Peds: Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever? "Children who have this diagnosis may have had strep throat." "The onset and progression of this disorder is rapid." "Being up-to-date on immunizations is the best way to prevent this disorder." "This disorder is caused by genetic factors."

"Children who have this diagnosis may have had strep throat." Explanation: Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle.

The parents of a 2-year-old toddler newly diagnosed with tricuspid atresia ask the nurse, "I do not understand why our toddler's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is best? "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." "Increased cardiac workload from your toddler's heart defect affects various parts of the body, including the fingers." "This is a common complication of tricuspid atresia. Unfortunately, there is nothing we can do to treat it." "The number of red blood cells has significantly increased from the heart defect, resulting in the cells pooling in the fingertips."

"The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." Explanation: Clubbing (which is what the parents are describing) of fingertips or toes can occur from the chronic hypoxia that occurs with disorders with decreased pulmonary blood flow, such as tricuspid atresia. Using the term "low oxygen levels in the blood" rather than "chronic hypoxia" is a better way to explain to the parents what is happening with their child. Clubbing is not the result of increased cardiac workload. Red blood cell pooling is not the cause of clubbing. Although clubbing is a possible result of tricuspid atresia, telling the parents this is a "common complication" does not address the parent's concerns.

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. "It's wonderful that our child will never have an abnormal heart rhythm again." "We will be sure to not allow our child to ride a bicycle for at least 2 weeks." "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." "Our child will be so excited to get back to soccer league in a few days." "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 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." Explanation: With the Gore® Helex device, strenuous activity should be avoided for 2 weeks after the procedure, so neither soccer or bicycle riding would be allowed. Children should be monitored for the possible presence of atrial arrhythmias (lifelong) after surgical closure for the defect. Infection is a complication that must be monitored for and reported to the physician, and medications must be given as prescribed.

An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize? "You need to lie very still during this test." "You'll have to wear the monitor for 24 hours." "You need to report any symptoms you are having during the test." "You get some medicine that will make you sleepy."

"You need to report any symptoms you are having during the test." Explanation: It is important for the child to report any symptoms felt during the test to help quantify the child's exercise tolerance. Exercise stress testing involves activity. Ambulatory electrocardiographic monitoring is performed over 24 hours. Sedation is not used for an exercise stress test. It is used for an arteriogram.

The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse? 1-week-old newborn whose oxygenation is not improving with oxygen 2-year-old child with clubbing noted on the fingers 6-month-old infant with edema on the face and presacral area 1-year-old child with a temporal temperature of 101°F (38.3°C)

1-week-old newborn whose oxygenation is not improving with oxygen Explanation: A newborn whose oxygenation is not improving with oxygen warrants immediate attention. Congenital heart disease needs to be suspected in the cyanotic newborn who does not improve with oxygen administration. In infants, peripheral edema occurs first in the face, then the presacral region, and then the extremities. This is an abnormal assessment finding that warrants follow-up but does not warrant immediate action. Clubbing is also an abnormal finding and warrants follow-up but not immediate action. It implies chronic hypoxia due to severe congenital heart disease. A temporal temperature of 101°F (38.3°C) is an abnormal assessment finding and warrants follow-up but not immediate action. Fever would suggest a possible infection.

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. Begin indomethacin infusion. Administer furosemide. Apply oxygen via oxyhood. Feed a high-calorie formula. Initiate intravenous access.

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

What will the nurse include in the feeding plan for a breastfed infant with congenital heart disease? Ensure output of a minimum 5 wet diapers daily. Assess weight gain monthly. Feed on schedule every 4 hours to promote rest. Breastfeed with small, frequent feeds.

Breastfeed with small, frequent feeds. Explanation: Some infants with congenital heart disease (CHD) tire easily and will require small, frequent breastfeeding to manage their energy and meet caloric needs. Their output and weight gain should be watched closely. Parents should anticipate more frequent weight checks in the first weeks, and a minimum of 6 to 8 wet diapers daily. Feeding every 4 hours will not promote the intake and growth required for an infant with CHD.

A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia? Increased WBC Decreased WBC Increased RBC Decreased RBC

Increased RBC Explanation: Polycythemia can occur in clients with a cyanotic heart defect. The body tries to compensate for having low oxygen levels and produces more red blood cells (RBCs). This would cause an increased result on the lab tests. This problem does not affect the white blood cells (WBCs).

A 6-year-old girl is diagnosed with aortic stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother? No treatment is necessary, as the defect will resolve spontaneously Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization Surgical closure by ductal ligation

Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing Explanation: Balloon angioplasty by way of cardiac catheterization is the initial procedure for aortic stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed area. As the balloon is inflated, it breaks any adhesions and opens the area. The other answers refer to interventions related to patent ductus arteriosus, not aortic stenosis.

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta? Pulses weaker in upper extremities compared to lower extremities Pulses weaker in lower extremities compared to upper extremities Cyanosis with feeding Cyanosis with crying

Pulses weaker in lower extremities compared to upper extremities Explanation: With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased systemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot.

A school nurse finds a 10-year-old's blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect? The child will probably need surgery. This is a normal result for a child this age. Advise the child go to the emergency room. The child will need the blood pressure checked two more times.

The child will need the blood pressure checked two more times. Explanation: The child will need the blood pressure checked two more times. It is routine to check the blood pressure on three separate occasions to get the most accurate analysis of the blood pressure. The child usually does not need surgery or need to go to the emergency room. This is not a normal result in a blood pressure finding.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding? The spleen size increases due to increased destruction of red blood cells. The spleen size increases due to frequent infection. The liver size increases in right-sided heart failure. The liver size increases due to cardiac medications.

The liver size increases in right-sided heart failure. Explanation: The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly.

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? The child should not be allowed to participate in sports. Beta-blocker education should be given to the parents. The nurse would review the child's 24-hour diet recall. Blood pressures should be measured daily.

The nurse would review the child's 24-hour diet recall. Explanation: With a child in the 90th percentile for blood pressure, diet and physical activity should be the main focus. Blood pressures should be measured but daily measurement is not necessary. Children are not routinely put on beta-blockers, and the child should be allowed to participate in sports if monitored.

A mother asks the nurse if the reason the infant has a congenital heart defect is because of something she did while pregnant. What is the best response by the nurse? The studies show it is impossible to know what causes heart defects. Yes, there is a chance you caused this defect. There are several reasons an infant can have a heart defect; let's talk about those causes. No, heart defects are mainly caused by genetic factors.

There are several reasons an infant can have a heart defect; let's talk about those causes. Explanation: Parents who have a newborn who has a defect are always concerned they did something wrong to cause the defect. They carry a large amount of guilt. The nurse should focus on the therapeutic communication in this situation, while still obtaining more information. A nurse should never blame the parent because it is not only nontherapeutic, but there are many reasons why congenital heart defects occur. The reason for the infant's heart defect may not be known. Using therapeutic communication will reduce the parent's anxiety and guilt. Congenital heart defects can be caused by genetic defects such as chromosomal anomalies but this is not always the case.

A mother asks the nurse if the reason the infant has a congenital heart defect is because of something she did while pregnant. What is the best response by the nurse? Yes, there is a chance you caused this defect. There are several reasons an infant can have a heart defect; let's talk about those causes. The studies show it is impossible to know what causes heart defects. No, heart defects are mainly caused by genetic factors.

There are several reasons an infant can have a heart defect; let's talk about those causes. Explanation: Parents who have a newborn who has a defect are always concerned they did something wrong to cause the defect. They carry a large amount of guilt. The nurse should focus on the therapeutic communication in this situation, while still obtaining more information. A nurse should never blame the parent because it is not only nontherapeutic, but there are many reasons why congenital heart defects occur. The reason for the infant's heart defect may not be known. Using therapeutic communication will reduce the parent's anxiety and guilt. Congenital heart defects can be caused by genetic defects such as chromosomal anomalies but this is not always the case.

A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education? An IV for fluids will be started immediately. This type of defect is caused by having a genetic predisposition for it. This is caused by an opening that usually closes by 1 week of age. Your child may need multiple surgeries to correct this defect.

This is caused by an opening that usually closes by 1 week of age. Explanation: A PDA is caused by an opening called the ductus arteriosus. A PDA usually closes by 1 week of age. If it does not close, the defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

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? Kawasaki Disease cardiomyopathy infective endocarditis heart failure

heart failure Explanation: Infective endocarditis would present with intermittent, unexplained low-grade fever, fatigue, anorexia, weight loss, or flu-like symptoms. Characteristics of cardiomyopathy include respiratory distress, fatigue, poor growth (dilated), chest pain, dizziness, and syncope. Abdominal pain, joint pain, fever, and irritability are signs of Kawasaki disease.

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? presacral region face hands lower extremities

lower extremities Explanation: Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities.

A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers? phenytoin antiviral nonsterioidal anti-inflammatory drugs (NSAIDs) insulin

nonsterioidal anti-inflammatory drugs (NSAIDs) Explanation: Medications used in the treatment of rheumatic fever include penicillin, NSAIDs, and corticosteroids. Insulin would be given for diabetes and phenytoin for seizure disorders. Antivirals are not relevant to the treatment of a bacterial infection.

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. pericarditis with the presence of a new heart murmur elevated erythrocyte sedimentation rate temperature of 101.2°F (38.4°C) painless nodules located on the wrists heart block with a prolonged PR interval

painless nodules located on the wrists pericarditis with the presence of a new heart murmur Subcutaneous nodules and carditis are considered major criteria used in the diagnosing of acute rheumatic fever. The other options are minor criteria.

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. penicillin nonsteroidal anti-inflammatory drugs intravenous immunoglobulin digoxin corticosteroids

penicillin corticosteroids nonsteroidal anti-inflammatory drugs Explanation: A full 10-day course of an antibiotic, such as penicillin or equivalent, is used. Anti-inflammatory agents, such as corticosteroids and nonsteroidal anti-inflammatory drugs, are also used in the treatment of acute rheumatic fever. Digoxin, an antiarrhythmic agent, a is used to treat heart failure, atrial fibrillation, atrial flutter, and supraventricular tachycardia. Intravenous immunoglobulin, an immunoglobulin therapy, is used to treat Kawasaki disease.

A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits? semi-Fowler lithotomy prone side-lying

semi-Fowler Explanation: Due to the hemodynamic changes accompanying the underlying structural defect, oxygenation is key. Provide frequent ongoing assessment of the child's cardiopulmonary status. Assess airway patency and suction as needed. Position the child in the Fowler or semi-Fowler position to facilitate lung expansion.

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding? steady weight gain since birth appropriate mastery of developmental milestones softening of the nail beds intact rooting reflex

softening of the nail beds Explanation: Softening of nail beds is the first sign of clubbing due to chronic hypoxia. Rounding of the fingernails is followed by shininess and thickness of nail ends.

A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis? coarctation of aorta tetralogy of Fallot aortic stenosis pulmonary stenosis

tetralogy of Fallot Explanation: Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction? stomach upset abdominal distress wheezing nausea with diarrhea

wheezing Explanation: The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset, nausea, and abdominal distress are common with oral antibiotics and do not need to be reported immediately.

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. "My child loves chicken and I can still serve it but I need to remove the skin." "I need to limit fat intake in meals to 40%." "Cooking with palm oil will be helpful." "I should plan to have vegetables with each evening meal served." "Adding fresh fruits to my child's lunch is a good idea."

"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." Explanation: Hyperlipidemia refers to high levels of lipids (fats/cholesterol) in the blood. High lipid levels are a risk factor for the development of atherosclerosis, which can result in coronary artery disease, a serious cardiovascular disorder occurring in adults. Dietary management is the first step in the prevention and management of hyperlipidemia in children older than 2 years of age. The diet should consist primarily of fruits, vegetables, low-fat dairy products, whole grains, beans, lean meat, poultry, and fish. As in adults, fat should account for no more than 30% of daily caloric intake. Fat intake may vary over a period of days, as many young children are picky eaters. Limit saturated fats by choosing lean meats, removing skin from poultry before cooking, and avoiding palm, palm kernel, and coconut oils as well as hydrogenated fats.

An infant suspected of having a patent ductus arteriosus is schedule for an echocardiogram. After teaching the parents about this procedure, the nurse determines that the teaching was successful based on which parental statement? "Although our baby will be exposed to some radiation, the exposure is minimal. "This test should not cause our baby any pain." "Our baby will need some type of anesthesia so this test can be done." "Catheters will be put into a large vein so the defect can be closed."

"This test should not cause our baby any pain." Explanation: A patent ductus arteriosus is confirmed with an echocardiogram. An echocardiogram is a noninvasive ultrasound of the heart that gives detailed information about heart structure and function. No radiation is involved. High-frequency sound waves are directed toward the heart to locate and study the movement and dimensions of cardiac structures. An echocardiogram is painless and does not require exposure to radiation. A transesophageal echocardiogram (TEE) is an imaging option in which the TEE probe is placed in the esophagus immediately posterior to the heart to provide high-quality images of intracardiac structures. If a TEE is necessary, it will be done under moderate sedation or general anesthesia because the infant will not tolerate a probe being placed down the esophagus while awake. A cardiac catheterization procedure is invasive; catheters are inserted through a large vein and artery and floated into the heart. Cardiac catheterization uses fluoroscopy, which is a form of imaging that uses radiation. It can be used to correct conditions such as the closure of a patent ductus arteriosus.

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed? "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years." "If she needs dental surgery, we might need additional medication." "We can stop the penicillin when her symptoms disappear." "She needs to take the drug for the full 14 days."

"We can stop the penicillin when her symptoms disappear." Explanation: For a child with rheumatic fever, drug therapy must be given for the full 10 to 14 days to ensure complete eradication of the infection. The drug must not be stopped when the signs and symptoms disappear. To prevent recurrent attacks, prophylactic antibiotic therapy is prescribed for at least 5 years or until the child is 18 years old. Additional prophylactic therapy should be instituted when dental or tonsillar surgery is planned.

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? "This is something we should talk with the physician about. Maybe it would help your baby." "Oxygen isn't always the best treatment for your child's condition. Surgery is necessary." "I can only place oxygen on your child if the doctor orders oxygen." "While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help."

"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help." Explanation: For children with congenital defects with increased pulmonary blood flow, oxygen supplementation is not helpful. Oxygen acts as a pulmonary vasodilator. If pulmonary dilation occurs, pulmonary blood flow is even greater, causing tachypnea, increasing lung fluid retention, and eventually causing a much greater problem with oxygenation; therefore, preventing the development of pulmonary disease via early surgical correction is essential. Although oxygen must be ordered by the physician and it isn't the best treatment, the nurse stating, "While it seems that oxygen would help, it actually makes the condition worse. Treating the cause of the disease will help" best answers the question while also showing empathy.

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? 94 beats/min 102 beats/min 80 beats/min 118 beats/min

80 beats/min Explanation: Prior to administering each dose of digoxin, the nurse would count the apical pulse for 1 full minute, noting rate, rhythm, and quality. The nurse would withhold the dose and notify the health care provider if the apical pulse is less than 60 in an adolescent, less than 90 in an infant.

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant? Restrict fluids. Administer oxygen. Administer antidiuretic. Provide large, less frequent feedings.

Administer oxygen. Explanation: If a child is experiencing heart failure, the infant will need oxygen. One of the medications the infant would be on is a diuretic. An infant with heart failure will need smaller, more frequent feedings to conserve energy for feeding. Infants are not usually put on fluid restriction.

The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level? Digoxin Spironolactone Ferrous sulfate Albuterol sulfate

Digoxin Explanation: The use of large doses of digoxin at the beginning of therapy to build up the blood levels of the drug to a therapeutic level is known as digitalization. During the 24 hours digitalization is occurring, the child should be on a cardiac monitor and the nurse should monitor the PR interval and a decreased ventricular rate. The other listed medications are not administered in this manner. Albuterol is inhaled for asthma treatment and used primarily for exacerbations. Ferrous sulfate is give for iron-deficiency anemia, and spironolactone is a diuretic.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention? Observe vitals every two hours. Administer epinephrine. Notify the doctor immediately. Elevate the head of the bed.

Notify the doctor immediately. Explanation: The nurse would notify the doctor immediately. Cardiac tamponade is a medical emergency and should be addressed. The child can die if intervention is postponed. It would not be appropriate to perform any interventions until confirming that this is the actual diagnosis.

A 1-year-old with tetralogy of Fallot turns blue during a temper tantrum. What will the nurse do first? Assess for an irregular heart rate. Listen for an increased respiratory rate. Place child in the knee-to-chest position. Explain to the child the need to calm down.

Place child in the knee-to-chest position. Explanation: Tetralogy of Fallot is a cyanotic heart defect. Hypercyanosis can develop suddenly. The symptoms are increased cyanosis, hypoxemia, dyspnea, and agitation. The nurse should use a calm, comforting approach with the child and place child in the knee-to-chest position. This position is the first priority of the child with tetralogy of Fallot. This position increases pulmonary blood flow by increasing systemic vascular resistance. The additional interventions for a hypercyanotic spell are to administer oxygen and give morphine, IV fluids, and propranolol. A child will not understand to calm down and cannot be expected to listen during a temper tantrum. Assessing the child's heart rate and respirations are not priority. Perfusion is priority for this client at this time.

The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority? Place the child in a knee-to-chest position. Provide supplemental oxygen. Administer morphine as prescribed. Use a calm, comforting approach.

Place the child in a knee-to-chest position. Explanation: The priority nursing action is to place the child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as prescribed. A calm, comforting approach should be used but is not the priority action.

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks the child seems to have lack of coordination, facial grimaces and repetitive involuntary movements. Based on these symptoms the nurse would suspect what condition? polyarthritis carditis arthralgia chorea

chorea Explanation: Rheumatic fever affects the heart, the central nervous system, skin and subcutaneous tissue. It causes carditis, arthritis, and chorea. Chorea is a disorder characterized by emotional instability, purposeless movements, and muscular weakness. The onset of chorea is gradual, with increasing incoordination, facial grimaces, and repetitive involuntary movements. Polyarthritis means there is arthritis in multiple joints which is common in rheumatic fever, but this is not a symptom of chorea. Arthralgia is a very common symptom of rheumatic fever. It is pain in the joints but again not a symptom of chorea. The heart muscle is affected in rheumatic fever as are the valves but not included in the symptoms of chorea.

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: femoral pulse weaker than brachial pulse. hepatomegaly. bounding pulse. narrow pulse.

femoral pulse weaker than brachial pulse. Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure.

A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers? phenytoin insulin nonsterioidal anti-inflammatory drugs (NSAIDs) antiviral

nonsterioidal anti-inflammatory drugs (NSAIDs) Explanation: Medications used in the treatment of rheumatic fever include penicillin, NSAIDs, and corticosteroids. Insulin would be given for diabetes and phenytoin for seizure disorders. Antivirals are not relevant to the treatment of a bacterial infection.