The Child with Cardiovascular Health Problems

Which initial physical finding indicates the development of carditis in a child with rheumatic fever? a. heart murmur b. low blood pressure c. irregular pulse d. anterior chest wall pain

a. heart murmur *75% of clients experience heart murmur in the first week of carditis.

Which signs/symptoms would lead the nurse to suspect a child has a tetralogy of Fallot (TOF)? Select all that apply. a. murmur b. history of squatting c. bounding pulses d. cyanosis e. faint pulse f. tachypnea

a. murmur b. history of squatting d. cyanosis f. tachypnea

The parent of a child hospitalized with tetralogy of Fallot tells the nurse that the child's 3 y/o sibling has become quiet and shy and demonstrates more than a usual amount of genital curiosity since this child's hospitalization. a. "This behavior is very typical for a 3 y/o." b. "This may be how your child expresses feeling a need for attention." c. "This may be an indication that your child has been sexually abused." d. "This may be a sign of depression in your child."

b. "This may be how your child expresses feeling a need for attention."

When assessing a child after heart surgery to correct tetralogy of Fallot, which finding should alert the nurse to suspect a low cardiac output? a. Bounding pulses and mottled skin. b. Altered level of consciousness and thready pulse. c. Capillary refill of 2 seconds and blood pressure of 96/67 mm Hg. d. Extremities warm to the touch and pale skin.

b. Altered level of consciousness and thready pulse.

When developing the plan of care for a newly admitted 2-year-old child with Kawasaki disease (KD), which intervention should be the priority? a. Taking vital signs every 6 hours. b. Monitoring intake and output every hour. c. Minimizing skin discomfort. d. Providing passive ROM exercises.

b. Monitoring intake and output every hour.

After surgery to correct a tetralogy of Fallot, the child's parents express concern to the nurse that their 4 y/o wants to be held more frequently than usual. The nurse recommends: a. Introducing a new skill. b. Play therapy. c. Encouraging the behavior. d. Having the volunteer hold the child.

b. Play therapy.

Which information should the nurse include when completing discharge instructions for the parents of a 12-month-old child diagnosed with KD and being discharged home? a. Offer the child extra fluids every 2 hours for 2 weeks. b. Take the child's temperature daily for several days. c. Check the child's blood pressure daily until the follow-up appointment. d. Call the HCP if the irritability lasts for 2 more weeks.

b. Take the child's temperature daily for several days.

A child diagnosed with tetralogy of Fallot becomes upsets, cries, and thrashes around when a blood specimen is obtained. The child becomes cyanotic, and the respiratory rate increases to 44 breaths/min. Which action should the nurse implement FIRST? a. Obtain a prescription for sedation for the child. b. Assess for an irregular heart rate and rhythm. c. Explain to the child that it will only hurt for a short time. d. Place the child in a knee-to-chest position.

d. Place the child in a knee-to-chest position.

Which action should the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? a. Maintain the joints in an extended position. b. Apply gentle traction to the child's affected joints. c. Support proper alignment with rolled pillows. d. Use a bed cradle to avoid the weight of bed linens on joints.

d. Use a bed cradle to avoid the weight of bed linens on joints.

A nurse is planning care for a 12 y/o with rheumatic fever. The nurse should teach the parents to: a. Observe the child closely. b. Allow the child to participate in activities that will not tire him. c. Provide for adequate periods of rest between activities. d. Encourage someone in the family to be with the child 24 hours a day.

c. Provide for adequate periods of rest between activities.

A 12 year-old with rheumatic fever has a history of long-term aspirin use. Which client statement MOST indicates that the client is experiencing a serious adverse reaction to aspirin? a. "I hear ringing in my ears." b. "I put lotion on my itchy skin." c. "My stomach hurts after I take that medicine." d. "These pills make me cough."

a. "I hear ringing in my ears."

An 18-month-old with a congenital heart defect is to receive digoxin twice a day. Which instructions should the nurse give the parents? a. Digoxin enables the heart to pump more effectively with a slower and more regular rhythm. b. Signs of toxicity include increased pulse and visual disturbances. c. Digoxin is absorbed better if taken with meals. d. If the child vomits within 15 min of administration, the dosage should be repeated.

a. Digoxin enables the heart to pump more effectively with a slower and more regular rhythm.

Discharge teaching for a 3-month-old infant with a cardiac defect who is to receive digoxin should include which information? Select all that apply. a. Give the medication at regular intervals. b. Mix the medication with a small volume of breast milk or formula. c. Repeat the dose one time if the child vomits immediately after administration. d. Notify the HCP of poor feeding or vomiting. e. Make up any missed doses as soon as realized. f. Notify the HCP if more than two consecutive doses are missed.

a. Give the medication at regular intervals. d. Notify the HCP of poor feeding or vomiting. f. Notify the HCP if more than two consecutive doses are missed.

Which outcome indicates that the activity restriction necessary for a 7-year-old child with rheumatic fever during the acute phase has been effective? a. Joints demonstrate absence of permanent. b. The resting heart rate is between 60 and 100 bpm. c. The child exhibits a decrease in chorea movements. d. The subcutaneous nodules over the joints are no longer palpable.

b. The resting heart rate is between 60 and 100 bpm

The HCP prescribes pulse assessments through the night for a 12-year-old child with rheumatic fever who has a daytime heart rate of 120 bpm. The nurse explains to the mother that this is to evaluate if the elevated heart rate is caused by: a. the morning digitalis. b. normal activity during waking hours. c. a warmer daytime environment. d. normal variations in day and evening hours.

b. normal activity during waking hours.

Which intervention is the greatest priority for the therapeutic management of a child with CHF caused by pulmonary stenosis? a. Educating the family about the signs and symptoms of infection. b. Administering enoxaparin to improve left ventricular contractibility. c. Assessing heart rate and blood pressure every 2 hours. d. Administering furosemide to decrease system venous congestion.

d. Administering furosemide to decrease system venous congestion.

As part of the postoperative teaching for the family of a child undergoing a tetralogy of Fallot repair, the nurse tells the family upon returning to the pediatric floor that the child may: a. Be placed on a reduced sodium diet. b. Have an activity restriction for several days. c. Be assigned to an isolation room. d. Have visits limited to a select few.

a. Be placed on a reduced sodium diet. *Reduce risk of CHF.

A child with KD is receiving low-dose aspirin. The mother calls the clinic and states t hat the child has been exposed to influenza. Which recommendations should the nurse make? Select all that apply. a. Increase fluid intake. b. Stop the aspirin. c. Keep the child home from school. d. Watch for fever. e. Weigh the child daily.

b. Stop the aspirin. d. Watch for fever.

A child had open heart surgery to repair a tetralogy of Fallot with a patch. The nurse should instruct the parents to: a. Notify all HCPs before invasive procedures for the next 6 months. b. Maintain adequate hydration of at least 10 glasses of water a day. c. Provide for frequent rest periods and naps during the first 4 weeks. d. Restrict the ingestion of bananas and citrus fruits.

a. Notify all HCPs before invasive procedures for the next 6 months. *At high risk for infection. Especially SBE.

An infant weight 9 kg is in the PICU following arterial switch surgery. In the past hour, the infant has had 16 mL of urine output. Which action should the nurse take? a. Notify the HCP immediately. b. Record the urine output in the medical record. c. Administer a fluid bolus immediately. d. Assess for other signs of hypervolemia.

b. Record the urine output in the medical record. *UO for an infant is 1mL/kg/h.

The nurse is caring for a newborn with a large ventricular septal defect. The client has undergone pulmonary artery banding. Which assessment findings indicate that the pulmonary artery band is functioning effectively? a. Capillary refill is less than 3 seconds. b. Urine output is greater than 1mL/kg/h. c. Breath sounds are clear and equal bilaterally. d. Radial pulses are bounding.

c. Breath sounds are clear and equal bilaterally.

A 16-month-old child diagnosed with KD is very irritable, refuses eat, and exhibits peeling skin on the hands and feet. What should the nurse do FIRST? a. Apply lotion to the hands and feet. b. Offer foods the toddler likes. c. Place the toddler in a quiet environment. d. Encourage the parents to go get some rest.

c. Place the toddler in a quiet environment.