Cardiac Dysfunctions (practice questions)
What are some clinical manifestations of rheumatic fever?
-Carditis (involves endocardium, pericardium, and myocardium; most commonly -the mitral valve) -Polyarthritis -Erythema marginatum (rash) -Subcutaneous nodules -chorea (CNS: involuntary movements) "St. Vitus Dance"
A 12-year-old is admitted to the hospital with a low-grade fever and joint pain. Which diagnostic test finding will assist to determine a diagnosis of rheumatic fever? A. Presence of Aschoff's bodies B. Absence of C-reactive protein C. Presence of Reed-Sternberg cells D. Decreased antistreptolysin O titer
A. Presence of Aschoff's bodies Rationale: Rheumatic fever develops after a group A β-hemolytic streptococcal infection, particularly pharyngitis. Initial diagnosis is made by noting the presence of Aschoff's bodies, or hemorrhagic bullous lesions, in the heart, joints, skin, and central nervous system; an elevated antistreptolysin O titer; an elevated C-reactive protein level; and an elevated erythrocyte sedimentation rate. Reed-Sternberg cells are found in Hodgkin's disease.
What is Captopril (Capoten) and Enalapril (Vasotec)?
ACE inhibitors (the "prils")
A 1-year-old infant with a diagnosis of heart failure is prescribed digoxin (Lanoxin). The nurse takes the apical pulse for 1 minute before administering the medication and obtains a result of 102 beats/min. Which action should the nurse take? A. Retake the apical pulse. B. Withhold the medication. C. Administer the medication. D. Withhold the medication and notify the health care provider.
C. Administer the medication.
Is hearing the S3 sound normal?
yes....just a variation among children
What are signs of digoxin toxicity?
-bradycardia -dysrhythmias -n/v (vomiting especially in infants) -anorexia
What is a dose of digoxin is missed...what do you do? What if child vomits?
-do not give an extra dose or increase the next dose -do NOT readminister after vomiting
What are clinical manifestations of COA?
-elevated BP/bounding pulses in upper extremities -decreased BP/cool skin in lower extremities -weak or absent femoral pulses -heart failure in infants -dizziness, HA, fainting, or nosebleeds in older children
What are nursing considerations with Lasix?
-encourage a diet high in K -monitor I&Os -monitor for adverse effects such as hypokalemia, n/v, and dizziness -monitor weight daily
What is endocarditis?
-infection of the valves or endocardium -causative organisms (strep, staph, fungal)
A child hospitalized with tetralogy of fallot has an acutely illness with fever. The nurse enter the room and find the child cyanotic, tachycardic, and tachypnic. What should the nurse do next? A. Have suction equipment available. B. Have oxygen equipment available. C. Place the child in a knee-chest position D. Place the child in Trendelenburg position.
C. Place the child in a knee-chest position
What is pulmonary stenosis?
narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles
When is the PDA supposed to close?
no later than 15 hours after birth
What two major medications are used to treat Kawasaki Disease?
-Gamma globulin (IVGG): given for inflammation -Aspirin (reduce blood clots and pain)
What are some peripheral clinical manifestations of endocarditis?
-Splinter hemorrhages are normally seen under the fingernails. They are usually linear and red for the first two to three days and brownish thereafter. -Conjunctival petechiae -Osler's nodes which are tender, subcutaneous nodules, often in the pulp of the digits -Janeway's lesions are nontender, erythematous, hemorrhagic, or pustular lesions, often on the palms or soles.
What is an ASD?
-atrial septal defect -hole in the septum b/t the right and left atria that results in increased pulmonary blood flow (left to right shunt)
What are characteristics of an innocent murmur?
-changes with position changes -occur in systole (S1) -not easy to hear -no transmission -normal growth and development -normal VS
What is a COA?
-coarctation of the aorta -narrowing of the lumen of the aorta, usually at or near the ductus arterioles, that results in obstruction of blood flow from ventricles
What are some post-proceudure actions by the nurse for a cardiac catheterization?
-continuos cardiac monitoring and pulse ox -assess heart and RR for 1 full minute -assess pulses fro equality and symmetry -assess temp/color -assess insertion site (femoral or antecubital area) for bleeding and/or hematoma -maintain clean dressing -keep affected extremity in straight position for 4-8 hrs post-op to prevent bleeding -monitor I&Os/hypoglycemia -encourage oral intake...start with clear liquids -encourage voiding to rid of contrast medium
What are clinical manifestations of tetralogy of fallot?
-cyanosis at birth (progressive cyanosis over the 1st year of life) -systolic murmur -"tet spells" - episodes of acute cyanosis and hypoxia (blue spells)
How do you administer oral elixir digoxin?
-direct med toward the side and back of mouth -have child rinse mouth out afterwards to prevent tooth decay -often will see dose in mcg -double check dosage with another RN
What is important to remember with cholesterol screenings in children?
-fast for 12 hrs prior to test -assess for febrile illness 3 weeks prior to screening as this will alter the results
What is tetralogy of fallot?
-four defects that result in mixed blood flow -defects (pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy)
What is important to assess during a cardiac exam?
-general appearance (skin color, position of comfort and nutritional status) -palpate for apical pulse (position of heart) -assess for thrills/murmurs -quality and symmetry of pulses -warmth of extremities -presence or absence of edema -HR and rhythm -lung sounds -assess BP in upper and lower extremities -cap refill
What is sinus arrhythmia?
-heart speeds up as the child takes a breath in -can be heard in athletes as well *this is a normal finding
What are s/s of Kawasaki Disease during the Acute Phase?
-high fever (>102) unresponsive to antipyretics and is lasting 5 days to 2 weeks -irritability -red eyes with no drainage -bright red, chapped lips -strawberry tongue with white coating -red oral mucous membranes -swelling of hand/feet with red palms and soles -nonblistering rash -bilateral joint pain -enlarged lymph nodes
What are clinical manifestations of aortic stenosis?
-infants (faint pulses, hypotension, tachycardia, poor feeding tolerance) -children (intolerance to exercise, dizzy, chest pain, possible ejection murmur) -decreased CO -left ventricle hypertrophy (increased pulmonary vascular resistance which leads to pulm HTN)
Which childhood conditions can aspirin be used to treat?
-juvenile arthritis -Kawasaki Disease -RHD
If you hear a questionable murmur...what is your next step?
-listen in sitting, standing, left lateral and possibly squatting position. *majority are benign
What are clinical manifestations of ASD?
-loud, harsh murmur with a fixed split second heart sound -heart failure -asymptomatic (possible) -right ventricle hypertrophy *can be treated with cardiac cath procedure
What is a VSD?
-ventricular septal defect -a hole in the septum b/t the right and left ventricle that results in increased pulmonary blood flow (left to right shunt)
A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following manifestations support this diagnosis? SELECT ALL THAT APPLY A. Erythema marginatum (rash) B. Continuous joint pain of the digits C. Tender, subcutaneous nodules D. Decreased erythrocyte sedimentation rate E. Elevated C-reactive protein
A. Erythema marginatum (rash) E. Elevated C-reactive protein *will have MIGRATORY joint pain of the large joints *NON-tender subq nodules of bony prominences *ELEVATED erythrocyte sedimentation rate
The nurse reviews the laboratory results for a child with rheumatic fever and would expect to note which findings? SELECT ALL THAT APPLY. A. Presence of Aschoff's bodies B. Absence of C-reactive protein C. Elevated antistreptolysin O titer D. Presence of Reed-Sternberg cell E. Elevated erythrocyte sedimentation rate
A. Presence of Aschoff's bodies C. Elevated antistreptolysin O titer E. Elevated erythrocyte sedimentation rate Rationale: Rheumatic fever usually develops after a group A beta-hemolytic streptococcal infection, particularly pharyngitis. Initial diagnosis is made by noting the presence of Aschoff's bodies, or hemorrhagic bullous lesions, in the heart, joints, skin, and central nervous system; an elevated C-reactive protein level; an elevated antistreptolysin O titer; and an elevated erythrocyte sedimentation rate. Reed-Sternberg cells are found in Hodgkin's disease.
A nurse is caring for an infant. Which of the following are clinical manifestations of coarctation of the aorta? SELECT ALL THAT APPLY A. weak femoral pulses B. cool skin of lower extremities C. severe cyanosis D. clubbing of the fingers E. heart failure
A. weak femoral pulses B. cool skin of lower extremities E. heart failure
The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instructions? A. "A balance of rest and exercise is important." B. "I can apply lotion or powder to the incision if it is itchy." C. "Activities in which my child could fall need to be avoided for 2 to 4 weeks." D. "Large crowds of people need to be avoided for at least 2 weeks after surgery."
B. "I can apply lotion or powder to the incision if it is itchy." Rationale: The mother should be instructed that lotions and powders should not be applied to the incision site after cardiac surgery. Lotions and powders can irritate the surrounding skin, which could lead to skin breakdown and subsequent infection of the incision site. Options 1, 3, and 4 are accurate instructions regarding home care after cardiac surgery.
A nurse is caring for a 2-year-old child who is cyanotic and is in the hospital for a cardiac catheterization to repair cardiac defects. The child will be transferred to the PICU following the procedure. Which of the following is an appropriate nursing action when providing care to this child? A. Place on NPO status for 12 hrs prior to procedure. B. Check for iodine or shellfish allergies prior to procedure. C. Elevate the affected extremity following the procedure D. Limit fluid intake following the procedure
B. Check for iodine or shellfish allergies prior to procedure.
A nurse is reviewing the health record of an infant with a diagnosis of congenital heart disease. The nurse notes documentation in the record that the infant has clubbing of the fingers. The nurse understands that this finding is caused by which problem? A. Chronic fatigue B. Poor oxygenation C. Poor sucking ability D. Consistent sucking on the fingers
B. Poor oxygenation
A nurse is assessing an infant. Which of the following should the nurse recognize as clinical manifestations of heart failure? SELECT ALL THAT APPLY A. bradycardia B. cool extremities C. peripheral edema D. increased urinary output E. nasal flaring
B. cool extremities C. peripheral edema E. nasal flaring
A nurse is providing teaching to the mother of an infant who is starting digoxin (Lanoxin). Which of the following instructions should the nurse include? A. "Do not offer your baby fluids after giving the medication." B. "Digoxin increases your baby's HR." C. "Give the correct dose of medication at regularly scheduled times." D. "If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount."
C. "Give the correct dose of medication at regularly scheduled times."
A child is being discharged from the hospital following heart surgery. Prior to discharge, the nurse reviews the discharge instructions with the mother. Which statement by the mother indicates a need for further teaching? A. "Quiet activities are allowed." B. "The child should play inside for now." C. "Visitors are not allowed for 1 month." D. "The regular schedule for naps is resumed."
C. "Visitors are not allowed for 1 month." Rationale: Visitors without signs of any infection are allowed to visit the child. The mother should be instructed, however, that the child needs to avoid large crowds of people for 1 week following discharge. Options 1, 2, and 4 are accurate instructions regarding activity following heart surgery.
A child with a diagnosis of tetralogy of Fallot exhibits an increased depth and rate of respirations. On further assessment, the nurse notes increased hypoxemia. The nurse interprets these findings as indicating which situation? A. Anxiety B. A temper tantrum C. A hypercyanotic episode D. The need for immediate health care provider (HCP) notification
C. A hypercyanotic episode Rationale: Children with tetralogy of Fallot or similar physiology may experience hypercyanotic episodes, or tet spells. These episodes are characterized by increased respiratory rate and depth and increased hypoxia. Immediate HCP notification is not required unless other appropriate nursing interventions are unsuccessful. Options 1 and 2 are unrelated to tetralogy of Fallot.
The nurse is reviewing the health care provider's prescriptions for a child with rheumatic fever (RF) who is suspected of having a viral infection. The nurse notes that acetylsalicylic acid (aspirin) is prescribed for the child. Which nursing action is most appropriate? A. Administer the aspirin if the child's temperature is elevated. B. Administer the aspirin if the child experiences any joint pain. C. Consult with the health care provider to verify the prescription. D. Administer acetaminophen (Tylenol) for temperature elevation.
C. Consult with the health care provider to verify the prescription. Rationale: Anti-inflammatory agents, including aspirin, may be prescribed for the child with RF. Aspirin should not be given to a child who has chickenpox or other viral infections. Therefore, the nurse should consult with the health care provider to verify the prescription. The nurse would not administer acetaminophen (Tylenol) without specific health care provider's prescriptions. Options 1 and 2 are not appropriate actions.
A nurse is caring for an infant with congenital heart disease. Which, if noted in the infant, should alert the nurse to the early development of heart failure (HF)? A. Paleness of the skin B. Strong sucking reflex C. Diaphoresis during feeding D. Slow and shallow breathing
C. Diaphoresis during feeding Rationale: The early symptoms of HF include tachypnea, poor feeding, and diaphoresis during feeding. Tachycardia would occur during feeding. Paleness of the skin, pallor, may be noted in the infant with HF, but it is not an early symptom. A strong sucking reflex is unrelated to the development of HF.
The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? A. Pallor B. Hyperactivity C. Exercise intolerance D. Gastrointestinal disturbances
C. Exercise intolerance Rationale: Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. A child with aortic stenosis shows signs of exercise intolerance, chest pain, and dizziness when standing for long periods. Pallor may be noted, but is not specific to this type of disorder alone. Options 2 and 4 are not related to this disorder.
The nurse is developing a plan of care for a child admitted with a diagnosis of Kawasaki disease. In developing the initial plan of care, the nurse should include to monitor the child for signs of which condition? A. Bleeding B. Failure to thrive C. Heart failure (HF) D. Decreased tolerance to stimulation
C. Heart Failure (HF) Rationale: Nursing care initially centers on observing for signs of HF. The nurse monitors for increased respiratory rate, increased heart rate, dyspnea, crackles, and abdominal distention. Options 1, 2, and 4 are not conditions directly associated with this disorder.
Assessment findings of an infant admitted to the hospital reveal a machinery-like murmur on auscultation of the heart and signs of heart failure. The nurse reviews congenital cardiac anomalies and identifies the infant's condition as which disorder? A. Aortic stenosis B. Atrial septal defect C. Patent ductus arteriosus D. Ventricular septal defect
C. Patent ductus arteriosus Rationale: A patent ductus arteriosus is failure of the fetal ductus arteriosus (artery connecting the aorta and the pulmonary artery) to close. A characteristic machinery-like murmur is present, and the infant may show signs of heart failure. Aortic stenosis is a narrowing or stricture of the aortic valve. Atrial septal defect is an abnormal opening between the atria. Ventricular septal defect is an abnormal opening between the right and left ventricles
The nurse is collecting data on a child with a diagnosis of rheumatic fever (RF). Which question should the nurse initially ask the mother of the child? A. "Has the child been vomiting?" B. "Has the child had any diarrhea?" C. "Does the child complain of chest pain and numbness in the right arm?" D. "Has the child complained of a sore throat within the past few months?"
D. "Has the child complained of a sore throat within the past few months?" Rationale: RF characteristically presents 2 to 6 weeks following an untreated or partially treated group A beta-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child or any family members have had a sore throat or unexplained fever within the past 2 months. Options 1, 2, and 3 are unrelated to RF.
The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin (Lanoxin). Which statement made by the parent indicates the need for further instructions? A. "I will not mix the medication with food." B. "I will take my child's pulse before administering the medication." C. "If more than one dose is missed, I will call the health care provider." D. "If my child vomits after medication administration, I will repeat the dose."
D. "If my child vomits after medication administration, I will repeat the dose."
The mother of a child being discharged after heart surgery asks the nurse when the child will be able to return to school. Which is the most appropriate response to the mother? A. "The child may return to school in 1 week." B. "The child will not be able to return to school during this academic year." C. "The child may return to school in 1 week but needs to go half-days for the first 2 weeks." D. "The child may return to school in 3 weeks but needs to go half-days for the first few days."
D. "The child may return to school in 3 weeks but needs to go half-days for the first few days." Rationale: After heart surgery, the child may return to school in 3 weeks but needs to go half-days for the first few days. The mother also should be told that that the child cannot participate in physical education for 2 months. Options 1, 2, and 3 are incorrect.
The nurse is monitoring an infant with heart failure (HF). Which sign alerts the nurse to suspect fluid accumulation and the need to call the health care provider (HCP)? A. Bradypnea B. Diaphoresis C. Decreased blood pressure D. A weight gain of 1 lb in 1 day
D. A weight gain of 1 lb in 1 day Rationale: HF is the inability of the heart to pump a sufficient amount of oxygen to meet the metabolic needs of the body. A weight gain of 0.5 kg (1 lb) in 1 day is caused by the accumulation of fluid. The nurse should assess urine output, assess for evidence of facial or peripheral edema, auscultate lung sounds, and report the weight gain to the HCP. Tachypnea and increased blood pressure occur with fluid accumulation. Diaphoresis is a sign of HF, but it is not specific to fluid accumulation and usually occurs with exertional activities.
A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen to the infant? A. During sleep B. When changing the infant's diapers C. When the mother is holding the infant D. When drawing blood for electrolyte level testing
D. When drawing blood for electrolyte level testing Rationale: Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. Crying exhausts the limited energy supply, increases the workload of the heart, and increases the oxygen demands. Oxygen administration may be prescribed for stressful periods, especially during bouts of crying or invasive procedures. Options 1, 2, and 3 are not likely to produce crying in the infant.
The nurse is assessing a newborn with heart failure before administering the prescribed digoxin (Lanoxin). In reviewing the laboratory data, the nurse notes that the newborn has a digoxin blood level of 2.4 ng/mL and an apical heart rate of 98 beats/min. The mother also tells the nurse that the newborn just vomited her formula. Which intervention should the nurse take? A. Retake the apical pulse. B. Administer the medication. C. Withhold the medication for 1 hour. D. Withhold the medication and notify the health care provider.
D. Withhold the medication and notify the health care provider. Rationale: The apical pulse rate for a newborn is 120 to 140 beats/min. The therapeutic digoxin level ranges from 0.5 to 2.0 ng/dL. Because the apical rate is low and the digoxin blood level is elevated, indicating toxicity, the nurse would withhold the medication and notify the health care provider. Therefore options 1, 2, and 3 are incorrect.
What is a thrill?
Palpable tremor over the chest of a patient with a murmur
How are murmurs classified?
rating of I-IV (rating of 4-6 is extremely loud and associated with thrills)
What is the function of the ACE inhibitors?
reduces after load by causing vasodilation, resulting in decreases pulmonary and systemic vascular resistance
What is a major risk factor for rheumatic fever?
usually occurs within 2-6 weeks following an untreated or partially treated upper respiratory infection (strep throat) with GABHS
What is Kawasaki Disease?
widespread inflammation of the small and medium sized blood vessels
What are nursing considerations with beta blockers?
-monitor BP and pulse prior to admin -monitor for adverse effects such as dizziness, hypotension, and HA
What are some nursing considerations with the ACE inhibitors?
-monitor BP before and after admin (hypotension) -monitor for evidence of hypokalemia
What are clinical manifestations of PDA?
-murmur (machine hum) -wide pulse pressure -bounding pulses -asymptomatic (possible) -heart failure
What is a PDA?
-patent ductus arteriosus -condition in which the normal fetal circulation conduit b/t the pulmonary artery and the aorta fails to close and results in increased pulmonary blood flow (left to right shunt)
What is done to prevent endocarditis?
-prophylactic antibiotic therapy should be given prior to dental and surgical procedures (dental extractions, surgical procedures involving the respiratory or GI mucosa) -this is only given to high risk patients
What are s/s of Kawasaki Disease during the Subacute Phase?
-resolution of fever -irritability -peeling skin around the nails, on the palms and soles
What are children at risk for with COA?
-stroke -ruptured aorta -aortic aneurysm *treat with balloon angioplasty (usually before 2 years of age) *post op complication is HTN
What are some clinical manifestations of pulmonary stenosis?
-systolic ejection murmur -asymptomatic (possible) -cyanosis varies with defect, worse with severe narrowing -cardiomegaly -heart failure -right ventricle hypertrophy
What are some pre-procedure actions by the nurse for a cardiac catheterization?
-take hx and perform physical exam (need to check for infection) -ask about allergies to shellfish and iodine -NPO status should be 4-6 hrs prior to procedure -baseline VS with pulse ox -locate and mark dorsal is pedis and posterior tibial pulses on both extremities -admin presedation as prescribed
What are must be done before you administer digoxin?
-take pulse -if <70 bpm in a child...withhold medication -if <90 bpm in an infant...withhold medication
What is important to remember about BP screenings?
-to diagnose HTN you must have 3 separate occasions of elevated BP -child needs to be relaxed and calm -use an appropriate sized cuff (cuff bladder that covers 80% to 100% of the circumference of the arm)
What are clinical manifestations of endocarditis?
-low grade fever -malaise -decreased appetite with weight loss
When weighing a diaper for I&Os, how do you detect how much fluid was lost?
1 g of diaper weight increase = 1cc of fluid
What are clinical manifestations of VSD?
-loud, harsh murmurs ausculated at the left sternal border -heart failure -many VSDs close spontaneously if small to moderate -pulmonary HTN -right ventricle hypertrophy
Where do you assess the apical HR in a child <8 years old?
4th intercostal space *>8 years should be at the 5th intercostal space
The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output? A. Weighing the diapers B. Inserting a Foley catheter C. Comparing intake with output D. Measuring the amount of water added to formula
A. Weighing the diapers
The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (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. Tachycardia Rationale: Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. The early signs of HF include tachycardia, tachypnea, profuse scalp sweating, fatigue and irritability, sudden weight gain, and respiratory distress. A cough may occur in HF as a result of mucosal swelling and irritation, but is not an early sign. Pallor may be noted in an infant with HF, but is not an early sign.
What is furosemide (Lasix)?
a potassium wasting diuretic that rids to the body of excess water and sodium
What does digoxin do?
acts directly on the heart to improve myocardial contractility and force of contraction
What is Metoprolol or carvedilol (Coreg)?
beta blockers (decrease HR and BP and promote vasodilation)
What are children with tetralogy of fallot at risk for?
emboli, seizures, sudden death
How often is digoxin administered?
every 12 hrs
What is rheumatic fever?
inflammatory disease that occurs as a reaction to Group A B-hemolytic streptococcus (GABHS) infection of the throat
What is aortic stenosis?
narrowing of the aortic valve
