Chapter 23: The Child with Cardiovascular Dysfunction ANS

When caring for the child with Kawasaki disease, the nurse should know which information?

Therapeutic management includes administration of gamma globulin and aspirin.

The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity?

Vomiting

Which explanation regarding cardiac catheterization is appropriate for a preschool child?

When the procedure is done, you will have to keep your leg straight for at least 4 hours.

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on which statement?

Child needs opportunities to play with peers.

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock?

Confusion and somnolence

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.)

Cool extremities and decreased skin turgor Confusion and somnolence Tachypnea and poor capillary refill time

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.)

Decreased urinary output Sweating (inappropriate) Fatigue

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, the nurse should prepare which medication for immediate administration?

Epinephrine (Adrenalin)

Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

Heart failure

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk?

Prevent dehydration.

The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot?

Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

Which action by the school nurse is important in the prevention of rheumatic fever?

Refer children with sore throats for throat cultures.

Which is the leading cause of death after heart transplantation?

Rejection

Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. Which action should the nurse take?

Report findings to physician.

Which is the most common causative agent of bacterial endocarditis?

Streptococcus viridans

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?

Tetralogy of Fallot

The nurse is teaching nursing students about shock that occurs in children. One of the most frequent causes of hypovolemic shock in children is:

blood loss.

Clinical manifestations of toxic shock syndrome include:

erythematous macular rash.

When discussing hyperlipidemia with a group of adolescents, the nurse should explain that cardiovascular disease can be prevented by high levels of:

high-density lipoproteins (HDLs).

A chest radiograph film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" The nurse's response should be based on knowledge that the x-ray film will show:

permanent record of heart size and configuration.

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to:

place the child in the knee-chest position.

As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in:

potassium.

Surgical closure of the ductus arteriosus would:

prevent the return of oxygenated blood to the lungs.

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:

adapted to his level of development so that he can understand.

The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:

apply direct pressure above catheterization site.

The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?

"I have to stay on strict bed rest for 3 days."

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct?

"You may need to increase the caloric density of your infant's formula."

A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response?

"Your child must lie quietly; sometimes a mild sedative is administered before the procedure."

Which is the acceptable mg/dl level, or below this level, low density lipoprotein (LDL) cholesterol for a child from a family with heart disease?

110

An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min.

70

A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min.

90 to 110

A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse be administering?

Captopril (Capoten)

The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for?

Cardiac arrhythmia

Which is a common, serious complication of rheumatic fever?

Cardiac valve damage

Which is an important nursing consideration when chest tubes will be removed from a child?

Administer analgesics before procedure.

Which is an important nursing consideration when suctioning a young child who has had heart surgery?

Administer supplemental oxygen before and after suctioning.

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement?

Administering penicillin

Which type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?

Anaphylactic

Nursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.)

Assess the affected extremity for temperature and color. Maintain a patent peripheral intravenous catheter until discharge.

Which defect results in increased pulmonary blood flow?

Atrial septal defect

The nurse is caring for a child after heart surgery. Which should the nurse do if evidence is found of cardiac tamponade?

Immediately report this to physician.

Which occurs in septic shock?

Increased cardiac output

The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)?

It decreases edema.

Which should the nurse consider when preparing a school-age child and the family for heart surgery?

Let child hear the sounds of an ECG monitor.

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. Once the airway is established, the nurse should do which action?

Obtain vascular access. Administer epinephrine. Keep child warm and calm.

The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands?

Organize nursing activities to allow for uninterrupted sleep.

Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?

Osler nodes

The parents of a young child with heart failure tell the nurse that they are "nervous" about giving digoxin (Lanoxin). The nurse's response should be based on which statement?

Parents must learn specific, important guidelines for administration of digoxin.

Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure?

Peripheral edema

An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during a routine blood draw. Which interventions should the nurse implement? Place in order from the highest-priority intervention to the lowest-priority intervention.

Place infant in knee-chest position. Administer 100% oxygen by blow-by. Give morphine subcutaneously or by an existing intravenous line. Remain calm.

The nurse is conducting a staff in-service on childhood-acquired heart diseases. Which is a major clinical manifestation of rheumatic fever?

Polyarthritis

The primary nursing intervention to prevent bacterial endocarditis is to:

counsel parents of high-risk children about prophylactic antibiotics.