PEDS Chapter 19 CV System

Involuntary limb movement Macular rash on trunk Tender swollen joints

The nurse is assessing a child with suspected rheumatic fever. What assessment findings are consistent with the disease process? Select all that apply.

Increase hours of sleep. Avoid any smoking. Exercise on a daily basis. Maintain a healthy weight.

The nurse is educating an adolescent female at risk for hypertension. Which interventions will the nurse recommend? Select all that apply.

penicillin corticosteroids nonsteroidal anti-inflammatory drugs

The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatment(s) would the nurse expect to administer if prescribed? Select all that apply.

High-frequency sound waves are directed toward the heart

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. What should the nurse mention in explaining how this diagnostic test works?

presence of either two major criteria or one major plus two minor criteria.

How is acute rheumatic heart fever diagnosed with the Jones Criteria?

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

A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education?

Feeding problems

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

nausea and vomiting

A nurse is administering digoxin to a 3-year-old child. What would be a reason to hold the dose of digoxin?

lower extremities

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?

Administer indomethacin. Give prostaglandin E1 (PGE1).

The nurse is caring for a child with aortic stenosis. Which health care provider prescription(s) will the nurse question? Select all that apply.

Administer oxygen

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant?

Administer oxygen.

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant?

Provide supplemental oxygen. Give parenteral morphine sulfate.

A nurse is developing the plan of care for a 7-year-old child diagnosed with congenital heart disease and a history of hypercyanotic spells. Which interventions would the nurse include in the child's plan of care to address these spells? Select all that apply.

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

A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which statement should the nurse make to the girl's mother in response to these findings?

bounding pulse

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note?

Assessing for the presence of femoral pulses

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition?

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

Parents are told that their infant has a heart defect with a left-to-right shunt. What is the best way for the nurse to explain this type of shunting to the parents?

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

Parents are told their infant has a hypoplastic left heart. How would the nurse explain this condition to the family?

To build the blood levels to a therapeutic level

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

how and when to use the event button

The nurse is caring for a child with suspected heart arrhythmia. The child will wear an ambulatory electrocardiograph monitor for 24 hours. What is the most important instruction for the nurse to give the child and parent during monitoring?

Carditis Migratory polyarthritis Subcutaneous nodules Erythema marginatum Sydenham chorea

Major criteria for Modified Jones Criteria

Polyarthralgia Elevated erythrocyte sedimentation rate or C-reactive protein Prolonged PR interval (unless carditis is a major criterion)

Minor criteria for the Modified Jones Criteria

The child's right foot is cool with a pulse assessed only with the use of a Doppler. The child has a temperature of 102.4° F (39.1° C). The child is reporting nausea

The child has returned to the nurse's unit following a cardiac catheterization. The insertion site is located at the right groin. Peripheral pulses were easily palpated in bilateral lower extremities prior to the procedure. Which finding should be reported to the child's physician? Select all that apply.

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

The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements? Select all that apply.

Assess the dressing at the insertion site.

The nurse is caring for a child admitted to the hospital for a cardiac catheterization. Upon return from the cardiac catheterization, which nursing action is priority?

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

The nurse is caring for a child who has been experiencing hypercyanotic episodes. Which treatments will be effective in managing them? Select all that apply.

magnetic resonance imaging (MRI) echocardiogram cardiac catheterization

The health care provider suspects an infant may have a ventricular septal defect. The parents ask the nurse what diagnostic tests the infant will need to have to determine this diagnosis. For what test(s) should the nurse provide education to the family? Select all that apply.

wheezing

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction?

90/64 mm Hg

The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding?

100 beats per minute

The nurse takes an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant?

Infuse no more than 4 mg per minute.

The primary health care provider has prescribed intravenous furosemide for a child diagnosed with congestive heart failure (CHF). Which action will the nurse take when administering this medication?

Palliative pulmonary artery banding should help the infant grow.

When educating the family of an ill infant with an atrioventricular canal defect/septal defect, what information would be included in the education if the doctor is planning on performing palliative care until the infant is healthier?

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

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education?

80 beats/min

A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate?

aspirin, IVIG

A nurse is providing care to a child with Kawasaki disease. Which medication(s) would the nurse expect the health care provider to prescribe? Select all that apply.

Auscultate heart rate. Measure respiratory rate. Determine ability to suck. Auscultate lung fields for crackles.

The nurse is caring for an infant suspected of having tricuspid atresia. What essential assessment(s) will the nurse complete for this infant? Select all that apply.

Notify the doctor immediately.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?

cessation of chest tube drainage heart rate increase from 88 to 136 beats/min

A 3-year-old child is postoperative from a cardiac surgery. Which assessment finding(s) by the nurse warrants immediate action? Select all the apply.

"This test uses sound waves to check the heart structures." "This test should not cause your child any pain."

A 4-year-old child is scheduled for an echocardiogram. The nurse is explaining this procedure to the child's parents. Which information would the nurse likely include? Select all that apply.

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

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection?

heart failure

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

chest pain with activity dizziness with prolonged standing thrill palpated at base of heart

The nurse is assessing a child with aortic stenosis. Which findings would the nurse most likely assess? Select all that apply.

100 to 120/70 to 80 mm Hg

The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy?

mild-to-late ejection click at the apex

The nurse is auscultating heart sounds of a child with a mitral valve prolapse. The nurse should expect which assessment finding?

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

The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents asks the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the nurse?

Begin formulas with increased calories.

What information would be included in the care plan of an infant in heart failure?

management includes administration of aspirin and IVIG.

When caring for a child with Kawasaki disease, the nurse would know that:

Tachycardia

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?

obstruction of blood flow to the lungs

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of what factor as the major mechanism involved?

Provide education to the parents. Auscultate lung sounds frequently. Apply a continuous pulse oximeter. Keep oxygen saturation above 75%.

Which collaborative actions will the nurse perform when caring for an infant with transposition of the great arteries scheduled for surgical repair of the defect? Select all that apply.

painless nodules located on the wrists pericarditis with the presence of a new heart murmur

Which finding(s) is a major criterion used to help the health care provider diagnose acute rheumatic fever in a child? Select all that apply.

Activity intolerance related to inability of heart to sustain extra workload

Which nursing diagnosis would best apply to a child with rheumatic fever?

reduced hemoglobin levels elevated erythrocyte sedimentation rate (ESR)

A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series of laboratory tests have been ordered. Which findings are consistent with this disease? Select all that apply.

serum potassium levels serum sodium levels

A child has been prescribed spironolactone. Which laboratory values should be reviewed when following up on this medication? Select all that apply.

arthralgia

A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify what as a major Jones criterion?

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

An 8-month-old infant has a ventricular septal defect. Which nursing diagnosis would best apply?

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

An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize?

"It will determine if the heart is enlarged."

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse?

placing the infant in a semi-Fowler position

What would be the most important measure to implement for an infant who develops heart failure?

"After several days, we do not need to keep any dressing on the site." "If we notice any drainage or bleeding at the site, we will call the health care provider." "If our child has pain, we can give acetaminophen or ibuprofen."

A 5-year-old child has undergone a cardiac catheterization and is being prepared for discharge home with the parents. The nurse is teaching the parents how to care for the child at home. The nurse determines that the teaching is successful based on which statement(s) by the parents? Select all that apply.

Begin synchronized cardioversion

A child presents to the emergency department with a heart rate of 178 bpm, dizziness, and decreased level of consciousness. The nurse places the child on a cardiac monitor and notes a narrow complex rhythm. The nurse initiates intravenous access and assists the child with a vagal maneuver but continues to note the same rhythm on the monitor. Which action will the nurse perform next?

Begin synchronized cardioversion.

A child presents to the emergency department with a heart rate of 178 bpm, dizziness, and decreased level of consciousness. The nurse places the child on a cardiac monitor and notes a narrow complex rhythm. The nurse initiates intravenous access and assists the child with a vagal maneuver but continues to note the same rhythm on the monitor. Which action will the nurse perform next?

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

A child will be undergoing a Holter monitor test. Which statement by the parent indicates the need for further instruction?

the contrast material used has a diuretic effect.

After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding that:

Child A with a total cholesterol of 150 mg/dl and low-density lipoprotein (LDL) of 80 mg/dl.

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia?

Grade IV.

The nurse performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a:

Conduct a focused cardiovascular assessment.

The nurse is assessing the heart rate of a 6-month-old infant and determines it to be 82 beats/min. What action should the nurse take first?

Administer furosemide. Initiate intravenous access. Apply oxygen via oxyhood Begin indomethacin infusion.

The nurse is caring for a 1-day-old newborn with patent ductus arteriosus with the following vital signs: pulse 160, respirations 80, oxygen saturation 92%, retractions, and crackles noted in bilateral lungs. Which nursing actions are appropriate at this time? Select all that apply.

a fixed split-S2 heart sound

The nurse is caring for a newborn in the hospital. Which assessment finding is most concerning?

16-year-old child with a heart rate of 54 beats per minute 2-year-old child whose digoxin level was 2.4 ng/ml from a blood draw this morning 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? Select all that apply.

overriding aorta right ventricular hypertrophy pulmonary stenosis

A nurse is reading a journal article about congenital heart conditions that are associated with decreased pulmonary blood flow. The nurse demonstrates understanding of the information when she identifies which anomalies as being associated with tetralogy of Fallot? Select all that apply.

"My child seems listless and slightly warm."

A nurse is taking the history of a 4-year-old child who will undergo a cardiac catheterization. Which statement by the parent may necessitate rescheduling of the procedure?

"Make sure you are fully immunized."

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

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

A mother asks why her infant with a cyanotic heart defect turns blue. What is the nurse's best explanation?

overriding of the aorta

A newborn is diagnosed with tetralogy of Fallot. When explaining this condition to the mother, which defect would the nurse's description include?

Nausea and vomiting

A nurse is administering digoxin to a 3-year-old child. What would be a reason to hold the dose of digoxin?

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

A group of nurses is reviewing the cardiovascular system and its function. Which statement by one of the nurses demonstrates an understanding of a child's cardiovascular system?

Ventricular septal defect Patent ductus arteriosus Atrioventricular canal defect

A health care provider and other health team members are discussing congenital heart disorders that increase pulmonary blood flow. Which disorders are topics for this discussion? Select all that apply.

Swab throat for culture.

The nurse is caring for a school-age child with reports of generalized joint pain and a pharyngitis. During assessment, the nurse notes a cardiac murmur. Which action by the nurse is priority?

a cerebrovascular accident (stroke).

The nurse is caring for a 3-month-old infant with history of congenital heart disease. The infant is brought to the emergency department with nausea and vomiting for 3 days. Admission laboratory results confirm dehydration. The nurse realizes that the dehydrated infant is at risk for:

"I know my child uses up a lot of energy feeding but it doesn't seem to cause distress when I breastfeed." "I'm sure it is likely that my baby will be in intensive care after surgery. I believe I can pump so he can still receive my milk." "I hope my baby doesn't have to have feeding through a feeding tube after surgery, but I know that is a possibility." "I have read that human milk fortifier can be added to my breast milk for additional calorie needs if necessary."

The nurse is caring for a newborn who is scheduled for cardiac surgery to correct a diagnosed defect. Which statements by the mother demonstrate understanding of the situation? Select all that apply.

Initiate intravenous access.

The nurse is caring for child who present to the emergency department with reports of a fever for 5 days. The nurse notes a diffuse maculopapular rash, reddened cracked lips, erythema of hands, and bilateral conjunctivitis and suspects Kawasaki disease. Which nursing action is priority?

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

The nurse is conducting a physical examination of a 7-year-old girl prior to a cardiac catheterization. The nurse knows to pay particular attention to assessing the child's pedal pulses. How can the nurse best facilitate their assessment after the procedure?

Give furosemide intravenously.

While assessing a neonate with a ventricular septal defect (VSD), the nurse notes crackles and retractions. The nurse obtains the following vital signs: temp 100.2°F (38°C), pulse 134 bpm, respirations 64 breaths/minute, oxygen saturation 97% on room air. What will the nurse do first?

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

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the:

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

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

"My child loves chicken and I can still serve it but I need to remove the skin." "I should plan to have vegetables with each evening meal served." "Adding fresh fruits to my child's lunch is a good idea."

The nurse is reviewing nutritional recommendations with the parents of a teen diagnosed with hyperlipidemia. Which statements indicate an understanding of the recommended diet for this condition? Select all that apply.