The Child with Cardiovascular Dysfunction

36. Which of the following is a major clinical manifestation of rheumatic fever? 1. Polyarthritis 2. Osler nodes 3. Janeway spots 4. Splinter hemorrhages of distal third of nails

ANS: 1 1. Polyarthritis, which is swollen, hot, red, and painful joints. The affected joints will change every 1 to 2 days. Primarily the large joints are affected.

8. Which of the following should be included in the instructions to an active adolescent who is going home after a cardiac catheterization? 1. Avoid tub baths but may shower. 2. Maintain strict bed rest for 3 days. 3. Leave pressure dressing on for 7 days. 4. Stay home from school until Band-Aid is removed.

ANS: 1 1. The catheterization site should be kept relatively dry with a adhesive bandage. Showers are recommended.

27. Which of the following should the nurse consider when preparing a school-age child and the family for heart surgery? 1. Unfamiliar equipment should not be shown. 2. Let child hear the sounds of an ECG monitor. 3. Avoid mentioning postoperative discomfort and interventions. 4. Explain that an endotracheal tube will not be needed if the surgery goes well.

ANS: 2 2. The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized

24. An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be which of the following? 1. Assess for neurologic defects. 2. Place the child in the knee-chest position 3. Begin cardiopulmonary resuscitation. 4. Prepare family for imminent death.

ANS: 2 2. The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated.

31. Which of the following is an important nursing consideration when chest tubes will be removed from a child? 1. Explain that it is not painful. 2. Explain that only a Band-Aid will be needed 3. Administer analgesics before procedure. 4. Expect bright red drainage for several hours after removal.

ANS: 3 3. It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing IV line

38. Which of the following actions by the school nurse is important in the prevention of rheumatic fever? 1. Encourage routine cholesterol screenings. 2. Conduct routine blood pressure screenings. 3. Refer children with sore throats for throat cultures. 4. Recommend salicylates instead of acetaminophen for minor discomforts.

ANS: 3 3. Nurses have a role in prevention; primarily in screening school-age children for sore throats caused by group A streptococci. This can be by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing.

20. The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on which of the following? 1. It is a very safe, frequently used drug. 2. It is difficult to either overmedicate or undermedicate with digoxin. 3. Parents lack the expertise necessary to administer digoxin. 4. Parents must learn specific, important guidelines for administration of digoxin.

ANS: 4 4. Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects

23. Which of the following is a sign of hypokalemia? 1. Apnea 2. Oliguria 3. Twitching 4. Muscle weakness

ANS: 4 4. Muscle weakness is a characteristic clinical manifestation of hypokalemia.

3. José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: 1. Directed at his parents, because he is too young to understand. 2. Detailed in regard to the actual procedures so he will know what to expect. 3. Done several days before the procedure so that he will be prepared. 4. Adapted to his level of development so that he can understand.

ANS: 4 4. Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations.

32. What is the most common causative agent of bacterial endocarditis? 1. Staphylococcus albus 2. Streptococcus hemolyticus 3. Staphylococcus albicans 4. Streptococcus viridans

ANS: 4 4. Staphylococcus viridans is the most common causative agent in bacterial (infective) endocarditis

4. Which of the following explanations regarding cardiac catheterization is appropriate for a preschool child? 1. Postural drainage will be performed every 4 to 6 hours after the test. 2. It is necessary to be completely "asleep" during the test. 3. The test is very short, usually taking less than 1 hour. 4. When the procedure is done, you will have to keep your leg straight for at least 4 hours.

ANS: 4 4. The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position

9. Surgical closure of the ductus arteriosus would do which of the following? 1. Stop the loss of unoxygenated blood to the systemic circulation 2. Decrease the edema in legs and feet 3. Increase the oxygenation of blood 4. Prevent the return of oxygenated blood to the lungs

ANS: 4 4. The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary artery

2. Which of the following is a complication that may occur after a cardiac catheterization? 1. Cardiac arrhythmia 2. Hypostatic pneumonia 3. Congestive heart failure 4. Rapidly increasing blood pressure

ANS: 1 1. Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient.

15. A beneficial effect of administering digoxin (Lanoxin) is that it: 1. Decreases edema. 2. Decreases cardiac output. 3. Increases heart size. 4. Increases venous pressure.

ANS: 1 1. Digoxin has a rapid onset and is useful increasing cardiac output, decreasing venous pressure, and as a result, decreasing edema.

33. What painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? 1. Osler nodes 2. Janeway lesions 3. Subcutaneous nodules 4. Aschoff nodes

ANS: 1 1. Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis.

12. Which of the following defects results in decreased pulmonary blood flow? 1. Atrial septal defect 2. Tetralogy of Fallot 3. Ventricular septal defect 4. Patent ductus arteriosus

ANS: 2 2. Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect

16. Which of the following drugs is an angiotensin-converting enzyme (ACE) inhibitor? 1. Captopril (Capoten) 2. Furosemide (Lasix) 3. Spironolactone (Aldactone) 4. Chlorothiazide (Diuril)

ANS: 1 1. Capoten is a drug which is an ACE inhibitor.

35. Which of the following is a common, serious complication of rheumatic fever? 1. Seizures 2. Cardiac arrhythmias 3. Pulmonary hypertension 4. Cardiac valve damage

ANS: 4 4. Cardiac valve damage is the most significant complication of rheumatic fever.

11. Which of the following structural defects constitute tetralogy of Fallot? 1. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy 2. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy 3. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy 4. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

ANS: 1 1. Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.

26. Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on which of the following? 1. Child needs opportunities to play with peers. 2. Child needs to understand that peers' activities are too strenuous. 3. Parents can meet all the child's needs. 4. Constant parental supervision is needed to avoid overexertion.

ANS: 1 1. The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace.

37. Therapeutic management of the child with rheumatic fever includes: 1. Administration of penicillin. 2. Avoid salicylates (aspirin). 3. Strict bed rest for 4 to 6 weeks. 4. Administration of corticosteroids if chorea develops.

ANS: 1 1. The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice

21. The infant with congestive heart failure has a need for: 1. Increased calories. 2. Increased fluids. 3. Decreased protein. 4. Decreased fat.

ANS: 1 1. The metabolic rate of infants with congestive heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue.

22. As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended for this child because they are high in which of the following? 1. Chlorides 2. Potassium 3. Sodium 4. Vitamins

ANS: 2 2. Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with this electrolyte

17. An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following? 1. 60 2. 70 3. 90 4. 100

ANS: 2 2. If a 1-minute apical pulse is less than 70 for an older child, the digoxin is withheld. 1. This is the cut-off for holding the digoxin dose in an adult.

25. The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which of the following is an important objective to decrease this risk? 1. Minimize seizures 2. Prevent dehydration 3. Promote cardiac output 4. Reduce energy expenditure

ANS: 2 2. In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes

34. The primary nursing intervention to prevent bacterial endocarditis is which of the following? 1. Institute measures to prevent dental procedures. 2. Counsel parents of high-risk children about prophylactic antibiotics. 3. Observe children for complications, such as embolism and heart failure. 4. Encourage restricted mobility in susceptible children.

ANS: 2 2. The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition.

40. Which of the following is the leading cause of death after heart transplantation? 1. Infection 2. Rejection 3. Cardiomyopathy 4. Congestive heart failure

ANS: 2 2. The posttransplant course is complex. The leading cause of death after cardiac transplant is rejection.

19. Which of the following is a common sign of digoxin toxicity? 1. Seizures 2. Vomiting 3. Bradypnea 4. Tachycardia

ANS: 2 2. Vomiting is a common sign of digoxin toxicity

1. A chest radiograph film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" The nurse's response should be based on knowledge that the x-ray film will do which of the following? 1. Show bones of chest but not the heart 2. Measure electrical potential generated from heart muscle 3. Provide permanent record of heart size and configuration 4. Provide computerized image of heart vessels and tissues

ANS: 3 3. A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will be provide a baseline for future comparisons

30. The nurse is caring for a child after heart surgery. Which of the following should the nurse do if evidence is found of cardiac tamponade? 1. Increase analgesia. 2. Apply warming blankets. 3. Immediately report this to physician. 4. Encourage child to cough, turn, and breathe deeply.

ANS: 3 3. If evidence is noted of cardiac tamponade, blood or fluid in the pericardial space constricting the heart, the physician is notified immediately of this life-threatening complication

29. Which of the following is an important nursing consideration when suctioning a young child who has had heart surgery? 1. Perform suctioning at least every hour. 2. Suction for no longer than 30 seconds at a time. 3. Administer supplemental oxygen before and after suctioning. 4. Expect symptoms of respiratory distress when suctioning.

ANS: 3 3. If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia

18. A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following? 1. 60 2. 70 3. 90 to 110 4. 110 to 120

ANS: 3 3. If the 1-minute apical is below 90 to 110, the digoxin should not be given to a 6-month-old.

14. Which of the following is a clinical manifestation of the systemic venous congestion that can occur with congestive heart failure? 1. Tachypnea 2. Tachycardia 3. Peripheral edema 4. Pale, cool extremities

ANS: 3 3. Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion

10. Which of the following defects results in increased pulmonary blood flow? 1. Pulmonic stenosis 2. Tricuspid atresia 3. Atrial septal defect 4. Transposition of the great arteries

ANS: 3 3. The atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery.

13. Which of the following is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? 1. Pulmonary congestion 2. Congenital heart defect 3. Congestive heart failure 4. Systemic venous congestion

ANS: 3 3. The definition of congestive heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body.

5. Nursing interventions for the child after a cardiac catheterization would include which of the following? 1. Allow ambulation as tolerated. 2. Monitor vital signs every 2 hours. 3. Assess the affected extremity for temperature and color. 4. Check pulses above the catheterization site for equality and symmetry.

ANS: 3 3. The extremity that was used for access for the cardiac catheterization must be checked for temperature and color. Coolness and blanching may indicate arterial occlusion.

6. After the child returns from cardiac catheterization, the nurse monitors the child's vital signs. The heart rate should be counted for how many seconds? 1. 10 2. 15 3. 30 4. 60

ANS: 4 4. After cardiac catheterization, the heart rate should be counted for a full minute to detect evidence of dysrhythmias or bradycardia.

39. When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what are thought to protect against cardiovascular disease? 1. Cholesterol 2. Triglycerides 3. Low-density lipoproteins (LDLs) 4. High-density lipoproteins (HDLs)

ANS: 4 4. HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high levels of proteins. It is thought that HDLs protect against cardiovascular disease.

41. When caring for the child with Kawasaki disease, the nurse should know which of the following? 1. Child's fever is usually responsive to antibiotics within 48 hours. 2. Principal area of involvement is the joints. 3. Aspirin is contraindicated. 4. Therapeutic management includes administration of gamma globulin and aspirin.

ANS: 4 4. High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness

7. The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is which of the following? 1. Notify physician. 2. Apply new bandage with more pressure. 3. Place in Trendelenburg position. 4. Apply direct pressure above catheterization site.

ANS: 4 4. If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture.

28. Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. The nurse should do which of the following? 1. Keep child warm with blankets. 2. Apply a hypothermia blanket. 3. Record temperature on nurses' notes. 4. Report findings to physician.

ANS: 4 4. In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7° C or 100° F as part of the inflammatory response to tissue trauma. If the temperature is higher or continues after this period, it is most likely a sign of an infection and immediate investigation is indicated