Pediatric Cardiovascular Disorders

61. The Jones Criteria established in 1944 was established to assist in the diagnosis of: 1. Kawasaki disease. 2. Rheumatic heart disease(RHD). 3. Subacute Bacterial Endocarditis. 4. Toxic Shock Syndrome.

ANS: 2 Feedback 1. The Jones Criteria was established for RHD. 2. The Jones Criteria has established minor and major criteria for the diagnosis of RHD. 3. The Jones Criteria was established for RHD. 4. The Jones Criteria was established for RHD.

49. The prevalent incidence of rheumatic heart disease occurs in: 1. Late spring and winter. 2. Summer and early spring. 3. Early spring and fall. 4. Early spring and winter.

ANS: 4 Feedback 1. There is a two-fold increase in the early spring, not late spring, and winter for the development of rheumatic fever. 2. The increase is not in the summer. 3. The increase is not in the fall. 4. There is a two-fold increase in the early spring and winter for the development of rheumatic fever.

6. When assessing a newborn, a nurse should check capillary refill: 1. On the fingernail beds. 2. On the sternum. 3. On the arm. 4. On the hand.

ANS: 2 Feedback 1. Because of peripheral cyanosis, the fingernail beds will not respond quickly for an adequate measurement of capillary refill. 2. The sternum responds quickly for an adequate measurement of capillary refill. 3. The hand does not respond quickly for an adequate measurement of capillary refill. 4. The hand does not respond quickly for an adequate measurement of capillary refill.

58. The nurse knows that a child on Digoxin (Lanoxin) requires frequent monitoring of: 1. Sodium levels. 2. Potassium levels. 3. Complete blood count. 4. Creatinine levels.

ANS: 2 Feedback 1. Sodium levels do not affect the function of Digoxin. 2. Potassium levels affect the contractility of the heart muscle and affect whether Digoxin should be administered. 3. Complete blood count would not affect the administration of Digoxin. 4. Creatinine levels do not affect the function of Digoxin.

19. A nurse caring for a child with Eisenmengers syndrome should assess for all of the following except: 1. Fatigue. 2. Acrocyanosis. 3. Shortness of breath. 4. Blood pressure.

ANS: 2 Feedback 1. The child will have increased fatigue due to the lack of oxygen in the body. 2. The child will have cyanosis. 3. The child will demonstrate a shortness of breath because of the lack of oxygen being perfused to the lungs. 4. The blood pressure should be assessed to monitor how the heart is pumping.

41. A father is discussing dietary needs for his son, who has a diagnosis of CHF. The nurse knows the father understands the dietary needs when he states: 1. I can let my son have french fries once a week. 2. I will need to make sure he drinks eight 8-ounce glasses of water every day. 3. When having scalloped potatoes and ham for dinner, we should plan an alternative meal for my son. 4. I will need to give my child his diuretic at bedtime because food can interfere with the medication action.

ANS: 3 Feedback 1. A diet that is low in sodium is needed. 2. Close monitoring of fluid intake is needed because the heart can easily become overloaded with fluid. 3. Ham has a large concentration of sodium, thus the child should have an alternative meal. 4. The diuretic should be given earlier in the day to decrease the number of times needed to urinate during sleep time.

56. The nurse knows that one of the most likely symptoms of congestive heart failure (CHF) in infants is: 1. Jugular vein distention (JVD). 2. Decreased blood pressure. 3. Periorbital edema. 4. Diaphoresis with feedings

ANS: 4 Feedback 1. JVD is not a symptom of CHF in infants. 2. Increased, not decreased, blood pressure is an indicator of CHF. 3. Although periorbital edema occurs in infants with prolonged CHF, it is not a likely symptom of CHF. 4. This is the most common symptom due to sympathetic stimulation.

11. A 6 month old has a known diagnosis of an Atrial Septal Defect (ASD). The nurse would anticipate all except which of the following during an assessment? 1. Shortness of breath 2. Enlarged liver 3. Poor feeding 4. A diastolic murmur

ANS: 4 Feedback 1. Shortness of breath is expected since more blood flows to the pulmonary area because of the hole. 2. The liver enlarges because of the increase in blood flow. 3. Poor feedings are expected as a result of shortness of breath because of the pulmonary hypertension issues. 4. A systolic murmur is expected due to the blood being forced through the pulmonary valve.

57. A nurse should be most concerned about which type cyanosis in a newborn infant? 1. Cyanosis of the hands 2. Cyanosis of the feet 3. Periorbital cyanosis 4. Circumoral cyanosis

1. Cyanosis of the hands is normal for a transitioning newborn. 2. Cyanosis of the feet is normal for a transitioning newborn. 3. While abnormal in a newborn, it may indicate a transitioning newborn. 4. Circumoral cyanosis of the mouth and mucus membranes indicates central cyanosis.

15. A nurse is assessing a child with a known VSD. The nurse anticipates auscultating: 1. A systolic thrill in the lower left sternal border. 2. Wet lung sounds bilaterally. 3. A diastolic thrill in the upper left sternal border. 4. A diastolic wetness in the right sternal border.

ANS: 1 Feedback 1. A thrill sound in the left sternal border will be heard because of where the valve is located. 2. The lung sounds should be clear. 3. A systolic thrill and lower left sternal border thrill will be noted. 4. A thrill sound in the left sternal border with diastolic sounds will be heard because of where the valve is located.

50. A 14-year-old girl is admitted to the pediatric emergency room with symptoms of fever, rash, syncope, nausea, and vomiting. The most important information that the admitting nurse should obtain is: 1. Are you currently menstruating? 2. When did you last eat? 3. Have you been in contact with anyone who has had the flu? 4. Are you sexually active?

ANS: 1 Feedback 1. If the girl is currently menstruating, the use of tampons may indicate toxic shock syndrome. 2. This is not the most important factor to obtain given the symptoms the patient has exhibited. 3. While knowledge of a childs exposure to viruses is important, it is not the most important factor to obtain. 4. This is not the most important factor to obtain given the symptoms the patient has exhibited

The nurse is providing care for a neonate diagnosed with tetralogy of Fallot. Prostaglandin E1 therapy is prescribed to keep the foramen ovale and the ductus arteriosus open. Which is the most important intervention for the nurse to include in the neonate's plan of care? 1. Maintain a separate IV access for continuous administration of the medication. 2. Watch for respiratory distress or apnea after adding medication to the breathing tube. 3. Monitor for and document evidence of flushing, bradycardia, and irritability as expected. 4. Monitor weight and adjust the dosage using a scale of 0.05 to 0.1 mcg/kg/min IV infusion.

ANS 1 1 This is correct. During the administration of prostaglandin E1, the nurse starts and maintains a separate IV access for continuous administration of the medication. 2 This is incorrect. During the administration of prostaglandin E1, the nurse monitors for respiratory distress or apnea. However, the medication is not administered via the neonate's breathing tube. 3 This is incorrect. During the administration of prostaglandin E1, the nurse will watch the neonate for flushing, bradycardia, irritability, and diarrhea, and monitor for bleeding. The nurse always documents assessment findings; however, the manifestations need to be reported to the primary health-care provider. 4 This is incorrect. The dosage for prostaglandin is usually 0.05 to 0.1 mcg/kg/min IV infusion, as ordered by the primary health-care provider. The nurse does not adjust the dose using any parameter.

7. Weak peripheral pulses can indicate: 1. A weak heart. 2. Poor cardiac output. 3. Hypertension. 4. Patent ductus arteriosus.

ANS: 2 Feedback 1. The heart may be weak, but does not indicate that the pulses will be weak. 2. A lower amount of output does not allow for peripheral pulses to be easily felt. 3. If the patient has hypertension, the pulses may be bounding. 4. Patent ductus arteriosus may have bounding pulses.

When assessing pulses of a child with coarctation of the aorta, the nurse should use the right subclavian artery. True or False

False The right brachial artery should be used because the subclavian can give a false reading.

76. A child with a VSD will have cardiomegaly of the left side of the heart. true or false

true The left side of the heart will be increased because of the increased pulmonary vascularity. 2. The increase in pulmonary vascularity causes cardiomegaly of the left side of the heart.

A 3-month-old infant is diagnosed with pulmonary stenosis. Which parent teaching does the nurse provide? 1. Options for treatment include a repair of the artery or the valve. 2. Balloon angioplasty is performed as an outpatient procedure. 3. Pulmonary stenosis repair can be delayed until 1 year of age. 4. After repair, the child is no longer at risk for cardiac problems.

ANS 1 1 This is correct. Options are to repair the pulmonary artery and/or pulmonic valve as soon as possible to avoid worsening side effects of the condition. 2 This is incorrect. Side effects of pulmonary stenosis include increased workload of the right ventricle, CHF, hepatomegaly, development of murmurs, shortness of breath, and cyanosis. Delaying corrective surgery will worsen effects of the condition. 3 This is incorrect. The infant with pulmonary stenosis will be hospitalized for assessment and treatment. 4 This is incorrect. The child must return to the cardiologist frequently for follow-up, and caregivers should be provided information on the recurrence of symptoms that may occur due to restenosis.

39. A nurse is discussing discharge instructions with parents of a child who received a cardiac transplant five weeks ago. The discharge instructions should include all of the following except: 1. Discussion of signs and symptoms of rejection. 2. The child should not participate in moderate to high physical activity. 3. Instructions to wear a medical alert bracelet. 4. Take the anti-rejection medications when signs of rejection arise.

ANS: 4 Feedback 1. The family should be informed about possible signs and symptoms for early detection. 2. Increased activity causes an increased workload on the heart, so this should be avoided until the doctor gives permission for increasing activity. 3. A medical alert bracelet is recommended so others are aware of needs of the patient. 4. The anti-rejection medications will need to be taken for the remainder of the childs life every day.

45. The nurse caring for a child with a suspected congenital heart defect performs the hyper-oxygenation test appropriately when he/she applies the pulse oximeter to the childs: 1. Left arm. 2. Right leg. 3. Left leg. 4. Right arm.

ANS: 4 Feedback 1. The left arm is postductal and not an accurate reflection of the true oxygen saturation. 2. The right leg, although preductal, is not the best choice for obtaining an accurate oxygen concentration that is close to the heart. 3. The left leg is postductal and not an accurate reflection of the true oxygen saturation. 4. The right arm is preductal and the most accurate assessment of the oxygen saturation prior to most congenital heart defects.

5. The nurse is assisting with high school sports physicals. The nurse performs a physical assessment on a male student who is tall and thin, with disproportionately long arms. Which additional finding will prompt the nurse to recommend a cardiac evaluation? 1. Notable laxity of joints 2. Sparsity of body hair 3. Deep tone to the voice 4. Slow, rhythmic gait

ANS 1 1 This is correct. Tall and thin with arms disproportionately long and with laxity of joints are physical manifestations of Marfan syndrome. The nurse may also notice dislocation of lenses, spinal problems, stretch marks, hernia, pectus abnormalities, and/or restrictive lung disease. Marfan syndrome is also associated with aortic aneurism as well as aortic and/or mitral regurgitation. 2 This is incorrect. A sparsity of body hair is not an indication of cardiac issues; male high school students may not exhibit heavy body hair. 3 This is incorrect. A male high school student is expected to have a deep tone to his voice. 4 This is incorrect. A slow, rhythmic gait may be unique to this student; however, it does not support the presence of Marfan syndrome.

The nurse is aware the neonate's blood circulation is different before birth than after birth. Which circulation pattern does the nurse recognize as occurring prior to birth? 1. Oxygenated blood flows from the right atrium to the left atrium through the foramen ovale. 2. Oxygenated blood flows from the right ventricle to the lungs and then to the left ventricle. 3. For a short time after birth, the neonate continues to depend on the mother for oxygen supply. 4. Once the neonate takes a first breath, the ductus venosus closes and blood goes to the lungs.

ANS 1 Feedback 1 This is correct. Prior to birth, oxygenated blood crosses from the right atrium to the left atrium via the patent foramen ovale (PFO) and is pumped by the left ventricle. 2 This is incorrect. Prior to birth, oxygenated blood does not flow from the right ventricle to the lungs and then to the left ventricle. 3 This is incorrect. Before birth, 90% of blood bypasses the lungs; the placenta is the organ of respiration. After the cord is cut and the placenta is delivered, the infant is expected to independently breathe. 4 This is incorrect. Upon birth and first breath, the foramen ovale and ductus arteriosus close.

The nurse works in a pediatric clinic with patients who have heart disease or who have undergone treatment for heart disease. The nurse is frequently asked about the need for prophylactic antibiotics for these patients during invasive dental care. Which patients does the nurse identify as being at risk for endocarditis and being in need of antibiotic therapy? Select all that apply. 1. A child with a prosthetic heart valve 2. A child with a congenital defect scheduled for surgical repair 3. A child who was previously diagnosed with endocarditis 4. A child with a confirmed diagnosis of rheumatic heart disease 5. A child who had a congenital heart defect repaired 9 months ago

ANS 1,2,3,4 1. This is correct. The American Heart Association recommends prophylactic antibiotics for the child with a valve replacement. 2. This is correct. The American Heart Association recommends prophylactic antibiotics for the child with a congenital defect who is scheduled for surgical repair. 3. This is correct. The American Heart Association recommends prophylactic antibiotics for the child who was previously diagnosed with endocarditis. 4. This is correct. The American Heart Association recommends prophylactic antibiotics for the child who is diagnosed with rheumatic heart disease, which affects the heart valves. 5. This is incorrect. Prophylactic antibiotics are recommended for the child with a congenital heart defect that has been corrected for the first 6 months after the repair. The child who is 9 months past the repair does not need prophylactic antibiotics.

The nurse is providing care for a 9-year-old patient who was recently diagnosed with cardiomyopathy after a viral infection. Which teaching does the nurse provide to the patient's parents about the diagnosed condition? Select all that apply. 1. Need for intensive care of the patient 2. Preparation for anticipatory grieving 3. The necessity for physical activity 4. Allowing patient to discuss feelings 5. Reasons for frequent medical visits

ANS 1,2,4,5 1. This is correct. The nurse will provide teaching about the intensive care necessary for a child with this life-threatening condition. 2. This is correct. The patient with cardiomyopathy has a possible terminal status. The nurse will prepare the parents for expected anticipatory grieving, which is expected with this life-threatening condition. 3. This is incorrect. The nurse will provide teaching about the activity restrictions to prevent overstimulation of the heart. 4. This is correct. The nurse will instruct the parents to allow the child to discuss feelings concerning the restriction of activity in the previously active child. 5. This is correct. The parents need to understand that frequent echocardiograms will be required to monitor the size and function of the heart.

A new mother brings her 2-week-old neonate to the pediatrician's office, stating, "I think something is wrong with my baby." When the infant is undressed, the nurse notices signs of possible cardiac problems. Which assessment findings support the nurse's suspicions? Select all that apply. 1. Prolonged capillary refill time 2. Bluish tinge to oral structures 3. Peripheral cyanosis of left leg 4. Amount of urinary output 5. Mottled appearance of skin

ANS 1,2,5 1. This is correct. Prolonged capillary refill time is a sign of poor perfusion; it can be indicative of possible cardiac or lung issues. The assessment is made by pressing on the sternum or forehead. 2. This is correct. Central cyanosis is the presence of bluish discoloration of mucous membranes, tongue, circumoral, or core body and is due to problems with the heart or lungs. 3. This is incorrect. Peripheral cyanosis (acrocyanosis) is often due to interruption in blood flow to the extremity. 4. This is incorrect. Urine output is indicative of perfusion to the kidneys; however, the nurse is unable to determine the amount of urinary output through observation. 5. This is correct. Skin that is pale, mottled, or gray in appearance indicates poor perfusion.

20. ECHMO is commonly used as a treatment for a baby with which defect/syndrome? 1. Eisenmengers syndrome 2. Coarctation of the aorta 3. ASD 4. Tetralogy of Fallot

ANS: 1 Feedback 1. ECHMO acts as a bypass for the heart and lungs to obtain enough oxygen for the body. 2. ECHMO acts as a bypass for the heart and lungs to obtain enough oxygen for the body. In coarctation, the heart and lungs are able to perfuse. 3. ECHMO acts as a bypass for the heart and lungs to obtain enough oxygen for the body. 4. ECHMO acts as a bypass for the heart and lungs to obtain enough oxygen for the body.

An infant with a patent ductus arteriosus will exhibit which type of heart murmur? 1. Washing machine murmur 2. Gallop style murmur 3. Clicking murmur 4. Harsh, loud murmur

ANS: 1 Feedback 1. PDA murmurs sound like a washing machine due to pulmonary congestion. 2. This is not the type of murmur heard in a PDA. 3. This is not the type of murmur heard in a PDA. 4. This is not the type of murmur heard in a PDA.

A neonate became dusky and developed respiratory distress at the age of 4 days and is diagnosed with a hypoplastic left heart. The surgeon obtains an informed consent from the parents to perform emergency surgery. Which information will the nurse provide to promote parental understanding? Select all that apply. 1. The left side of the neonate's heart did not develop correctly. 2. The function of left side of the heart is to pump blood to the body. 3. Provide reassurance to the parents that surgery will fix the problem. 4. Share that medical management of the condition is needed for one year. 5. A normally existing hole in the wall of the heart at birth will be enlarged.

ANS 1,2,5 1. This is correct. The hypoplastic left heart is the second most common congenital heart defect, caused by underdevelopment of the left side of the heart, aorta, aortic valve, left ventricle, and mitral valve. 2. This is correct. The nurse is correct in providing information about the normal functioning of the left side of the heart to clarify the existing condition. 3. This is incorrect. The nurse needs to provide the parents with information about the severity of the condition. The nurse anticipates possible transport out of the facility for heart transplant. 4. This is incorrect. The neonate will require clinical and medication management for life. 5. This is correct. Symptoms appear when the PDA closes; the condition is usually fatal within the first days or months of life unless treated. It is appropriate for the nurse to describe the surgery in terms the parents can understand.

The pediatric nurse is providing care for a school-age patient diagnosed with rheumatic heart disease. When developing a plan of care for the patient's hospital stay, which interventions does the nurse include? Select all that apply. 1. Administer inflammatory and antibiotic medications as prescribed. 2. Assess for the presence of strep throat or other throat infections. 3. Include chest pain and heart palpation assessment with vital signs. 4. Begin patient/family teaching about the possibility of surgery. 5. Organize daily care and treatments to provide for joint pain relief.

ANS 1,3,5 1. This is correct. The nurse will address interventions for the administration of inflammatory and antibiotic medications as prescribed. 2. This is incorrect. The nurse does not need to add assessment interventions for strep throat or other throat infections in a patient diagnosed with rheumatic heart disease. 3. This is correct. The nurse will include the intervention of including assessment for chest pain or heart palpitations with vital signs, because rheumatic heart disease causes heart valve damage. 4. This is incorrect. The scenario does not specify the reason for the patient's hospitalization. Patient/family teaching is not initiated until surgery is planned. 5. This is correct. Rheumatic heart disease can cause polyarthritis; it is necessary for the nurse to include interventions that will promote rest and relieve joint pain.

The parents are preparing to take their newborn, who was diagnosed with tetralogy of Fallot with pulmonary atresia, home. The nurse is developing a teaching sheet regarding care of the newborn for the parents. Which information does the nurse need to include in the teaching plan? 1. There is no need to limit activities. 2. It is important to maintain caloric intake. 3. No secondary complications are expected. 4. The neonate has natural immunity to infections.

ANS 2 1 This is incorrect. The parents will be taught to calm the infant by holding the infant over the caregiver's shoulders with the infant's knees drawn up toward the chest. This will increase the blood flow to the lungs. The parents will limit cardiac stress by keeping the infant calm. 2 This is correct. Due to a clinical finding of failure to gain weight, the parents are instructed on the importance of maintaining caloric intake. Frequent small feedings are necessary to meet this need and not increase cardiac stress. 3 This is incorrect. Parents need to monitor for signs and symptoms of heart failure. 4 This is incorrect. Educate parents on the increased risk of bacterial endocarditis and the prescribed medication regimen.

The nurse is providing care for a neonate diagnosed with a cardiovascular disorder immediately after birth. When gathering assessment information from the mother, which comment will the nurse recognize as the most likely contributing factor for the defect? 1. "We live in the country, and we get all our water from a well." 2. "I quit my preschool job when a child was diagnosed with measles." 3. "The baby was born a week early; I hope that is not the cause." 4. "We were in a European country before pregnancy was confirmed."

ANS 2 2 This is correct. The nurse is most likely to contribute exposure to a child with measles as a causative factor for the neonate's heart defect. The nurse will assess further for timelines and manifestations. 1 This is incorrect. Using a well as a water source does not necessarily place a neonate at risk for developing a heart defect. 3 This is incorrect. The mother's concern about the neonate being born a week early is not recognized as a contributing factor to the neonate's heart defect. 4 This is incorrect. Traveling to a foreign country during the first trimester may or may not effect fetal development. The nurse needs additional information before making a connection between the travel and heart defect.

The nurse is performing a physical assessment on a 7-year-old child as a requirement for playing a sport at school. The nurse reports which assessment finding as abnormal and requests a follow-up from a primary care physician? 1. Systolic blood pressure is 84 mm Hg. 2. Systolic blood pressure is 90 mm Hg and diastolic is 20 mm Hg. 3. Pulse oximeter reading is 95% on room air. 4. PMI is at 4th or 5th intercostal space at the midclavicular line.

ANS 2 2 This is correct. Wide pulse pressures—diastolic pressures are low, with a wide gap between diastolic and systolic pressures—are indicative of such processes as patent ductus arteriosus. 1 This is incorrect. Average systolic blood pressures are considered 70+ (2´ age in years). This would be 84. 3 This is incorrect. Pulse oximeter readings of 95% of room air are considered normal. 4 This is incorrect. The point of maximum impulse (PMI) is heard at the fourth or fifth intercostal space at the midclavicular line (MCL).

A parent brings a 2-year-old child with a fever and a rash to the pediatric clinic. The health-care provider suggests the child may have one of several conditions that present with similar symptoms, but wants to rule out Kawasaki disease. Which tests does the nurse expect to be performed? Select all that apply. 1. Chest x-ray 2. White blood cell count 3. Allergy testing 4. Baseline echocardiograms 5. MRI of the chest

ANS 2,4 1. This is incorrect. A chest x-ray will not reveal Kawasaki's, as it is a blood infection. 2 This is correct. The WBC will reveal lymphocytosis and thrombosis, which are present with Kawasaki disease. 3. This is incorrect. Kawasaki is not an allergy reaction, and allergy testing is inappropriate. 4. This is correct. A life-threatening complication of Kawasaki disease is the development of coronary artery aneurysms. Baseline echocardiogram 6 to 8 weeks after the onset of symptoms is used to rule out this complication. 5. This is incorrect. Magnetic resonance imaging will not reveal Kawasaki disease.

The nurse is reviewing medications for the treatment of a heart rhythm disorder in a patient who is 8 years of age. The parent of the patient states that the physician recently prescribed medication to treat the patient's attention deficit-hyperactivity disorder. Using knowledge of recent professional recommendations, which statement by the nurse is correct? 1. "We need to remind the physician there is a heart condition." 2. "Do not start the medication until I can check for safety warnings." 3. "Children with heart disorders have a higher incidence of ADHD." 4. "Giving the medication can cause death if there is a cardiac issue."

ANS 3 1 This is incorrect. A black box warning about giving medications for ADHD to children with heart problems was issued in 2006. The AAP and the AHA state that medications used to treat ADHD have not been shown in most cases to cause heart disease or result in sudden cardiac death (CDC, 2016; Magellan Health, 2016a). There is no reason to contact the prescribing physician. 2 This is incorrect. If the nurse is knowledgeable about current medication recommendations, the nurse does not tell the parent to hold the medication until the safety can be checked by the nurse. 3 This is correct. Joint statements by the AAP and the AHA show that children with heart conditions have a higher incidence of ADHD, but that medications used to treat ADHD have not been shown in most cases to cause heart disease or result in sudden cardiac death. 4 This is incorrect. It is inaccurate and inappropriate for the nurse to tell the parent that the prescribed medication can cause death in children with cardiac issues.

The nurse is providing care for a 12-year-old patient who is hospitalized with generalized weakness and muscle wasting, which began in the hips, pelvic area, thighs, and shoulders. The physician suspects Duchenne muscular dystrophy. Which action by the physician does the nurse expect? 1. Prescribe physical therapy to improve muscle strength. 2. Suggest homeschooling until the acute stage ends. 3. Perform an echocardiogram to evaluate cardiac functioning. 4. Perform muscle biopsies to identify the stage of the disease.

ANS 3 3 This is correct. The physician is likely to order cardiac testing, especially to rule out cardiomyopathy, a condition frequently associated with Duchenne muscular dystrophy. 1 This is incorrect. Duchenne muscular dystrophy is a progressive genetic disease. Physical therapy is not prescribed to improve muscle strength; it is used to maintain body function for as long as possible. 2 This is incorrect. Duchenne muscular dystrophy is a progressive genetic disease. The physician may recommend homeschooling when the patient is no longer able to attend classes. There is no acute stage to this disease that will improve. 4 This is incorrect. The physician is more likely to prescribe neuromuscular tests to determine the extent of the disease.

The nurse is teaching a pediatric electrocardiogram (EKG) class to nurses in a pediatric cardiac unit. Which anatomical structure does the nurse use to describe the initiation of cardiac electrical conduction? 1. The Purkinje fibers in the ventricles 2. The bundle branch in the left atrium 3. The sinoatrial node in the right atrium 4. The bundle of His in the ventricle walls

ANS 3 4 This is incorrect. From the SA, the electrical impulse is conducted to the fibers called the bundle of His located in the walls of the ventricles. The process of electrical conduction does not start here. 1 This is incorrect. The Purkinje fibers are located in the ventricles; however, the process of electrical conduction does not start here. The fibers initiate contractions of the ventricles. 2 This is incorrect. The bundle branches are divided into either left or right bundles; however, the process of electrical conduction does not start here. 3 This is correct. When teaching the electrical conduction of the heart, the nurse starts with the sinoatrial (SA) node in the right ventricle, which is known as the pacemaker of the heart.

The nurse on a pediatric unit is providing care for a 5-year-old child diagnosed with congestive heart failure. The physician prescribes digoxin therapy. Which medication-focused interventions does the nurse include when creating a plan of care for the patient? Select all that apply. 1. Hold medication if an antibiotic is prescribed. 2. Evaluate parent's ability to obtain radial pulse. 3. Administer medication at the same time every day. 4. Administer 1 hour before or 2 hours after meals. 5. Replace medication if a dose is vomited within 1 hour.

ANS 3,4 1. This is incorrect. The child on digoxin therapy needs to be closely monitored for digoxin toxicity with antibiotic therapy, which is caused by changes in intestinal flora. The nurse will not include any interventions for holding digoxin on the plan of care. 2. This is incorrect. Educating parents on how to assess an infant's apical pulse rate and to notify the health-care practitioner if the heart rate is out of the range set by the health-care provider is included in the plan of care. However, the nurse will not include teaching parents how to take radial pulses. 3. This is correct. The nurse will include interventions on the plan of care regarding medication administration. The medication is administered at the same time every day and at the correct frequency. 4. This is correct. In order to promote absorption of digoxin, the nurse will administer the medication 1 hour before or 2 hours after meals. This intervention can be included on the plan of care. 5. This is incorrect. The nurse will not include an intervention on the plan of care addressing when to replace vomited or missed doses; the medication is not to be replaced. There is no way to determine how medication was already absorbed.

The nurse is providing information to the parents of a toddler who is scheduled for surgery for the replacement of the pulmonic valve. The parents have many questions about the function of the valve. Which information from the nurse is correct? 1. The valve must work correctly to get oxygen from the lungs to the body. 2. If the valve does not work correctly, blood is kept from entering the heart. 3. When the valve is defective, the blood leaving the heart is decreased. 4. A defect in the valve causes less blood to get to the lungs for oxygenation.

ANS 4 4 This is correct. When there is a defect in the right pulmonic valve, the blood has difficulty leaving the right ventricle and getting to the lungs for reoxygenation. This explanation by the nurse correctly describes the function of the valve and the purpose of the surgery. 1 This is incorrect. The aortic valve must work correctly for oxygenated blood to be carried from the left side of the heart to the rest of the body. 2 This is incorrect. Blood must enter the right side of the heart from the body in order to be reoxygenated. The unoxygenated blood enters the right atrium through the tricuspid valve into the right ventricle. 3 This is incorrect. A defect in the aortic valve would cause problems with oxygenated blood leaving the left ventricle.

43. A child with hyperlipidemia should consume no more than _________ mg of cholesterol a day. 1. 200 2. 500 3. 50 4. 100

ANS: 1 Feedback 1. A child should not consume more than 200 mg of cholesterol a day. 2. Too much cholesterol for a healthy diet 3. Too little cholesterol for a healthy diet 4. Too little cholesterol for a healthy diet

32. A baby is born with a known hypoplastic left heart. At the delivery, the nurse should anticipate which of the following in the initial assessment after birth if the PDA closes? 1. Tachypnea and an ashy color 2. Tachycardia, pale in color, and apnea 3. Bradycardia and apnea 4. Ruddy color and tachycardia

ANS: 1 Feedback 1. Rapid breathing and an ashen look will be present because the baby is not able to push the blood to the lungs in order to get oxygen. 2. Tachycardia and apnea are not present. 3. Bradycardia and apnea are not present. 4. The baby would be ashen and have rapid tachypnea.

16. An 18 month old with known Tetralogy of Fallot is seen squatting after running in the hospital playroom. The nurse knows the child is: 1. Having a rapid drop in the amount of oxygen in the blood and is short of breath. 2. Having a bowel movement. 3. About to faint because of the lack of oxygen in his blood. 4. Mimicking others in the playroom.

ANS: 1 Feedback 1. Squatting allows the child to take breaths and gain oxygen. 2. The child is attempting to inhale oxygen quickly. 3. The child is maintaining a position to gain oxygen in order to prevent fainting. 4. The child is squatting in order to take deep breaths and gain oxygen after the playing.

63. Which of the following symptoms would an 18-month-old child exhibit when experiencing left-sided heart failure? 1. Tachypnea 2. Tachycardia 3. Syncope 4. Nausea and vomiting

ANS: 1 Feedback 1. Tachypnea is caused by the pooling of secretions and increased incidence of congestive heart disease. 2. Tachycardia is a late sign of left-sided heart failure. 3. Syncope is not a sign of left-sided heart failure. 4. Nausea and vomiting are not symptoms of left-sided heart failure.

3. In fetal development, the _________ is open to allow blood to flow in the heart. 1. Patent ductus arteriosus 2. Pulmonic valve 3. Aortic valve 4. Bicuspid valve

ANS: 1 Feedback 1. The patient ductus arteriosus is the opening in the heart that allows blood to flow in the heart. 2. The pulmonic valve is not the opening. 3. The aortic valve is open before and after birth. 4. The bicuspid valve is open before and after birth.

52. In educating the caregivers about the administration of Digoxin (Lanoxin) to their child, the nurse instructs the caregivers to: 1. Notify the physician of weight gain of two pounds or more per day. 2. Administer the medication at any set time during the day, every day. 3. Administer the medication two hours before meals and one hour after meals. 4. Hold the Digoxin if the heart rate is <60/minute or >120/minute

ANS: 1 Feedback 1. The physician should be notified of weight gain, which can place extra strain on the heart and may indicate congestive heart failure. 2. The Digoxin should be administered in the morning. 3. The medication should be given one hour before meals and two hours after meals. 4. The medication should be held for a heart rate <60/minute and >100/minute.

18. A newborn with a diagnosis of Tetrology of Fallot is demonstrating heart failure. The doctor orders a prostaglandin E1 drip. The nurse knows this is used to: 1. Maintain blood flow to the lungs. 2. Open the patent foramen ovale. 3. Increase blood flow to the extremities. 4. Decrease resistance of blood flow through the heart.

ANS: 1 Feedback 1. The prostaglandin will allow the Patent Ductus Arteriosis to have patency. 2. The patent foramen ovale is already open when a Tetrology of Fallot is present. 3. Blood flow to the heart and lungs rather than the extremities is the priority. 4. Because of the holes in the heart, the resistance is already low.

24. A common bacteria that causes scarring on the aortic valve is: 1. Group A streptococcus bacteria. 2. Group B streptococcus bacteria. 3. Staphylococcus aureus. 4. E. coli.

ANS: 1 Feedback 1. This common bacteria causes scarring on the aortic valve. 2. This is not a common bacteria in the heart. 3. Common in endocarditis, but not a common cause of scarring on the aortic valve. 4. Usually attacks the GI tract

5. A nurse is discussing heart disorders that cause the mixing of oxygenated and deoxygenated blood with a new nurse. The nurse should explain that the mixed disorders consist of all of the following except: 1. Tetralogy of Fallot. 2. Hypoplastic left heart. 3. Truncus afteriosus. 4. Transposition of the great vessels.

ANS: 1 Feedback 1. This is an obstructive disorder. 2. A mixed blood heart defect 3. A mixed blood heart defect 4. A mixed blood heart defect

66. A 12 year old is suspected of having rheumatic heart disease. What factors would indicate that this child has this disease? 1. The onset of symptoms occurs around 20 days after streptococcus throat infection or scarlet fever. 2. The child lives in the most common area of the western United States. 3. The disease produces lesions in the mouth and oropharynx. 4. The disease results in damage to the peripheral sensory nerves.

ANS: 1 Feedback 1. This is the normal course of this disease. 2. Most cases occur in the northeastern part of the United States. 3. The disease produces polyarthritis, carditis, subcu nodules, and a low-grade fever. 4. The disease produces polyarthritis, carditis, St. Vitus Dance, and a low-grade fever.

68. Identify the common nursing practices for a newborn with a known patent ductus arteriosus diagnosis. Select all that apply. 1. Maintain intake and output 2. Daily weight checks 3. Monitor feeding tolerance 4. Weekly weight checks 5. Monitor output only

ANS: 1, 2, 3 Feedback 1. Fluid balance will indicate if the newborns body is able to excrete fluid. 2. Daily weight checks will indicate the cardiac performance. 3. Feeding tolerance will indicate the level of energy needed to digest food. 4. Weight checks need to be monitored closer because the newborn could go into fluid overload if only checked once a week. 5. Intake monitoring is needed so a measure can be made of the amount of fluid the body is retaining and voiding.

Parents have been given the news that their unborn baby will be born with Tetralogy of Fallot. The parents are asking the nurse what the defects will consist of with this diagnosis. The nurse knows the defects are: (Select all that apply.) 1. VSD 2. Pulmonary stenosis 3. Overriding aorta 4. Thickening of the left ventricle 5. Patent Foramen Ovale

ANS: 1, 2, 3 Feedback 1. Present in Tetralogy of Fallot 2. Present in Tetralogy of Fallot 3. Present in Tetralogy of Fallot 4. Thickening of the right ventricle occurs because of the restrictive blood flow. 5. The patent foramen ovale is not present in Tetralogy of Fallot.

22. A nurse is assessing a child with coarctation of the aorta. The nurse knows she will find all the following except: 1. Decreased femoral pulses. 2. A report of chest pain. 3. Shortness of breath. 4. Poor growth.

ANS: 2 Feedback 1. The decreased blood flow to the lower extremities is noted in coarctation by assessing the pulses. 2. Coarctation can be asymptomatic. 3. Shortness of breath may be noted when exerting the body. 4. The child will have a slower growth rate than peers.

74. The nurse is aware that the risk factors for the development of congenital heart disease include: (Select all that apply.) 1. Family history of congenital heart disease or genetic disorders. 2. Exposure to alcohol, cocaine, or phenytoin. 3. Exposure to teratogens. 4. Weight at birth. 5. Infants of diabetic mothers.

ANS: 1, 2, 3, 5 1. A family history of CHD or genetic defects significantly increases the chances of an infant being born with a CHD. 2. Alcohol, cocaine, or other drugs act as teratogens to the developing fetus. 3. A teratogen results in congenital defects, including heart disease. 4. Weight at birth has no influence on the development of CHD. 5. Infants of diabetic mothers have a higher incidence of developing CHD.

71. Identify common characteristics in an assessment of a child with a truncus arteriosus heart defect. Select all that apply. 1. Cyanosis 2. Narrow pulse pressures 3. Grunting and retractions while breathing 4. Diaphoresis 5. Bradycardic

ANS: 1, 3, 4 Feedback 1. Cyanosis is present because of an incompetent truncal valve. 2. Pulse pressures widen with the disorder. 3. These reactions are present because of the lack of blood being oxygenated and the vascular resistance on the vessel going over the right and left ventricles. 4. Diaphoresis is present because of the increased workload on the heart and also due to vascular resistance. 5. The heart rate is usually within normal limits.

The nurse in a pediatric office is aware that certain factors may be indicators of heart disease in children. Which children does the nurse recognize with manifestations related to heart disease? Select all that apply. 1. The newborn with dysmorphic facial features 2. The school-age patient with slow capillary refill 3. Identification of scoliosis in a new adolescent patient 4. An infant who is unable to meet developmental milestones 5. A toddler with clubbing and erythema of the fingers and toes

ANS: 1, 3, 4, 5 1. This is correct. Dysmorphic facial features can be identified at any age and can be indicative of heart disease. 2. This is incorrect. Slow capillary refill can be from multiple causes, such as poor circulation, low oxygenation, anemia, exposure to cold, and/or stress. The finding alone does not cause the nurse to recognize a manifestation of heart disease. 3. This is correct. When assessing a new patient, the nurse recognizes that scoliosis is common in adolescents with congenital heart disease. The nurse will perform additional assessment. 4. This is correct. When an infant is unable to meet developmental milestones, the nurse recognizes that children with congenital heart defects are more likely to have developmental disabilities. 5. This is correct. Clubbing and erythema in fingers and toes may result from longstanding cyanosis due to increased formation and enlargement of the capillaries in the periphery to improve circulation. This is a manifestation of heart disease in a toddler.

67. A child has been struck by a car and has perfuse bleeding from the left leg. The nurse at the scene is assessing the patient. Identify the signs and symptoms the patient will have if hypovolemic shock is occurring. Select all that apply. 1. Sweating 2. Ruddy skin 3. Bounding pulses in the lower extremities 4. A rapid respiratory rate 5. A rapid heart rate

ANS: 1, 4, 5 Feedback 1. Will be present if the child is in hypovolemic shock 2. The skin will be pale. 3. The pulse will be weak in the extremities because the body is trying to perfuse vital organs only. 4. The respiratory rate will be increased due to the ineffective pumping by the heart to the lungs. 5. The heart rate will be increased because the heart is trying to push the limited amount of blood available to the body.

73. Cardiovascular disease in children can be classified according to: (Select all that apply.) 1. Increased or decreased pulmonary blood flow. 2. Acyanotic flow. 3. Obstructive flow. 4. Acquired. 5. Mixed blood flow.

ANS: 1,3,4,5 Feedback 1. Nurses know that one of the classifications of heart disease is increased or decreased pulmonary blood flow. 2. This is a current incorrect classification of cardiovascular disease in children. 3. Obstructive flow is a current classification of cardiovascular disease. 4. Acquired cardiovascular disease is accurate. 5. Mixed blood flow is accurate for cardiovascular disease.

28. An 18-pound, 12-month-old child with a known diagnosis of Tetralogy of Fallot with pulmonary atresia has been ordered to receive a calorie intake of 150 calories/kg per day. The total caloric intake prescribed is: 1. 1528 2. 1227 3. 2700 4. None of the above

ANS: 2 18/2.2= 8.18 kg 8.18 kg x 150 calories= 1227 calories per day Feedback 1. Too many calories per day 2. Adequate calories per day 3. Too many calories per day 4. One answer is correct.

21. A child with a known diagnosis of coarctation of the aorta will have an increase in: 1. Blood pressure in the lower extremities. 2. Blood pressure in the upper extremities. 3. Blood pressure in the heart. 4. Blood pressure in the aortic arch.

ANS: 2 Feedback 1. Because of the low flow of blood, the lower extremities will have a lower flow of blood. 2. The upper extremities will demonstrate an increase in blood pressure. 3. The blood pressure affects the extremities. 4. The blood pressure affects the extremities.

44. A nursing student is assessing children at a well-child clinic. The nursing student should know that routine monitoring of blood pressure should begin at what age? 1. 4 years of age 2. 3 years of age 3. 10 years of age 4. 12 years of age

ANS: 2 Feedback 1. Screening should be done prior to this age. 2. Screening should begin at this age. 3. Screening should be done prior to this age. 4. Screening should be done prior to this age.

8. Identify the child that is demonstrating acrocyanosis. 1. A newborn shows slow capillary refill. 2. A newborns hands are blue following delivery. 3. A newborn with a fever has red hands. 4. A newborn with a lack of oxygen has blue hands.

ANS: 2 Feedback 1. Slow capillary refill can be demonstrated with acrocyanosis, but is not the cause. 2. The vasoconstriction after birth is a cause of acrocyanosis 3. A newborn with a fever will not demonstrate acrocyanosis. 4. Lack of oxygen will cause central cyanosis.

51. The primary mechanism responsible for the closure of fetal ducts following birth is: 1. Suctioning of the nose and mouth. 2. The first breath of the infant. 3. High carbon dioxide levels. 4. Stimulation of the infant.

ANS: 2 Feedback 1. Suctioning of the nose and mouth do not assist in closing the fetal ducts, but instead result in hypoxia. 2. The first breath by the infant results in higher oxygen levels and relaxation of the pulmonary artery. In turn, the pressure gradients within the heart change and force the fetal ducts to close. 3. High carbon dioxide levels would result in pulmonary vasoconstriction, which would not close the fetal ducts. 4. Stimulation of the infant may assist the infant in taking his/her first breath, but it is the first breath that assists in closing the fetal ducts.

9. A newborn is born with patent ductus arteriosus. If the patent ductus arteriosus does not close during this time, the newborn will exhibit: 1. Narrowing pulse pressures. 2. Widening pulse pressures. 3. A decreased heart rate. 4. Quick capillary refill.

ANS: 2 Feedback 1. The pulse pressures widen because of the low pressure gradient within the heart. 2. The widening occurs because of the low pressure gradient within the heart. 3. The heart rate will increase because of not perfusing to the lungs. 4. The capillary refill will be sluggish because the oxygenated blood is not going out to the rest of the body.

31. Identify the heart condition that will cause profound cyanosis, shock, and congestive heart failure if the PDA closes. 1. Truncus arteriosus 2. Total anomalous pulmonary venous return 3. Transposition of the greater vessels 4. ASD

ANS: 2 Feedback 1. The truncal valve remains open, so these signs and symptoms will not be noted. 2. The PDA must remain open to allow the oxygen from the pulmonary veins to move to the left atrium. 3. Transposition causes cyanosis, but does not lead to shock. 4. An ASD does not lead to shock.

1. The right ventricle is responsible for: 1. Pumping blood to the left atrium. 2. Pumping deoxygenated blood to the lungs. 3. Pumping oxygenated blood to the body. 4. Returning oxygenated blood from the lungs.

ANS: 2 Feedback 1. The ventricle pumps blood to the lungs via the pulmonary artery. 2. The right ventricle pumps blood to the lungs to become oxygenated. 3. The left ventricle pumps oxygenated blood to the body. 4. The pulmonary artery returns the oxygenated blood from the lungs.

55. In a newborn nursery, a nurse indicates she hears a soft murmur in one of the newborns. After obtaining blood pressures on all four extremities, she finds that the blood pressure is higher in the right arm than the right leg. The nurse knows this can indicate: 1. Nothing, as this is a normal finding. 2. Coarctation of the aorta. 3. Ventricular septal defect. 4. Shock due to poor perfusion in the lower extremities.

ANS: 2 Feedback 1. This is not a normal finding. 2. This is a predominant sign of COA due to a narrowing of the aortic arch after the innervation to the upper extremities, thus resulting in a lower blood pressure in the lower extremities. 3. This is not a sign of VSD. 4. Shock would indicate a low blood pressure in all extremities.

26. Pulmonary stenosis causes an increased workload on: 1. The left atrium. 2. The right ventricle. 3. The left ventricle. 4. The right atrium.

ANS: 2 Feedback 1. This type of stenosis occurs in the right ventricle. 2. The right ventricle has an increased workload because of the lack of blood being pushed out of the heart. 3. The left ventricle does not have the workload because it is pushing oxygenated blood to the body. 4. The right atrium is filling with blood and does not have the resistance to push it to the lungs, thus decreasing the workload.

2. The heart valve that connects the left atria and the left ventricle is: 1. The tricuspid valve. 2. The bicuspid valve. 3. The pulmonic valve. 4. The aortic valve.

ANS: 2 Feedback 1. This valve connects the right atria to the right ventricle. 2. This valve connects the left atria and the left ventricle. 3. This valve connects the right ventricle and the pulmonary artery. 4. This valve connects the left ventricle and the ascending aorta.

70. Identify the characteristics of a patient with Tetralogy of Fallot with pulmonary atresia. Select all that apply. 1. Ventricle defects 2. Anal anomalies 3. Transesophageal anomalies 4. Atrial anomalies 5. Acrocyanosis

ANS: 2, 3 Feedback 1. The defects are not in the ventricles. 2. The defects of the heart are usually associated with other defects, primarily in the anal and transesophageal regions. 3. The defects of the heart are usually associated with other defects, primarily in the anal and transesophageal regions. 4. Atrial anomalies are not noted in a patient with these defects. Cyanosis is noted in the patient.

72. A nurse assessing a 6 year old with cardiomyopathy would anticipate which of the following signs in his assessment? Select all that apply. 1. A murmur with a thrill 2. Fatigue when eating 3. Dysrhythmia after playing with toy cars 4. Sweating while sitting in bed watching cartoons 5. Dizziness when standing at the bedside

ANS: 2, 3, 5 Feedback 1. The murmur will be a gallop. 2. Fatigue occurs with many activities, including eating. 3. Dysrhythmias can occur at any time. 4. Sweating occurs when eating, not during quiet times. 5. Dizziness while standing or changing positions is common.

The nurse is preparing an 8-year-old patient for a cardiac catheterization. Which intervention will the nurse initiate immediately postprocedure? 1. Observe for signs and symptoms of infection. 2. Hold food and fluids until gag reflex returns. 3. Keep the involved extremity straight for 4 to 6 hours. 4. Notify physician if green or yellow drainage is noted.

ANS: 3 1 This is incorrect. It is not likely for the patient to develop an infection immediately following a cardiac catheterization. 2 This is incorrect. The patient will receive a sedative before the procedure to reduce anxiety; a local anesthetic is used at the puncture site. Neither intervention is likely to cause an absent or depressed gag reflex. 3 This is correct. Immediately after the procedure the nurse will assure that the limb used for cardiac catheterization is kept straight with no movement for 4 to 6 hours. The child should be positioned flat on the back; a sandbag may be used on the extremity. All precautions are to prevent bleeding from the puncture site. 4 This is incorrect. Immediately after a cardiac catheterization, the nurse will not expect to see yellow or green drainage, which is indicative of an infection. The nurse will include this intervention in parent teaching.

10. A nurse is assessing a newborn with a known patent ductus arteriosus defect of the heart. The mother asks when she can start breastfeeding her infant. The best explanation by the nurse would be: 1. The newborn will need to have the defect repaired before oral feedings can start. 2. The newborn will need to have extensive rest time between feedings, so plan on breastfeeding one time, then we will give a nasogastric feeding the next time. 3. The nursing staff will monitor the newborn during feedings because she may sweat and have increased difficulty breathing. 4. The newborn should have no issues while breastfeeding.

ANS: 3 Feedback 1. Feedings can begin before the repair if the newborn does not demonstrate difficulties in cardiac and respiratory status. 2. Rest time will be needed before and after feedings, but there is no need to alternate between breast and nasogastic feedings. 3. Monitoring will enable the nurse to assess when the newborn needs a break in feedings. 4. The newborn will have some issues with feedings because of the heart issues.

48. The nurse has been caring for a child on the pediatric floor and notes that the childs PMI has shifted to the midline. The nurse is aware that this can indicate: 1. Poor inspiratory effort by the child. 2. Pneumonia in the left lung. 3. Pneumothorax. 4. Neurological integrity has been compromised.

ANS: 3 Feedback 1. Point of maximum impulse is the hearts sounds. 2. Pneumonia may mask the hearts sounds, but should not indicate a shift in the PMI. 3. Air is very heavy and will shift the heart to the midline of the sternum, resulting in a shift of the point of maximum impulse. 4. PMI does not refer to any neurological alterations.

46. The nurse is caring for a 4-year-old child who comes to the pediatricians office with cold symptoms and appears pale. Vital signs are obtained and the childs blood pressure is 68/42 mmHg, a pulse of 98, and respirations of 20. The nurse is aware that: 1. The vital signs are normal in a child this age with cold symptoms. 2. The respiratory rate is elevated and should be communicated to the physician immediately. 3. The systolic blood pressure is too low and should be communicated to the physician. 4. The pulse is too rapid and should be communicated to the physician

ANS: 3 Feedback 1. The blood pressure is too low. 2. The respiratory rate is consistent with a 4 year old with cold symptoms. 3. The systolic blood pressure is 70 mmHg + (two times the age in years) or 78 mmHg. 4. The pulse is normal for a 4-year-old child.

The nurse knows that Kawasaki disease is: 1. Contagious, especially among children in close settings, such as day-care institutions. 2. Mainly due to a cascading process. 3. Diagnosed as an exclusion process. 4. Most prevalent when the signs and symptoms have been present for less than three days.

ANS: 3 Feedback 1. The disease is not contagious among children, but is seen in certain geographic areas during certain times of the year. 2. This disease is thought to be caused by an infectious organism. 3. Kawasaki disease is diagnosed as a process of exclusion. 4. Symptoms of red lips and a strawberry tongue usually occur following a fever after 5 days.

34. A doctor orders a blood-thinning medication for a 2 year old with known cardiomyopathy. The type of cardiomyopathy that may require blood-thinning medications would be: 1. Hypertrophic cardiomyopathy. 2. Restrictive cardiomyopathy. 3. Dilated cardiomyopathy. 4. Chronic cardiomyopathy.

ANS: 3 Feedback 1. The heart enlarges with hypertrophic cardiomyopathy and has leaky valves, but blood flows through at an adequate rate, decreasing the risk for clotting. 2. Restrictive cardiomyopathy makes the heart rigid, so blood does not have time to pool to create clots. 3. Dilated cardiomyopathy has slow-moving blood because the heart is not effectively pumping blood out of the chambers, increasing clot formation. 4. Chronic is not a type of cardiomyopathy.

4. A nurse is assessing a 4-year-old child with a known atrial septal defect. Identify what the nurse should expect to see in the assessment. 1. An increased heart rate 2. An increased respiratory rate 3. Lower oxygen saturation 4. A lower heart rate

ANS: 3 Feedback 1. The heart rate will be a normal rate for a 4-year-old child. 2. The respiratory rate will be a normal rate for a 4-year-old child. 3. Oxygen saturations are expected to be lower because of the leakage caused by the defect. 4. The heart rate will be a normal rate for a 4-year-old child.

40. A 16 year old who is in the ER after an automobile accident is exhibiting signs of shock. The assessment indicates that the teen has a steering wheel bruise mark on his chest. The teen is exhibiting signs of cardiogenic shock. The nurse working with the trauma team knows the patient: 1. Has had a large loss of blood, which causes cardiogenic shock. 2. Has overwhelming sepsis from the accident, which is causing the cardiogenic shock. 3. The bruising to the chest could have caused damage to the heart, causing it to not be an effective pump, which results in cardiogenic shock. 4. The trauma to the chest has caused capillary leaking, leading to cardiogenic shock.

ANS: 3 Feedback 1. The large loss of blood volume depletes the patient, causing hypovolemic shock. 2. Overwhelming sepsis causes septic shock. 3. The bruising indicates that the chest and heart could have damaged the heart, causing cardiogenic shock. 4. The trauma can cause bruising to the heart muscle, but the capillary leaking will not cause cardiogenic shock.

30. A newborn with transposition of the grater arteries has been prescribed Captopril. The mother asks why the child needs to be on such a medication. The best response by the nurse would be: 1. Your child needs the beta-blocker to decrease the angiotensin in the body. 2. The medication will help decrease the shortness-of-breath episodes. 3. The medication is an antihypertensive that helps relax the coronary arteries. 4. Your child is not responding to the prostaglandin E drip, so the Captopril needs to be started to decrease the blood pressure.

ANS: 3 Feedback 1. The medication is an ACE inhibitor. 2. The medication will not alter the respiratory rate. 3. The medication is an antihypertensive and relaxes the coronary arteries to help decrease blood pressure. 4. A prostaglandin E drip is not a long-term solution.

36. A physicians assistant has ordered Adderall for a 14-year-old boy with ADHD and a history of cardiomyopathy. The nurse should question the order because: 1. The dosing will need to be high because of the cardiac history and the bodys ability to quickly metabolize the medication. 2. Adderall is not effective for children over the age of 12. 3. ADHD medications should be avoided because they can cause sudden death in children with a history of cardiomyopathy. 4. The ADHD medication will not reach a therapeutic level because of the negative interactions with cardiac medications.

ANS: 3 Feedback 1. The medication should not be given with a history of cardiomyopathy. 2. Adderall can be effective in children over the age of 12. The issue is the past history of cardiomyopathy. 3. Sudden cardiac arrest can occur because of the history of cardiomyopathy. 4. Cardiomyopathy and ADHD medications cause an increased risk for sudden death.

62. A child with congenital heart disease is more prone to develop which complication? 1. Urinary disturbances 2. Bleeding tendencies 3. Repeated abdominal distention 4. Repeated respiratory infections

ANS: 4 Feedback 1. Congenital heart disease does not cause urinary disturbances. 2. Congenital heart disease does not result in bleeding tendencies. 3. Congenital heart disease does not result in repeated abdominal distention. 4. Congenital heart disease does predispose the child to repeated respiratory infections due to pulmonary congestion.

38. A mother calls the nursing clinic to report that her 13-year-old daughter has been using tampons for the last two days and now has a high fever. She has developed a rash over her entire body in the last hour. The mother asks if she should make a clinic appointment. The best response by the nurse would be: 1. Your daughter probably has a virus, so provide her with plenty of fluids. They symptoms should subside in a few days. 2. If you feel your daughter should be seen, then I will transfer you to the front desk to make an appointment. 3. Since your daughter is using tampons and has a high fever, she needs to be seen soon. Let me make an appointment for you as soon as possible today. 4. You daughter has toxic shock syndrome and should be seen right away.

ANS: 3 Feedback 1. The symptoms are similar to those of toxic shock syndrome, and the teen should be seen immediately. 2. Passing the patient to someone else for an appointment increases the chance of the parent hanging up the phone. The nurse should take responsibility in this situation. 3. The mother is reporting signs of toxic shock syndrome and should be seen immediately for confirmation of the syndrome. 4. A full assessment needs to be made by the doctor to confirm a medical diagnosis.

13. A nurse knows that the mother understands the discharge instructions for an 8 month old that had a cardiac catheterization for an ASD when the mother states: 1. We will need to schedule weekly visits to make sure the heart is functioning properly. 2. The surgical site will require us to keep our child in isolation at home. 3. We will need to monitor the insertion site for drainage and temperature changes. 4. My child will not have any more issues with arrhythmias

ANS: 3 Feedback 1. The visits will need to be prescribed by the doctor. Visits usually take place three months to one year after the procedure area heals. 2. The child will have a short recovery time and does not need to be in isolation. 3. The insertion site must be monitored for signs and symptoms of infection and bleeding. 4. The child may have arrhythmias his/her entire life.

33. A mother arrives at a birth care center in full labor with no prenatal history. The mother states she has a form of mental illness that requires her to take lithium daily. The nurse knows that lithium use during pregnancy can cause which type of heart defect? 1. Hypoplastic left heart 2. Truncus arteriosus 3. An Epstein anomaly 4. Cardiomyopathy

ANS: 3 Feedback 1. There is no known reason for the development of a hypoplastic left heart. 2. Truncus arteriosus is not linked to use of lithium during pregnancy. 3. Maternal use of lithium has a strong correlation with an Epstein anomaly, which causes the tricuspid valve to be in the right ventricle, along with an enlarged right atrium and cardiomegaly. 4. Cardiomegaly occurs in an Epstein anomaly, but is not the direct defect.

65. An 8 year old is receiving Digoxin (Lanoxin) for congestive heart failure. The nurse provides the caregiver with the following education, indicating that the medication is effective when: 1. The child is happy and active. 2. The child is pink and breathing easily. 3. The childs urine output increases. 4. The child has an improvement in his/her sleeping at night.

ANS: 3 Feedback 1. This is not an indicator of effective drug mechanisms. 2. This is not an indicator of effective drug mechanisms. 3. This indicates improved cardiac output, resulting in improved urine output. 4. This is not an indicator of effective drug mechanisms.

75. In educating an adolescent and his/her caregivers on the modifiable risk factors related to the hypertension, the nurse would include information related to: (Select all that apply.) 1. Age. 2. Race or ethnicity. 3. Hyperlipidemia. 4. Exercise levels. 5. Weight management.

ANS: 3, 4, 5 Feedback 1. Age is not a modifiable risk factor. 2. Race and ethnicity are not modifiable risk factors. 3. Hyperlipidemia through diet education is a modifiable risk factor. 4. Exercise levels are modifiable risk factors that can reduce hypertension. 5. Weight management is a modifiable risk factor that can reduce hypertension.

35. A 12 year old has been admitted to the pediatric floor for cardiomyopathy. During the acute phase, the nurse should: 1. Have defibrillation equipment present for tachycardic situations. 2. Monitor for crackles in the lungs. 3. Provide string cheese for a snack. 4. All of the above would be appropriate nursing actions during the acute phase.

ANS: 4 Feedback 1. A defibrillator should be present if the child is having tachycardic instances. 2. Crackles in the lungs will indicate if excess fluid is present. 3. String cheese will provide the carnitine needed in the childs diet. 4. A defibrillator should be present if the child is having tachycardic instances. Crackles in the lungs will indicate if excess fluid is present. String cheese will provide the carnitine needed in the childs diet.

47. The nurse is aware that utilizing the proper size cuff is important for an accurate assessment of the blood pressure. For this reason, the nurse chooses a cuff that: 1. Is somewhat smaller than the circumference of the childs left arm. 2. Is somewhat larger than the circumference of the childs right arm. 3. Fits snugly, but not too tight around either arm. 4. The cuff should fit 40 percent of the upper arm between the acromion process and the elbow.

ANS: 4 Feedback 1. A smaller size cuff will result in a higher blood pressure. 2. A larger size cuff will result in a lower blood pressure. 3. This fit will not give an accurate measurement for blood pressure. 4. This is the correct method of measuring the size of a blood pressure cuff.

14. The most common heart defect is: 1. ASD. 2. Patent Foramen Ovale (PFO). 3. Hypertrophic left heart syndrome. 4. Ventricular Septal Defect (VSD)

ANS: 4 Feedback 1. An ASD is not a common heart defect. Usually see closure within a few hours after birth. 2. The PFO is common in premature neonates. Not common in full-term neonates thus is not the most common defect. 3. A rare heart congenital heart defect. 4. The most common defect. The defect can be medically managed with minimal intervention.

23. When assessing a child with coarctation of the aorta, the nurse should perform assessments to all of the follow areas except: 1. Blood pressure in all of the extremities. 2. Monitoring the perfusion to the extremities. 3. Pre-assessment for Digoxin before giving the prescribed doses. 4. Assessing the narrowing pulse pressures.

ANS: 4 Feedback 1. Blood pressure will greatly differ in the upper extremities versus the lower extremities. 2. Perfusion to the lower extremities will be worse than in the upper extremities. 3. Digoxin should always have a pre-assessment of an apical pulse for one minute. 4. Pulse pressures do not give adequate data for a child with coarctation of the aorta.

42. The nurse assessing a child with known right-sided heart failure will expect to find which of the following symptoms? 1. Crackles in the lungs 2. Increased edema in the face 3. A galloping rhythm 4. All of the above are symptoms of right-sided heart failure.

ANS: 4 Feedback 1. Crackles may be present because of the pooling of blood in the lungs. 2. The edema occurs because of the lack of venous return. 3. A galloping rhythm will be present. 4. Crackles may be present because of the pooling of blood in the lungs. The edema occurs because of the lack of venous return. A galloping rhythm will be present.

25. Identify a common characteristic of pulmonary atresia. 1. Acrocyanosis at birth 2. Weight gain is similar to that of well newborns. 3. A murmur will be noted with an ASD or a PDA. 4. Severe cyanosis will be present at birth.

ANS: 4 Feedback 1. Cyanosis will be noted at birth. 2. Weight gain will be slower than peers. 3. A murmur will not be present with the ASD and the PDA. 4. Cyanosis will be noted at birth because of the fistula not allowing blood to go to the lungs in order to oxygenate.

27. The nurse is assessing a baby with a known diagnosis of Tetralogy of Fallot with pulmonary atresia. The nurse should expect which of the following in her assessment of the baby? 1. A VSD murmur 2. Normal growth and development 3. Decreased peripheral pulses 4. Profound cyanosis

ANS: 4 Feedback 1. PDA murmur is common, not a VSD. 2. Growth and development will be delayed. 3. Peripheral pulses will be bounding. 4. Cyanosis will be present due to where the holes in the heart are located.

37. A nurse is preparing to administer Digoxin to a 4 year old. The nurse should: 1. Administer the medication and check the blood pressure one hour later. 2. Give the medication with food. 3. Take the apical pulse for 30 seconds prior to giving the medication. 4. Note the rate, rhythm, and quality of the heart prior to giving the medication.

ANS: 4 Feedback 1. The baseline blood pressure is needed prior to the administration of the medication. 2. The medication should be taken on an empty stomach. 3. The apical pulse should be taken for 60 seconds. 4. A baseline of the rate, rhythm, and quality is needed.

64. A 7-year-old child is discharged following a cardiac catheterization yesterday. The nurse should instruct the mother to: 1. Allow the child to take a tub bath today. 2. Allow the child to resume normal physical activities, including sports. 3. Limit diet within the first few days to prevent straining to stool. 4. Observe for signs and symptoms of infection for the first few days.

ANS: 4 Feedback 1. The child can take showers, not baths, for the first several days. 2. The child should not lift anything heavy and should not resume physical activity for two weeks. 3. There is no limit on the diet of the child. 4. The child should be monitored for signs and symptoms of infection.

29. When a child with transposition of the greater vessels is assessed, the nurse should anticipate that: 1. The lower extremities will have bounding pulses. 2. Cyanosis will be noted when the child is sleeping on his/her back. 3. An ASD murmur will be present. 4. The oxygen saturations in the upper extremities will be lower than the oxygen saturations in the lower extremities.

ANS: 4 Feedback 1. The extremities will have weak pulses and low oxygen saturations. 2. Cyanosis will be present when crying. 3. The child will have a PDA. 4. The difference in oxygenation is caused by the aorta receiving deoxygenated blood.

17. Jaycob, a 24-month-old child with a diagnosis of RSV and Tetrology of Fallot, is being cared for by a new nurse. Jaycob is agitated and is crying when care is provided. He begins to drop his oxygen saturations below an acceptable range. The nurse should: 1. Have the parent console the child. 2. Feed the child. 3. Call the doctor for an order for a sedative. 4. Cluster the care and allow the child time to rest.

ANS: 4 Feedback 1. The question does not state that the parent is available. 2. Feeding the child may cause oxygen saturations to drop lower. 3. All attempts at consoling the child should first be provided before asking for a sedative. 4. Clustering cares will allow for time to rest and result in less stress for the child.

12. A nurse should question which of the following orders for a child with a known ASD? 1. A transesophogeal ultrasound 2. Digoxin 3. EKG 4. All are appropriate orders for a child with an ASD.

ANS: 4 Feedback 1. The ultrasound allows for the entire heart to be viewed in order to find the exact location of the ASD. 2. Digoxin will help with the cardiac output. 3. An EKG will help identify heart function. 4. All the orders would be appropriate for the child because each aids in gathering all the information needed for proper treatment of the defect

54. Children who have defects with decreased pulmonary blood flow exhibit which of the following common symptoms? 1. Nausea and vomiting 2. Weight gain 3. Tachypnea, bradycardia, and diaphoresis 4. Cyanosis, tachypnea, and polycythemia

ANS: 4 Feedback 1. This is not a symptom of decreased pulmonary blood flow. 2. This is more a symptom of congestive heart failure. 3. Tachypnea and diaphoresis are correct, but bradycardia, or slow heart rate, is not a symptom of decreased pulmonary blood flow. 4. Cyanosis and tachypnea are symptoms of decreased pulmonary blood flow, which decreases the bodys ability to oxygenate the blood. Polycythemia occurs due to a chronic decrease in oxygenation. The body attempts to produce more red blood cells to carry additional oxygen.

53. In caring for a patient with Tetralogy of Fallot, the nurse understands that during a tet spell, the following nursing intervention will reduce the symptoms of this disorder. 1. Increase the oxygen level of the child 2. Set the infant in an upright position 3. Bounce or pat the child until they are consoled. 4. Place infant in a knee-chest position

ANS: 4 Feedback 1. While this may improve oxygenation, it will not alleviate the symptoms of the disorder. 2. This will have no effect on the clamping down of the vasculature. 3. Although there is an emotional component to the tet spell, this will not alleviate the symptoms of the disorder. 4. Placing the child in a knee-chest position will aid in returning the blood flow back to the heart and improving the cyanosis. Flexing the legs decreases venous flow from the lower extremities and decreases shunting through the ventricular septal defect. It increases vascular resistance and increases pressure in the left ventricle.