/kg IV). Place the child in a knee-to-chest position.

Place the child in a knee-to-chest position.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority? A. Place the infant in the knee-chest position. B. Prepare the infant for surgery. C. Start an IV for fluids. D. Raise the head of the bed.

Place the infant in the knee-chest position.

What would be the most important measure to implement for an infant who develops heart failure? A. Planning ways to reduce salt intake B. Placing her in a semi-Fowler's position C. Restricting milk intake daily D. Keeping her supine and playing quiet games

Placing her in a semi-Fowler's position

When reviewing the record of a child with tetralogy of Fallot, which of the following would you expect to discover? Leukopenia Anemia Increased platelet level Polycythemia

Polycythemia

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta? A. Pulses weaker in lower extremities compared to upper extremities B. Pulses weaker in upper extremities compared to lower extremities C. Cyanosis with crying C. Cyanosis with feeding

Pulses weaker in lower extremities compared to upper extremities

A parent brings an infant in for poor feeding. Which of the following assessment data would most likely indicate a coarctation of the aorta?

Pulses weaker in lower extremities compared to upper extremities

A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits? A. Semi-Fowler B. Lithotomy C. Side lying D. Prone

Semi-Fowler Explanation: Due to the hemodynamic changes accompanying the underlying structural defect, oxygenation is key. Provide frequent ongoing assessment of the child's cardiopulmonary status. Assess airway patency and suction as needed. Position the child in the Fowler or semi-Fowler position to facilitate lung expansion.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor? A. Serum sodium level B. Erythrocyte sedimentation rate C. Serum potassium level D. Oxygen saturation level

Serum potassium level

An infant girl is prescribed digoxin. You would teach her parents that the action of this drug is to

Slow and strengthen her heartbeat.

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents the following expected finding: Appropriate mastery of developmental milestones Steady weight gain since birth Softening of the nail beds Intact rooting reflex

Softening of the nail beds

A nurse is caring for a newborn with congenital heart disease (CHD). Which of the following would the nurse interpret as indicating distress?

Subcostal retraction at the time of feeding

A nurse is caring for a child who is experiencing heart failure. Which of the following assessment data was most likely seen when initially examined? A. Bradycardia B. Splenomegaly C. Tachycardia D Polyuria

Tachycardia

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure? Inability to sweat Splenomegaly Bradycardia Tachycardia

Tachycardia

At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important? Assuring the child that the procedure is now over Allowing the child to talk about the procedure Allowing the child to adapt to the light in the room gradually Taking pedal pulses for the first 4 hours

Taking pedal pulses for the first 4 hours

A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis? Tetralogy of Fallot Pulmonary stenosis Aortic stenosis Coarctation of aorta

Tetralogy of Fallot

A newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis? a) Coarctation of aorta b) Aortic stenosis c) Pulmonary stenosis d) Tetralogy of Fallot

Tetralogy of Fallot

A nurse is providing education to a family about cardiac catheterization. What information would be included in the education? The catheter will be placed in the femoral artery. The procedure will be performed even if the child has a fever. The child will be able to move their leg again immediately after the procedure. The catheter will be placed in the brachial artery.

The catheter will be placed in the femoral artery.

A child is being placed on a cardiopulmonary bypass machine. The nurse understands the heart will pump again on its own when which of the following occurs? The child starts getting warm again When digoxin is administered When chest compressions are performed When cardioplegia is administered

The child starts getting warm again.

A school nurse finds a 10-year-old's blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect?

The child will need the blood pressure checked two more times.

After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding that: the contrast material used has a diuretic effect. blood loss during the procedure can be significant. the insertion of the catheter into the heart stimulates a diuretic response. the prolonged preprocedure fasting state places the child at risk for dehydration.

The contrast material used has a diuretic effect.

A nursing instructor is preparing for a class about the structural and functional differences in the cardiovascular system of infants and children as compared to adults. What would the instructor include in the class discussion? The heart's apex is higher in the chest in children younger than the age of 7 years. The heart is about four times the birth size between the ages of 6 and 12 years. Left ventricular function predominates immediately after birth. Blood pressure is initially high at birth but gradually decreases to adult levels.

The heart's apex is higher in the chest in children younger than the age of 7 years.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. Which of the following would most likely explain this assessment finding?

The liver increases in right-sided heart failure.

A nurse is interviewing a mother who is about to give birth. Which response would alert the nurse for a higher potential for a heart defect in the newborn? A. The mother states she has lupus. B. The mother states she took acetaminophen while pregnant. C. The mother has seizures, but did not take medication while pregnant. D. The mother states she slept all the time while pregnant.

The mother states she has lupus.

The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. Which of the following would be included in the intervention strategies?

The nurse would review the child's 24-hour diet recall.

A parent asks if the reason her infant has a congenital heart defect is because of something she did while she was pregnant. What is the best response by the nurse? No, heart defects are mainly caused by genetic factors. The studies show it is impossible to know what causes heart defects. Yes, there is a chance you caused this defect. There are several reasons a baby can have a heart defect, let's talk about those causes.

There are several reasons a baby can have a heart defect, let's talk about those causes.