Perry Ch 42 Practice Questions
Indomethacin may be given to close which CHD in newborns?
PDA
A heart transplant may be indicated for a child w/ severe heart failure and: a) PDA b) VSD c) Hypoplastic left heart syndrome d) PS
C Hypoplastic left heart syndrome is treated by the Norwood procedure, or heart transplant.
Which interventions decrease cardiac demands in an infant w/ CHF? Select all that apply. a) Allow parents to hold and rock their child b) Feed only when the infant is crying c) Keep the child uncovered to promote low body temperature d) Make frequent position changes e) Feed the child when sucking the fists f) Change bed linens only when necessary g) Organize nursing activities
A, D, E, F, G All of these interventions decrease cardiac demands.
The nurse provides home care instructions to the parents of a child w/ HF regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? a) "I will not mix the medication w/ food" b) "I will take my chid's pulse before administering the medication" c) "If more than 1 dose is missed, I will call the HCP" d) "If my child vomits after medication administration, I will repeat the dose"
D The parents need to be instructed that if the child vomits after digoxin is administered, they are not to repeat the dose.
The neonatal cardiologist orders digoxin for a newborn in CHF. The baby weighs 7lb 8 oz and is 12 inches long. The drug reference states: for full-term newborns, 8-10 mcg/kg/day in divided doses q12h. Which of the following orders would be safe for the nurse to administer? a) 10 mcg PO q12h b) 15 mcg PO q12h c) 20 mcg PO q12h d) 25 mcg PO q12h
B 15 mcg PO q12h is between the minimum and maximum recommended dosages for digoxin and is the correct response.
A clinical manifestation of the systemic venous congestion that can occur w/ CHF is: a) Tachypnea b) Tachycardia c) Peripheral edema d) Pale, cool extremities
C Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion.
Which medication should the nurse give to a child diagnosed w/ transposition of the great vessels? a) Ibuprofen b) Betamethasone c) Prostaglandin E d) Indocin
C Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery.
The most common cardiac dysrhythmia in pediatrics is: a) Ventricular tachycardia b) Sinus bradycardia c) Suptraventricular tachycardia d) First-degree heart block
C Supraventricular tachycardia is most common in children.
Which assessment indicates that the parent of a 7 y/o is following the prescribed treatment for CHF? a) HR of 56 bpm b) Elevated RBC count c) 50th percentile height and weight for age d) Urine output of 0.5 cc/kg/hr
C The 50th percentile height and weight for age shows good growth and development, indicating good nutrition and perfusion.
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) Congestive heart failure d) Systemic venous congestion
C The definition of CHF 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.
The nurse is monitoring an infant w/ CHD closely for signs of HF. The nurse should assess the infant for which early sign of HF? a) Pallor b) Cough c) Tachycardia d) Slow and shallow breathing
C The early signs of HF include tachycardia, tachypnea, profuse scalp sweating, fatigue and irritability, sudden weight gain, and respiratory distress.
The nurse is caring for a 9-month-old who was born w/ a CHD. Assessment reveals HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of:
Congestive heart failure (CHF)
A newborn baby is receiving digoxin and furosemide for CHF. Which of the following actions would be appropriate for the nurse to perform? a) Hold digoxin if the apical HR is 170 bpm b) Hold digoxin for a digoxin level of 1 ng/mL c) Hold both the digoxin and furosemide for a weight increase of 5% in one day d) Hold both the digoxin and furosemide for a potassium 3.2 mEq/L
D A serum potassium level of 3.2 mEq/L is well below the normal for a newborn of 3.7 to 5.9 mEq/L. The nurse should hold both medications and notify the HCP who ordered them.
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 that: 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
D Digoxin has a narrow therapeutic range.
What is an expected finding in a child w/ COA? a) Orthostatic hypotension b) Systolic hypertension in the lower extremities c) BP higher on the left side of the body d) Disparity in BP between the upper and lower extremities
D The classic finding in children w/ coarctation of the aorta is a disparity in pulses and BPs between the upper and lower extremities.
A 3-month-old has been diagnosed w/ a VSD. The flow of the blood through the heart is:
Left to right
PDA causes what type of shunt?
Left to right
A newborn is diagnosed w/ a CHD. The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as:
Patent ductus arteriosus (PDA)
Treatment for CHF in an infant began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear, and HR is 96 bpm when the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: a) 0.5 cc/kg/hr b) 1 cc/kg/hr c) 30 cc/hr d) 1 oz/hr
B Normal pediatric urine output is 1 cc/kg/hr.
A baby that was born 5 minutes earlier is tachypneic, tachycardic, and markedly cyanotic. A STAT ECG confirms the presence of a cyanotic congenital cardiac defect. Which of the following defects would be consistent w/ the assessment findings? a) PDA b) Transposition of the great vessels c) ASD d) VSD
B TGV is a cyanotic defect.
A nurse is teaching nursing students the physiology of CHDs. Which defect results in decreased pulmonary blood flow? a) ASD b) TOF c) VSD d) PDA
B TOF results in decreased blood flow to the lungs.
The Norwood procedure is used to correct: a) Transposition of the great vessels b) Hypoplastic left heart syndrome c) TOF d) PDA
B The Norwood procedure is specific to hypoplastic left heart syndrome.
What should the nurse assess prior to administering digoxin? Select all that apply. a) Sclera b) Apical pulse rate c) Cough d) Liver function test
B The apical pulse rate is assessed because digoxin decreases the HR, and if the HR is <60, digoxin should not be administered.
The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated w/ which CHD? a) Pulmonary stenosis b) PDA c) VSD d) COA
B The classic murmur associated w/ PDA is a machinery-like one that can be heard throughout both systole and diastole.
While assessing a newborn w/ respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCo2, and decreased PO2. The nurse suspects that the newborn has: a) Pulmonary hypertension b) PDA c) VSD d) Bronchopulmonary dysplasia
B The main identifier in the stem is the machine-like murmur, which is the hallmark of a PDA.
A baby, exhibiting no signs of CHF, has been diagnosed w/ a small VSD. Which of the following information should the nurse explain to the baby's parents? a) The baby will likely need open-heart surgery within a week b) The defect will likely close without therapy c) The defect likely developed in the second trimester d) The baby will likely be placed on high-calorie formula
B The majority of small VSDs close spontaneously.
The nurse is evaluating a child who is taking digoxin for her cardiac condition. The nurse is cognizant that a common sign of digoxin toxicity is: a) Seizures b) Vomiting c) Bradypnea d) Tachycardia
B Vomiting is a common sign of digoxin toxicity.
Which plan would be appropriate in helping to control CHF in an infant? a) Promoting fluid restriction b) Feeding a low-salt formula c) Feeding in semi-Fowler position d) Encouraging breast milk
C The infant has a great deal of difficulty feeding w/ CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so fluid in the lungs can go to the base of the lungs, allowing better expansion.
During play, a toddler w/ a history of TOF might assume which position? a) Sitting b) Supine c) Squatting d) Standing
C The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload.
In which CHD would the nurse need to take upper and lower extremity BPs? a) Transposition of the great vessels b) Aortic stenosis c) Coarctation of the aorta d) TOF
C With COA there's narrowing of the aorta, which increases pressure proximal to the defect and decreases pressure distal to the defect.
Which statement by a parent of an infant w/ CHF who is being sent home on digoxin indicates the need for further education? a) "I will give the medication at regular 12hr intervals" b) "If he vomits, I will not give a make-up dose" c) "If I miss a dose, I will not give an extra dose" d) "I will mix the digoxin in some formula to make it taste better"
D If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate.
During a well-child checkup for an infant w/ TOF, the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: a) Lay the child flat to promote hemostasis b) Lay the child flat w/ legs elevated to increase blood flow to the heart c) Sit the child on the parent's lap, w/ legs dangling to promote venous pooling d) Hold the child in knee-chest position to decrease venous blood return
D The increase in the SVR would increase afterload and increase blood return to the pulmonary artery.
Tetralogy of Fallot involves which defects? Select all that apply. a) VSD b) Right ventricular hypertrophy c) Left ventricular hypertrophy d) Pulmonic stenosis e) Pulmonic atresia f) Overriding aorta g) PDA
A, B, D, F TOF is a congenital defect w/ a ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta.
A beneficial effect of administering digoxin (Lanoxin) is that it: a) Decreases edema b) Decreases cardiac output c) Increases heart size d) Increases venous pressure
A Digoxin has a rapid onset and is useful in increasing cardiac output, decreasing venous pressure, and as a result decreasing edema.
Which intervention should be included in the plan of care for an infant with the nursing diagnosis of excess fluid volume r/t CHF? 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
A Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention.
A nursing action that promotes ideal nutrition in an infant w/ CHF is: a) Feeding formula that is supplemented w/ additional calories b) Allowing the infant to nurse at each breast for 20 minutes c) Providing large feedings every 5 hours d) Using firm nipples w/ small openings to slow feedings
A Formula can be supplemented w/ extra calories, either from a commercial supplement, such as Polycose, or from corn syrup.
Which physiological changes occur as a result of hypoxemia in CHF? a) Polycythemia and clubbing b) Anemia and barrel chest c) Increased WBC and low platelets d) Elevated ESR and peripheral edema
A The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increased oxygen by having more RBCs carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia.
The nurse is caring for an infant w/ congestive heart disease. 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
A The infant requires rest and conservation of energy for feeding.
A child diagnosed w/ CHF is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she's looking at the lights in the room, and her HR is 70 bpm. The nurse expects which laboratory finding? a) Hypokalemia b) Hypomagnesemia c) Hypocalcemia d) Hypophosphatemia
A The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR is slow for her age and also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk for digoxin toxicity.
