Cardiac Disorders in Children (Exam 3)

The nurse is assessing a child with suspected rheumatic fever. What findings would the nurse expect to assess? Select all that apply. a) Macular rash on trunk b) Diastolic murmur c) Tender swollen joints d) Involuntary limb movement e) Nonpalpable subcutaneous nodules

a) Macular rash on trunk c) Tender swollen joints d) Involuntary limb movement Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.

When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover? a) Polycythemia b) Increased platelet level c) Leukopenia d) Anemia

a) Polycythemia Children who cannot oxygenate red cells well often produce excess red blood cells or develop polycythemia

The nurse is conducting a physical examination of a child with a suspected cardiovascular disorder. Which finding would the nurse most likely expect to assess if the child had transposition of the great vessels? a) Significant cyanosis without presence of a murmur b) Soft systolic ejection c) Holosystolic murmur d) Abrupt cessation of chest output with an increase in heart rate/filling pressure

a) Significant cyanosis without presence of a murmur Significant cyanosis without presence of a murmur is highly indicative of transposition. Abrupt cessation of chest output accompanied by an increase in heart rate and filling pressure is indicative of cardiac tamponade. A soft systolic ejection or holosystolic murmur can be found with other disorders, such as hypoplastic left heart syndrome, but is not highly suspicious of transposition.

The infant has been hospitalized and develops hypercyanosis. The physician has ordered the nurse to administer 0.1 mg of morphine sulfate per every kilogram of the infant's body weight. The infant weighs 15.2 lb (6.81 kg). Calculate the infant's morphine sulfate dose. Record your answer using one decimal place. __________mg

0.7 mg The does should be calculated weight in kilograms. The infant weighs 6.81 kg. For each kilogram of body weight, the infant should receive 0.1 mg of morphine sulfate. 6.81 kg x 0.1 mg/1 kg = 0.681 mg Rounded to the tenth place = 0.7 mg The infant will receive 0.7 mg of morphine sulfate.

The nurse is reviewing the medical record of a child with infective endocarditis. What would the nurse expect to find? Select all that apply. a) Electrocardiogram with prolonged PR interval b) Microscopic hematuria with urinalysis c) White blood cell count revealing leukopenia d) Petechiae on palpebral conjunctiva e) Lungs clear on auscultation

a) Electrocardiogram with prolonged PR interval b) Microscopic hematuria with urinalysis d) Petechiae on palpebral conjunctiva With infective endocarditis, leukocytosis, microscopic hematuria, prolonged PR interval, adventitious lung sounds, and petechiae on the palpebral conjunctiva are noted.

The nurse is assessing an infant for peripheral edema. Based on the nurse's knowledge, the nurse would expect edema to occur in which area first? a) Face b) Presacral region c) Upper extremities d) Lower extremities

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

The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which statement by the mother indicates a need for further teaching? a) "I need to feed him every hour to make sure he eats enough." b) "Gavage feedings may be required for now." c) "Small, frequent feedings are best if tolerated." d) "The baby may need as much as 150 cal/kg/day."

a) "I need to feed him every hour to make sure he eats enough." Although offering small frequent feedings is appropriate if the infant tolerates them, feeding every hour is not necessary. During the acute phase, continuous or intermittent gavage feedings may be needed to help the infant maintain or gain weight. Due to the increased metabolic demands, the infant may require as much as 150 calories/kg/day.

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? Select all that apply. a) 16-year-old child with a heart rate of 54 bpm b) 12-year-old child whose digoxin level was 0.9 ng/ mL on a blood draw this morning c) 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning d) 4-month-old child with an apical heart rate of 102 bpm e) 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse

a) 16-year-old child with a heart rate of 54 bpm c) 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning e) 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse The nurse should not administer digoxin to children with the following issues: The adolescent with an apical pulse under 60 beats per minute, the child with a digoxin level above 2 ng/mL, and the child who exhibiting signs of digoxin toxicity.

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? a) Administer next dose as ordered in 12 hours. b) Contact the physician. c) Offer a snack and administer another dose. d) Immediately administer another dose.

a) Administer next dose as ordered in 12 hours. Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose. It is not necessary to contact the physician.

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition? a) Assessing for the presence of femoral pulses b) Observing for excessive crying c) Auscultating for a cardiac murmur d) Recording an upper extremity blood pressure

a) Assessing for the presence of femoral pulses Infants with a narrowing (coarctation) of the aorta have decreased pressure in the lower extremities or absence of femoral pulses.

A child with suspected dyslipidemia undergoes laboratory testing. The nurse is reviewing the results. Which finding would the nurse interpret as supporting the diagnosis? Select all that apply. a) Total cholesterol level of 220 mg/dL b) LDL level of 90 mg/dL c) Total cholesterol level of 150 mg/dL d) LDL level of 140 md/dL e) Total cholesterol level of 180 mg/dL f) LDL level of 120 mg/dL

a) Total cholesterol level of 220 mg/dL d) LDL level of 140 md/dL A total cholesterol level over 200 mg/dL and LDL level above 130 mg/dL are considered high and would support the diagnosis of dyslipidemia. Total cholesterol levels between 170 to 199 mg/dL and LDL levels between 110 to 129 mg/dL are considered borderline. Total cholesterol levels less than 170 mg/dL and LDL levels less than 110 mg/dL are acceptable in children

Nursing students are reviewing information about the different types of congenital heart defects. They demonstrate understanding of the information when they identify which of these as disorders with increased pulmonary blood flow? Select all that apply. a) Ventricular septal defect b) Atrioventricular canal defect c) Coarctation of the aorta d) Pulmonary stenosis e) Patent ductus arteriosus

a) Ventricular septal defect b) Atrioventricular canal defect e) Patent ductus arteriosus Congenital heart defects classified as disorders with increased pulmonary blood flow include ventricular septal defect, patent ductus arteriosus, and atrioventricular canal defect. Pulmonary stenosis and coarctation of the aorta are classified as disorders with obstruction to blood flow.

After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding that: a) the contrast material used has a diuretic effect. b) the insertion of the catheter into the heart stimulates a diuretic response. c) the prolonged preprocedure fasting state places the child at risk for dehydration. d) blood loss during the procedure can be significant.

a) the contrast material used has a diuretic effect. The contrast material has a diuretic effect so the nurse assesses the child closely for signs and symptoms of dehydration and hypovolemia. Although blood loss can occur, this is not the reason for monitoring the child's fluid balance. Catheter insertion into the heart does not initiate a diuretic response. Typically, food and fluid is withheld for 4 to 6 hours before the procedure.

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe? Select all that apply. a) Ibuprofen b) Acetaminophen c) Intravenous immunoglobulin d) Aspirin e) Alprostadil

b) Acetaminophen c) Intravenous immunoglobulin d) Aspirin In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever. Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent in infants with ductal-dependent congenital heart defects.

A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the physician will most likely order which medication? a) Heparin b) Indomethacin c) Spironolactone d) Alprostadil

b) Indomethacin Indomethacin is the drug typically ordered to close a patent ductus arteriosus. Alprostadil would be indicated to maintain the ductus arteriosus temporarily in infants with ductal-dependent congenital heart defects. Heparin would be used for prophylaxis and treatment of thromboembolic disorders, especially after surgery. Spironolactone would be used to manage edema due to heart failure and to treat hypertension.

Which findings are major criteria used to help the physician diagnose acute rheumatic fever in a child? Select all that apply. a) Elevated erythrocyte sedimentation rate b) Pericarditis with the presence of a new heart murmur c) Painless nodules located on the wrists d) Heart block with a prolonged PR interval e) Temperature of 101.2° F(38.4° C)

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

The nurse assesses a child for clubbing. What would the nurse identify as the initial sign? a) Rounding of the fingers b) Softening of the nail beds c) Thickening of the nail ends d) Shininess of the nail ends

b) Softening of the nail beds The first sign of clubbing is softening of the nail beds followed by rounding of the fingernails, followed by shininess and thickening of the nail ends.

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure? a) "He does not seem sick." b) "He seems to have a normal appetite." c) "He gets sweaty when he eats." d) "He does not seem short of breath."

c) "He gets sweaty when he eats." Diaphoresis with nipple feeding indicates heart failure. Shortness of breath would suggest heart failure. Children with heart failure experience subtle signs that suggest that something is wrong. Children with heart failure often display subtle signs such as difficulty feeding.

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? a) 80 to 100/64 to 80 mm Hg b) 94 to 112/56 to 60 mm Hg c) 100 to 120/70 to 80 mm Hg d) 80 to 90/40 to 64 mm Hg

c) 100 to 120/70 to 80 mm Hg The normal adolescent's blood pressure averages 100 to 120/70 to 80 mm Hg. The average infant's blood pressure is about 80/55 mm Hg. The toddler or preschooler's blood pressure averages 90 to 110/55 to 75 mm Hg. The normal school-ager's blood pressure averages 100 to 120/60 to 75 mm Hg.

A group of nurses is reviewing the cardiovascular system and its function. Which statement is the most accurate regarding the cardiovascular system in the child? a) The heart rate of the child decreases if the child has a fever. b) The heart matures and functions like an adult's between 12 and 15 years of age. c) At birth, the right and left ventricle are about the same size. d) Between the ages of 5 and 6, the left ventricle grows to about two times the size of the right.

c) At birth, the right and left ventricle are about the same size. At birth, both the right and left ventricles are about the same size, but by a few months of age, the left ventricle is about two times the size of the right. If the infant has a fever, respiratory distress, or any increased need for oxygen, the pulse rate goes up to increase the cardiac output. Although the size is smaller, by the time the child is 5 years old, the heart has matured, developed, and functions just as the adult's heart.

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks she has noticed that the child seems to have lack of coordination. In addition she reports the child has had facial grimaces and repetitive involuntary movements. The signs the caregiver reports indicate the child has: a) Polyarthritis b) Carditis c) Chorea d) Arthralgia

c) 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

The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive heart failure. Which clinical manifestation would likely have been noted in the child with this diagnosis? a) Clubbing of the fingers b) Scissoring of the legs with toes pointed down c) Failure to gain weight d) Jerking movements of the arms and legs

c) Failure to gain weight In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and clubbing of the fingers is seen in cystic fibrosis.

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? a) Provide supplemental oxygen. b) Use a calm, comforting approach. c) Place the child in a knee-to-chest position. d) Administer propranolol (0.1 mg/kg IV).

c) Place the child in a knee-to-chest position. The priority nursing action is to place the infant or 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 ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen would be provided as ordered. Once a child is placed in the knee-to-chest position, medications would be given as ordered.

When caring for a child with Kawasaki disease, the nurse would know that: a) antibiotics should be administered exactly every 8 hours by IV. b) joint pain is a permanent problem. c) management includes administration of aspirin and IVIG. d) steroid creams are used for the hand peeling.

c) management includes administration of aspirin and IVIG. Kawasaki disease is managed with IVIG and aspirin to prevent cardiac complications. Joint pain is not necessarily a permanent problem associated with Kawasaki disease. Antibiotics and steroid creams are not used for this disorder.

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 to reduce the risk of this type of condition occurring in her baby. What information should the nurse mention to this client? a) "There is really nothing you can do." b) "Make sure that you encourage your child to exercise as he grows up." c) "Make sure you encourage a low-sodium diet in your child as he grows up." d) "Make sure you are fully immunized."

d) "Make sure you are fully immunized." The cause of congenital heart disease often cannot be documented, although it is associated with familial patterns of inheritance and possibly triggers such as rubella (German measles) and varicella (chickenpox) infection during pregnancy. Women need to enter pregnancy fully immunized to help prevent infection during pregnancy. Encouraging the child to eat a low-sodium diet and exercise as he grows up will help prevent acquired heart disease, not congenital heart disease.

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education? a) "The medication prostaglandin E1 is used to try to close the hole." b) "Surgery is usually performed in the first two months of life for this." c) "The medication indomethacin is used to try to close the hole." d) "Most infants do not need surgical repair for this."

d) "Most infants do not need surgical repair for this." Most infants do not need surgical repair for an ASD unless they are symptomatic. The hole will close spontaneously 87% of the time. The medication indomethacin is used to help close the opening of a PDA, and the medication prostaglandin E1 is used to keep a patent ductus arteriosus (PDA) open. These medications are not used for ASDs.

A child with heart failure is receiving supplemental oxygen. The nurse understands that in addition to improving oxygen saturation, this intervention also has what effect? a) Promote diuresis b) Increase pulmonary vascular resistance c) Mobilize secretions d) Cause vasodilation

d) Cause vasodilation Oxygen improves oxygen saturation and also functions as a vasodilator and decreases pulmonary vascular resistance. Diuretics promote dieresis. Chest physiotherapy helps to mobilize secretions.

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? a) Increased pulmonary blood flow b) Narrowing of the major vessel c) Mixing of well-oxygenated and poorly oxygenated blood d) Obstruction of blood flow to the lungs

d) Obstruction of blood flow to the lungs Tricuspid atresia is a congenital heart defect in which the valve between the right atrium and right ventricle fails to develop, resulting in no opening to allow blood to flow from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs. It is classified as a disorder of decreased pulmonary blood flow due to obstruction of blood flow to the lungs. Defects with connections involving the left and right sides, such as atrial or ventricular septal defects, will shunt blood from the higher-pressure left side to the lower-pressure right side and subsequently more blood will go to the lungs. A narrowed major vessel leads to an obstructive defect, interfering with the ability of the blood to flow freely through the vessel. Mixed defects such as transposition of the great vessels involve the mixing of well-oxygenated with poorly oxygenated blood, leading to a systemic blood flow that contains a lower oxygen content.

In developing a plan of care for the child diagnosed with rheumatic fever, the nursing intervention, which is the highest priority for this child, is to a) Position the child to relieve joint pain b) Provide age-appropriate diversional activities c) Monitor the C-reactive protein and ESR levels d) Promote rest periods and bed rest

d) Promote rest periods and bed rest As long as the rheumatic process is active, progressive heart damage is possible. To prevent heart damage, bed rest is essential to reduce the heart's work load. Laboratory tests for ESR and C-reactive protein can be used to evaluate disease activity and guide treatment, but they do not improve the child's health itself. The child's comfort is important, so it is essential to relieve joint pain and prevent injury with padded bed rails. But these measures are less important than rest when it comes to preventing long-term complications such as residual heart disease.

A parent is told 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 parent? a) This type of shunting causes a decrease of blood to the brain. b) This type of shunting causes an increase of blood to the systemic circulation. c) This type of shunting causes a decrease of blood to the lungs. d) This type of shunting causes an increase of blood to the lungs.

d) This type of shunting causes an increase of blood to the lungs. This type of shunting causes an increase of blood to the lungs. A right to left shunt causes an increase in blood to the systemic circulation that is mixed with deoxygenated blood.