cardiovascular

18. A 2-month-old with TOF is seen in your clinic for a check-up. During the examination, the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.

18. 1. Laying the child flat would increase preload, increasing blood to the heart, therefore making respiratory distress worse. 2. Laying the child flat with legs elevated would increase preload, increasing blood to heart, therefore making respiratory distress worse. 3. Sitting the child on the parent's lap with legs dangling might possibly help, but it would not be as effective as the knee-chest position in occluding the venous return. 4. The increase in the SVR would increase afterload and increase blood return to the pulmonary artery. TEST-TAKING HINT: The test taker should choose the response that decreases the preload in this patient.

19. Hypoxic spells in the infant with CHD can cause which of the following? Select all that apply. 1. Polycythemia. 2. Blood clots. 3. CVA. 4. Developmental delays. 5. Viral pericarditis. 6. Brain damage. 7. Alkalosis.

19. 1, 2, 3, 4, 6. 1. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 2. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 3. Hypoxia causes polycythemia, which can lead to increased blood viscosity, which can lead to blood clots and a stroke. 4. Developmental delays can be caused by multiple hospitalizations and surgeries. The child usually catches up to the appropriate level. 5. Hypoxia can increase the risk for bacterial endocarditis, not viral pericarditis. 6. Brain damage can be caused by hypoxia, blood clots, and stroke. 7. Hypoxic episodes cause acidosis, not alkalosis. TEST-TAKING HINT: Consider hypoxia and hemoglobin B and hematocrit level.

2. A newborn is diagnosed with a CHD. The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.

2. PDA. TEST-TAKING HINT: This is a defect with increased pulmonary flow. It should close in the first few weeks of life.

27. While looking through the chart of an infant with a CHD of decreased pulmonary blood flow, the nurse would expect what laboratory finding? 1. Decreased platelet count. 2. Polycythemia. 3. Decreased ferritin level. 4. Shift to the left.

27. 1. The nurse should expect a decreased platelet count in an infant with a CHD of decreased pulmonary blood flow. 2. Polycythemia is the result of the body attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood cells to carry the oxygen. 3. Ferritin measures the amount of iron stored in the body and not affected by decreased pulmonary blood flow. 4. "Shift to the left" refers to an increase in the number of immature white blood cells. TEST-TAKING HINT: The test taker needs to know what laboratory values hypoxia can affect.

28. The nurse is caring for a 9-month-old who was born with a CHD. Assessment reveals an HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of ___________________.

28. CHF. TEST-TAKING HINT: All of these are signs of pump failure. The infant is likely to have diaphoresis only on the scalp. The signs are not unlike those of an adult with this condition.

30. The nurse is caring for a preschool female diagnosed with CHF. She is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse suspects which laboratory finding? 1. Hypokalemia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypophosphatemia.

30. 1. The rubbing of the child's eyes may mean that she is seeing halos around the lights, indicating digoxin toxicity. The HR, slow for her age, also indicates digoxin toxicity. A decrease in serum potassium because of the furosemide can increase the risk for digoxin toxicity. 2. Hypomagnesemia does not affect digoxin and is not related to the child rubbing her eyes. 3. Hypocalcemia does not affect digoxin and is not related to the child rubbing her eyes. 4. Hypophosphatemia does not affect digoxin and is not related to the child rubbing her eyes. TEST-TAKING HINT: The test taker needs to know that furosemide causes the loss of potassium and can cause digoxin toxicity.

31. A 2-month-old is being treated with furosemide for CHF. Which of the following plans would also be appropriate in helping to control the CHF? 1. Promoting fluid restriction. 2. Feeding a low-salt formula. 3. Feeding in semi-Fowler position. 4. Encouraging breast milk.

31. 1. The nurse would not need to restrict fluids, as the child likely would not be getting overloaded with oral fluids. 2. The infant likely will have sodium depletion because of the chronic diuretic use; the infant needs a normal source of sodium, so low-sodium formula would not be used. 3. The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so fluid in the lungs can go to the base of the lungs, allowing better expansion. 4. Breast milk has slightly less sodium than formula, and the child needs a normal source of sodium because of the diuretic. TEST-TAKING HINT: Infants are not able to concentrate urine well and may have sodium depletion, so they need a normal source of sodium.

33. A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess: 1. Pain. 2. Pulses. 3. Hemoglobin and hematocrit levels. 4. Catheterization report.

33. 1. Pain needs to be assessed post procedure but is not the priority. 2. Checking for pulses, especially in the canulated extremity, would assure perfusion to that extremity and is the priority post procedure. 3. Hemoglobin and hematocrit levels would be checked post procedure if the child had bled very much during or after the procedure. 4. The catheterization report would be of interest to know what was determined from the procedure. This would also be good to check on the patient post procedure. TEST-TAKING HINT: The test taker would know that the priority is assessing the cannulated extremity checking for adequate perfusion.

34. Which statement by the mother of a male toddler with RF shows she has good understanding of the care of her child? 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him the aspirin that is ordered for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain."

34. 1. During the acute phase, limit any manipulation of the joint, and avoid heat or cold. 2. During the acute phase, limit any manipulation of the joint, and avoid heat or cold. 3. Aspirin is the drug of choice for treatment of RF. 4. During the acute phase, limit any manipulation of the joint, and avoid heat or cold. TEST-TAKING HINT: The test taker should know that aspirin is the drug of choice and that manipulation of the joint should be limited during the acute phase.

The school-aged female for whom you are caring has been diagnosed with valvular disease following RF. During patient teaching, you discuss the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."

35. 1. This could be true for a patient with a less severe form of RF. 2. This could be true for a patient with a less severe form of RF. 3. This could be true for a patient with a less severe form of RF. 4. Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life. TEST-TAKING HINT: The test taker would know that the severity of the damage to the heart valves determines how long prophylaxic antibiotics will be administered.

412. The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF? 1. Pallor 2. Cough 3. Tachycardia 4. Slow and shallow breathing

412. 3 Rationale: HF is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. The early signs ofHF include tachycardia, tachypnea, profuse scalp sweating, fatigue and irritability, sudden weight gain, and respiratory distress. A cough may occur in HF as a result of mucosal swelling and irritation, but is not an early sign. Pallor may be noted in an infant with HF, but is not an early sign. Test-Taking Strategy: Note the strategic word, early. Think about the physiology and the effects on the heart when fluid overload occurs. These concepts will assist in directing you to the correct option. Review: Early signs of h eart failure in the infant Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Content Area: Pediatrics—Cardiovascular Priority Concepts: Clinical Judgment; Perfusion Reference: Hockenberry, Wilson (2015), p. 1268.

413. The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? 1. Immunoglobulin 2. Red blood cell count 3. White blood cell count 4. Anti-streptolysin O titer

413. 4 Rationale: Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and central nervous system. Adiagnosis of rheumatic fever is confirmed by the presence of 2 major manifestations or 1 major and 2 minor manifestations from the Jones criteria. In addition, evidence of a recent streptococcal infection is confirmed by a positive anti- streptolysin O titer, Streptozyme assay, or anti-DNase B assay. Options 1, 2, and 3 would not help to confirm the diagnosis of rheumatic fever. Test-Taking Strategy: Focus on the subject, definitive diagnosis of rheumatic fever. Recalling that rheumatic fever characteristically is associated with streptococcal infection will direct you to the correct option. Review: Rheumatic fever Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Analysis Content Area: Pediatrics—Cardiovascular Priority Concepts: Clinical Judgment; Inflammation Reference: Hockenberry, Wilson (2015), pp. 1296-1297

415. The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? 1. "I will not mix the medication with food." 2. "I will take my child's pulse before administering the medication." 3. "If more than 1 dose is missed, I will call the health care provider." 4. "If my child vomits after medication administration, I will repeat the dose."

415. 4 Rationa le: Digoxin is a cardiac glycoside. The parents need to be instructed that if the child vomits after digoxin is administered, they are not to repeat the dose. Options 1, 2, and 3 are accurate instructions regarding the administration of this medication. In addition, the parents should be instructed that if a dose ismissed and is not identified until 4 hours later, the dose should not be administered. Test-Taking Strategy: Note the strategic words, need for further instruction. These words indicate a n egative event query and ask you to select an option that is an incorrect statement. General knowledge regarding digoxin administration will assist in eliminating option 3. Principles related to administering medications to children will assist in eliminating option 1. From the remaining options, select the correct option because if the child vomits, it would be difficult to determine whether the medication also was vomited or was absorbed by the body. Review: Guidelines for administration of digoxin Level of Cognitive Ability: Evaluating Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Content Area: Pediatrics—Cardiovascular Priority Concepts: Client Education; Safety Reference: Hockenberry, Wilson (2015), p. 1270.

416. The nurse is closelymonitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output? 1. Weighing the diapers 2. Inserting a urinary catheter 3. Comparing intake with output 4. Measuring the amount of water added to formula

416. 1 Rationale: Heart failure is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. The most appropriate method for assessing urine output in an infant receiving diuretic therapy is to weigh the diapers. Comparing intake with output would not provide an accurate measure of urine output. Measuring the amount of water added to formula is unrelated to the amount of output. Although urinary catheter drainage is most accurate in determining output, it is not the most appropriate method in an infant and places the infant at risk for infection. Test-Taking Strategy: Note the strategic words, most appropriate. Eliminate options 3 and 4 first because they are comparable or alike and will not provide an indication of urine output. Noting the strategic words will direct you to the correct option from the remaining options. Review: Care of an infant receiving diuretic therapy Level of Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Content Area: Pediatrics—Cardiovascular Priority Concepts: Clinical Judgment; Perfusion Reference: Hockenberry, Wilson (2015), pp. 957-958, 1271.

417. The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? 1. Pallor 2. Hyperactivity 3. Exercise intolerance 4. Gastrointestinal disturbances

417. 3 Rationale: Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Achild with aortic stenosis shows signs of exercise intolerance, chest pain, and dizziness when standing for long periods. Pallor may be noted, but is not specific to this type of disorder alone. Options 2 and 4 are not related to this disorder. Test-Taking Strategy: Focus on the subject, the characteristics of aortic stenosis. Options 2 and 4 can be eliminated first because they are not associated with a cardiac disorder. From the remaining options, noting the word specifically in the question will direct you to the correct option. Review: Aortic stenosis Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Content Area: Pediatrics—Cardiovascular Priority Concepts: Elimination; Perfusion Reference: Hockenberry, Wilson (2015), p. 1291

418. The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a n eed for further instruction? 1. "A balance of rest and exercise is important." 2. "I can apply lotion or powder to the incision if it is itchy." 3. "Activities in which my child could fall need to be avoided for 2 to 4 weeks." 4. "Large crowds of people need to be avoided for at least 2 weeks after surgery."

418. 2 Rationale: The mother should be instructed that lotions and powders should not be applied to the incision site after cardiac surgery. Lotions and powders can irritate the surrounding skin, which could lead to skin breakdown and subsequent infection of the incision site.Options 1, 3, and 4 are accurate instructions regarding home care after cardiac surgery. Test-Taking Strategy: Note the strategic words, need for further instruction. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Using general principles related to postoperative incisional site care will direct you to the correct option. Review: Home care instructions following cardiac surgery Level of Cognitive Ability: Evaluating Client Needs: Physiological Integrity Integrated Process: Teaching and Learning Content Area: Pediatrics—Cardiovascular Priority Concepts: Client Education; Health Promotion Reference: Hockenberry, Wilson (2015), p. 1224.

419. A child with rheumatic fever will be arriving to the nursing unit for admission. On admission assessment, the nurse should ask the parentswhich question to elicit assessment information specific to the development of rheumatic fever? 1. "Has the child complained of back pain?" 2. "Has the child complained of headaches?" 3. "Has the child had any nausea or vomiting?" 4. "Did the child have a sore throat or fever within the last 2 months?"

419. 4 Rationale: Rheumatic fever is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and central nervous system. Rheumatic fever characteristically manifests 2 to 6 weeks after an untreated or partially treated group A β-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child had a sore throat or an unexplained fever within the past 2 months. Options 1, 2, and 3 are unrelated to rheumatic fever. Test-Taking Strategy: Focus on the subject, the pathophysiology and etiology associated with rheumatic fever. Also, note the similarity between the words rheumatic fever in the question and the word fever in the correct option. Review: Etiology related to rheumatic fever Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Assessment Content Area: Pediatrics—Cardiovascular Priority Concepts: Clinical Judgment; Inflammation Reference: Hockenberry, Wilson (2015), pp. 1296-1297.

42. A nursing action that promotes ideal nutrition in an infant with CHF is: 1. Feeding formula that is supplemented with additional calories. 2. Allowing the infant to nurse at each breast for 20 minutes. 3. Providing large feedings every 5 hours. 4. Using firm nipples with small openings to slow feedings.

42. 1. Formula can be supplemented with extra calories, either from a commercial supplement, such as Polycose, or from corn syrup. Calories in formula would increase from 20 kcal/oz to 30 kcal/oz or more. 2. The infant would get too tired while feeding, while increasing cardiac demand. Limit feeding to a half hour. 3. Smaller feedings more often, such as every 2 to 3 hours, would decrease cardiac demand. 4. Soft nipples that are easy for the infant to suck would make for less work getting nutrition. TEST-TAKING HINT: Allow the child to get the most nutrition most effectively.

420. A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen to the infant? 1. During sleep 2. When changing the infant's diapers 3. When the mother is holding the infant 4. When drawing blood for electrolyte level testing

420. 4 Rationale: Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. Crying exhausts the limited energy supply, increases the workload of the heart, and increases the oxygen demands. Oxygen administration may be prescribed for stressful periods, especially during bouts of crying or invasive procedures. Options 1, 2, and 3 are not likely to produce crying in the infant. Test-Taking Strategy: Focus on the subject, the need to administer oxygen to the infant with HF, and recall the situations that would place stress and an increased workload on the heart; this should direct you to the correct option. Drawing blood is an invasive procedure, which would likely cause the infant to cry. Review: Care of the child with h eart failure Level of Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process—Implementation Content Area: Pediatrics—Cardiovascular Priority Concepts: Clinical Judgment; Perfusion Reference: Hockenberry, Wilson (2015), p. 1267.

44. The nurse is caring for a 1-year-old who has been diagnosed with CHF. Treatment began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear and equal bilaterally, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is: 1. 0.5 cc/kg/hr 2. 1 cc/kg/hr 3. 30 cc/hr 4. 1 oz/hr

44. 1. This is incorrect because 0.5 cc/kg/hr is below the normal pediatric output. 2. Normal pediatric urine output is 1 cc/kg/hr. 3. This is incorrect because 30 cc/hr is above the normal pediatric output. 4. This is incorrect because 1 oz/hr is above the normal pediatric output. TEST-TAKING HINT: The test taker needs to know that normal urine output for a child is 1 cc/kg/hr.

45. A 3-month-old has been diagnosed with a VSD. The flow of blood through the heart with this type of defect is: 1. Right to left. 2. Equal between the two chambers. 3. Left to right. 4. Bypassing the defect.

45. 1. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. 2. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. 3. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. 4. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. TEST-TAKING HINT: The test taker should know that the classification for this defect is left to right.

46. The nurse is caring for a 3-month-old with a VSD. The physicians have decided not to repair it surgically. The parents express concern that this is not best for their child and ask why their daughter will not have an operation. The nurse's best response to the parents is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your daughter's defect is small and will likely close on its own by the time she is 2 years old." 3. "It is common for the physicians to wait until an infant develops respiratory distress before they do the surgery because of the danger." 4. "With a small defect like this, we will wait until the child is 10 years old to do the surgery."

46. 1. This is not a collegial response, and the nurse should explain to the parents why an operation is not necessary now. 2. Usually a VSD will close on its own within the first year of life. 3. It is not common for physicians to wait until respiratory distress develops because that puts the infant at greater risk for complications. The defect is small and will likely close on its own. 4. Small defects usually close on their own within the first year. TEST-TAKING HINT: Know the various treatments depending on size of the defect. VSD is the most common CHD.

47. A 5-month-old has been diagnosed with an ASD. The flow of blood through the heart with this type of defect is: 1. Right to left. 2. Equal between the two chambers. 3. Left to right. 4. Bypassing the defect.

47. 1. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. 2. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. 3. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. 4. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood. TEST-TAKING HINT: What is the CHD classification of ASD?

48. An infant has been diagnosed with an ASD, or AVC defect. The flow of blood through the heart with this type of defect is: 1. Right to left. 2. Equal between the two chambers. 3. Bypassing the defect. 4. In either direction.

48. 1. The blood flow generally is left to right. 2. There is blood flow between all the chambers. 3. The blood flow is dependent on the pulmonary and systemic circulations. 4. The blood flow can be in any direction but generally is left to right. TEST-TAKING HINT: What is the CHD classification of AVC?

5. An infant with CHF is receiving digoxin to enhance myocardial function. What should the nurse assess prior to administering the medication? 1. Yellow sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.

5. 1. Yellow sclera has nothing to do with CHF. It is seen in patients with liver disease. 2. The apical pulse rate is ordered because digoxin decreases the HR, and if the HR is <60 digoxin should not be administered. 3. Cough would not be assessed before administration. It is more commonly seen in patients who have been prescribed ACE inhibitors. 4. Liver function tests are not assessed before digoxin is administered. Digoxin can lower HR and cause dysrhythmias. TEST-TAKING HINT: The test taker should know that yellow sclera and liver function tests have nothing to do with digoxin. Cough could be associated with ACE inhibitors.

51. Which medication should the nurse give to a patient who is diagnosed with transposition of the great vessels? 1. Ibuprofen. 2. Betamethasone. 3. Prostaglandin E. 4. Indocin.

51. 1. Ibuprofen blocks prostaglandins, which would speed up the closing of the PDA. 2. Betamethasone blocks prostaglandins, which would speed up the closing of the PDA. 3. Prostaglandin E inhibits closing of the PDA, which connects the aorta and pulmonary artery. 4. Indocin is used to treat osteoarthritis and gout. TEST-TAKING HINT: The test taker would know that children who have transposition of the great vessels also have another cardiac defect, and the common one is PDA.

52. Which statement by the mother of a patient with RF shows she has an understanding of prevention in her other children? 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A streptococcus, I will give them their antibiotic." 4. "If their culture is positive for staphylococcus A, I will give them their antibiotic."

52. 1. Do not use an antibiotic if the disease is not bacterial in origin. Some sore throats are viral. 2. RF is caused by group A beta-hemolytic streptococcus, and the drug of choice is penicillin. RF is a bacterial infection and is treated by antibiotic. 3. RF is caused by a streptococcus infection, not by staphylococcus. 4. RF is cause by a streptococcus infection, not by staphylococcus. TEST-TAKING HINT: The test taker needs to know the cause of RF and how it is treated.

54. What two physiological changes occur as a result of hypoxemia in CHF? 1. Polycythemia and clubbing. 2. Anemia and barrel chest. 3. Increased white blood cells and low platelets. 4. Elevated erythrocyte sedimentation rate and peripheral edema.

54. 1. The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia. 2. Anemia and barrel chest do not occur as a result of hypoxemia. Hypoxemia stimulates the production of erythropoietin to increase the number of red blood cells to carry more oxygen. The barrel chest is the result of air trapping. 3. Increased white blood cells occur as the result of an infection, not hypoxemia. Hypoxemia does not cause a decreased number of platelets. 4. An elevated erythrocyte sedimentation rate is the result of inflammation in the body. Peripheral edema can be caused by CHF. TEST-TAKING HINT: The test taker could eliminate answers 2, 3, and 4 by knowing that they do not cause hypoxemia in CHF.

55. Aspirin has been ordered for the child with RF in order to: 1. Keep the PDA open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis.

55. 1. Aspirin is not used to treat this condition. A PDA does not occur with RF. 2. Joint inflammation is experienced in RF; aspirin therapy helps with inflammation and pain. 3. Strawberry tongue is manifested in KD; aspirin is not used to treat this disease. 4. Aspirin is not used to treat this condition. TEST-TAKING HINT: Know the manifestations of RF.

58. During play, a toddler with a history of TOF might assume which of the following positions? 1. Sitting. 2. Supine. 3. Squatting. 4. Left lateral recumbent.

58. 1. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. This occurs with squatting. 2. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. This occurs with squatting. 3. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. 4. The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow. TEST-TAKING HINT: The child self-assumes this position during the spell.

6. Which statement by the mother of an infant boy with CHF who is being sent home on digoxin indicates she needs further education on the care of her child? 1. "I will give him the medication at regular 12-hour intervals." 2. "If he vomits, I will not give him a make-up dose." 3. "If I miss a dose, I will not give an extra dose, but keep him on his same schedule." 4. "I will mix the digoxin in some of his formula to make it taste better for him."

6. 1. This is appropriate for digoxin administration. 2. This is appropriate for digoxin administration. 3. This is appropriate for digoxin administration. 4. If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate. TEST-TAKING HINT: What if the child does not drink all the formula?

61. Which of the following assessments indicate that the parents of a 7-year-old are following the prescribed treatment for CHF? 1. HR of 56 beats per minute. 2. Elevated red blood cell count. 3. 50th percentile height and weight for age. 4. Urine output of 0.5 cc/kg/hr.

61. 1. HR of 56 beats per minute is likely due to digoxin toxicity. 2. Elevated count of red blood cells indicate polycythemia secondary to hypoxemia. 3. The 50th percentile height and weight for age shows good growth and development, indicating good nutrition and perfusion. 4. Urine output of 0.5 cc/kg/hr indicate that furosemide is not being given as ordered; the output is too low. TEST-TAKING HINT: The test taker should know the expected responses of medications used to treat CHF.

7. A 1-year-old child is being prepared for a cardiac catheterization procedure. Which of the following findings about the child might delay the procedure? 1. 30th percentile for weight. 2. Severe diaper rash. 3. Allergy to soy. 4. Oxygen saturation of 91% on room air.

7. 1. This may be a reason the child needs the catheterization. 2. A child with severe diaper rash has potential for infection if the interventionist makes the standard groin approach. 3. Shellfish, not soy, is an allergy concern. 4. This may be a reason the child needs the catheterization. TEST-TAKING HINT: Consider the risk for infection as a delaying factor.

8. The nurse is caring for a child who has undergone cardiac catheterization. During the recovery phase, the nurse notices the dressing is saturated with bright red blood and a 6-inch circle of blood on the crib sheet. The nurse's first action is to: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.

8. 1. This is not an appropriate action. 2. This is not an appropriate action. 3. This can be done after number 4. 4. Applying direct pressure 1 inch above the puncture site will localize pressure over the vessel site. TEST-TAKING HINT: Consider the risk for volume depletion.

9. The nurse is caring for an infant with CHF. The following are interventions to decrease cardiac demands on the infant. Select all that apply. 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities

9. 1, 4, 5, 6, 7. 1. Rocking by the parents will comfort the infant and decrease demands. 2. The infant would not be fed when crying because crying increases cardiac demands. The infant might choke if the nipple is placed in the mouth and the child inhales when trying to swallow. 3. Keep the child normothermic to reduce metabolic demands. 4. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. 5. An infant sucking the fists could indicate hunger. 6. Change bed linens only when necessary to avoid disturbing the child. 7. Organize nursing activities to avoid disturbing the child. TEST-TAKING HINT: Do all that can be done to decrease demands on the child.

1. A nurse is caring for an infant. Which of the following are clinical manifestations of coarctation of the aorta? (Select all that apply.) A. Weak femoral pulses B. Cool skin of lower extremities C. Severe cyanosis D. Clubbing of the fingers E. Heart failure

A. CORRECT: Narrowing of the lumen of the aorta results in obstruction of blood flow from the ventricle, resulting in weak or absent femoral pulses. B. CORRECT: Narrowing of the lumen of the aorta results in obstruction of blood flow from the ventricle, resulting in cool skin of the lower extremities. C. INCORRECT: A client who has coarctation of the aorta exhibits adequate oxygenation of blood. Therefore, severe cyanosis is not present. D. INCORRECT: Clubbing of the fingers is a clinical manifestation of chronic hypoxemia and will not be observed in an infant who has coarctation of the aorta. E. CORRECT: Heart failure occurs when the heart is unable to meet the body's demands, and is a clinical manifestation of coarctation of the aorta. NCLEX® Connection: Physiological Adaptations, Pathophysiology

5. A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following manifestations support this diagnosis? (Select all that apply.) A. Erythema marginatum (rash) B. Continuous joint pain of the digits C. Tender, subcutaneous nodules D. Decreased erythrocyte sedimentation rate E. Elevated C-reactive protein

A. CORRECT: Rheumatic fever is caused by Group A β-hemolytic streptococcus. An erythema marginatum (rash) is a clinical manifestation. B. INCORRECT: A client who has rheumatic fever exhibits migratory joint pain of the large joints. C. INCORRECT: A client who has rheumatic fever exhibits nontender subcutaneous nodules of bony prominences. D. INCORRECT: Rheumatic fever is caused by Group A β-hemolytic streptococcus, which results in an elevated erythrocyte sedimentation rate. E. CORRECT: Rheumatic fever is caused by Group A β-hemolytic streptococcus. An increase in C-reactive protein is a clinical manifestation. NCLEX® Connection: Physiological Adaptations, Pathophysiology

2. A nurse is assessing an infant. Which of the following should the nurse recognize as clinical manifestations of heart failure? (Select all that apply.) A. Bradycardia B. Cool extremities C. Peripheral edema D. Increased urinary output E. Nasal flaring

A. INCORRECT: A client who has heart failure will exhibit tachycardia as the heart attempts to meet the body's demands. B. CORRECT: A client who has heart failure will exhibit cool extremities as the heart is unable to adequately circulate oxygenated blood. C. CORRECT: A client who has heart failure will exhibit peripheral edema as the heart is unable to adequately circulate blood through the body and back to the heart. D. INCORRECT: With heart failure, the heart is unable to keep up with the body's demands. A decrease in urinary output is a clinical manifestation of heart failure. E. CORRECT: A client who has heart failure will exhibit nasal flaring due to inadequate oxygenation of blood. NCLEX® Connection: Physiological Adaptations, Pathophysiology

3. A nurse is providing teaching to the mother of an infant who is to start taking digoxin (Lanoxin). Which of the following instructions should the nurse include? A. "Do not offer your baby fluids after giving the medication." B. "Digoxin increases your baby's heart rate." C. "Give the correct dose of medication at regularly scheduled times." D. "If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount."

A. INCORRECT: Digoxin can be given without regard to food or fluids. B. INCORRECT: Digoxin slows the heart rate by increasing contractility of the heart. C. CORRECT: The correct amount of digoxin should be administered at regularly scheduled times to maintain therapeutic blood levels. D. INCORRECT: It is not recommended to repeat digoxin following an emesis because it is impossible to determine how much medication was lost. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration

4. A nurse is caring for a 2-year-old child who is cyanotic and is in the hospital for a cardiac catheterization to repair cardiac defects. The child will be transferred to the pediatric ICU following the procedure. Which of the following is an appropriate nursing action when providing care to this child? A. Place on NPO status for 12 hr prior to the procedure. B. Check for iodine or shellfish allergies prior to the procedure. C. Elevate the affected extremity following the procedure. D. Limit fluid intake following the procedure

A. INCORRECT: The child should remain NPO 4 to 6 hr prior to the procedure. B. CORRECT: Iodine-based dyes may be used in this procedure, so the child is assessed for allergies to iodine or shellfish which could lead to anaphylaxis. C. INCORRECT: The affected extremity should be maintained in a straight position following the procedure. D. INCORRECT: Fluids should be encouraged after the procedure to maintain adequate urine output and promote excretion of the dye. NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests

What is the nurse's first action when planning to teach the parents of an infant with a CHD? a. Assess the parents' anxiety level and readiness to learn. b. Gather literature for the parents. c. Secure a quiet place for teaching. d. Discuss the plan with the nursing team.

ANS: A Any effort to organize the right environment, plan, or literature is of no use if the parents are not ready to learn or have high anxiety. Decreasing level of anxiety is often needed before new information can be processed. A baseline assessment of prior knowledge should be taken into consideration before developing any teaching plan. Locating a quiet place for meeting with parents is appropriate; however, an assessment should be done before any teaching is done. Discussing a teaching plan with the nursing team is appropriate after an assessment of the parents' knowledge and readiness. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1085 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

A beneficial effect of administering digoxin is that it a. decreases edema. b. decreases cardiac output. c. increases heart size. d. increases venous pressure.

ANS: A Digoxin improves cardiac output, which will lead to decreased edema although it is not a diuretic. It does not increase heart size or increase venous pressure. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1083 OBJ: Nursing Process: Implementation MSC:Client Needs: Physiologic Integrity

What intervention should be included in the plan of care for an infant with the nursing diagnosis of excess fluid volume related to congestive heart failure? a. Weigh the infant every day on the same scale at the same time. b. Notify the physician when weight gain exceeds more than 20 g/day. c. Put the infant in a car seat to minimize movement. d. Administer digoxin as ordered by the physician.

ANS: A Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency. An excessive weight gain for an infant is an increase of more than 50 g/day. With fluid volume excess, skin will be edematous. The infant's position should be changed frequently to prevent undesirable pooling of fluid in certain areas. Digoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1084 OBJ: Nursing Process: Implementation MSC:Client Needs: Physiologic Integrity

A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality? a. Polycythemia b. Infection c. Dehydration d. Anemia

ANS: A Polycythemia is a compensatory response to chronic hypoxia. The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood. Infection, dehydration, and anemia are not clinical consequences of cyanosis. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1088 OBJ: Nursing Process: Assessment MSC:Client Needs: Physiologic Integrity

Before giving a dose of digoxin the nurse checked an infant's apical heart rate and it was 114 beats/minute. What should the nurse do next? a. Administer the dose as ordered. b. Hold the medication until the next dose. c. Wait and recheck the apical heart rate in 30 minutes. d. Notify the physician about the infant's heart rate.

ANS: A The infant's heart rate is above the lower limit for which the medication is held (100 beats/minute in an infant). The dose can be given. No other action is needed. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1084 OBJ: Nursing Process: Implementation MSC:Client Needs: Physiologic Integrity

The nurse discovers a heart murmur in an infant 1 hour after birth. What does the nurse know about when fetal shunts close in the neonate? a. When the umbilical cord is cut b. Within several days of birth c. Within a month after birth d. By the end of the first year of life

ANS: B In the normal neonate, fetal shunts functionally close in response to pressure changes in the systemic and pulmonary circulations and to increased oxygen content. This process may take several days to complete. With the neonate's first breath, gas exchange is transferred from the placenta to the lungs. The separation of the fetus from the umbilical cord does not contribute to the establishment of neonatal circulation. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1079 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Which statement best describes patent ductus arteriosus? a. Patent ductus arteriosus involves a defect that results in a right-to-left shunting of blood in the heart. b. Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close. c. Patent ductus arteriosus is a stenotic lesion that must be surgically corrected at birth. d. Patent ductus arteriosus causes an abnormal opening between the four chambers of the heart.

ANS: B Patent ductus arteriosus is failure of the fetal shunt between the aorta and the pulmonary artery to close. Patent ductus arteriosus allows blood to flow from the high-pressure aorta to the low-pressure pulmonary artery, resulting in a left-to-right shunt. Patent ductus arteriosus is not a stenotic lesion. Patent ductus arteriosus can be closed both medically and surgically. Atrioventricular defect occurs when fetal development of the endocardial cushions is disturbed, resulting in abnormalities in the atrial and ventricular septa and the atrioventricular valves. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1093 | Table 46.3 OBJ: Nursing Process: Assessment MSC:Client Needs: Physiologic Integrity

Which strategy is appropriate when feeding the infant with congestive heart failure? a. Continue the feeding until a sufficient amount of formula is taken. b. Limit feeding time to no more than 30 minutes. c. Always bottle feed every 4 hours. d. Feed larger volumes of concentrated formula less frequently.

ANS: B The infant with congestive heart failure may tire easily, so the feeding should not continue beyond 30 minutes. If inadequate amounts of formula are taken, gavage feedings should be considered. The infant is fed smaller volumes of concentrated formula every 3 hours. PTS: 1 DIF: Cognitive Level: Application REF: p. 1085 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

A child had an aortic stenosis defect surgically repaired 5 months ago. Which antibiotic prophylaxis is indicated for an upcoming tonsillectomy? a. No antibiotic prophylaxis is necessary. b. Amoxicillin is taken orally 1 hour before the procedure. c. Oral penicillin is given for 7 to 10 days before the procedure. d. Parenteral antibiotics are administered for 5 to 7 days after the procedure.

ANS: B The standard prophylactic agent is amoxicillin given orally 1 hour before the procedure. Antibiotic prophylaxis is indicated for the first 6 months after surgical repair. Antibiotic prophylaxis is not given for 7 to 10 days nor is it given parenterally. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1105 OBJ: Nursing Process: Planning MSC:Client Needs: Physiologic Integrity

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well? a. Recheck the infant's blood pressure. b. Alert the provider. c. Withhold oral feeding. d. Increase the oxygen rate.

ANS: B These are signs of early congestive heart failure, and the provider should be notified. Rechecking the blood pressure is not necessary. Withholding the infant's feeding is an incomplete response to the problem. Increasing oxygen may alleviate symptoms, but medications such as digoxin and furosemide are necessary to improve heart function and fluid retention. Notifying the provider is the priority nursing action. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1084 OBJ: Nursing Process: Implementation MSC:Client Needs: Physiologic Integrity

A nurse is conducting a class for nursing students about fetal circulation. Which statement is accurate about fetal circulation and should be included in the teaching session? a. Oxygen is carried to the fetus by the umbilical arteries. b. Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale. c. Pulmonary vascular resistance is high because the lungs are filled with fluid. d. Blood flows from the ductus arteriosus to the pulmonary artery.

ANS: C Resistance in the pulmonary circulation is very high because the lungs are collapsed and filled with fluid. Oxygen and nutrients are carried to the fetus by the umbilical vein. The inferior vena cava empties blood into the right atrium. The direction of blood flow and the pressure in the right atrium propel most of this blood through the foramen ovale into the left atrium. Most of the blood in the pulmonary artery flows though the ductus arteriosus into the descending aorta. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1079 OBJ: Integrated Process: Teaching-Learning MSC:Client Needs: Physiologic Integrity

When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure? a. The right arm b. The left arm c. All four extremities d. Both arms while the child is crying

ANS: C When a CHD is suspected, the blood pressure should be measured in all four extremities while the child is quiet. Discrepancies between upper and lower extremities may indicate cardiac disease. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1091 | Table 46.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if which conditions occur? (Select all that apply.) a. Respiratory rate of 36 at rest b. Appetite slowly increasing c. Temperature above 37.7° C (100° F) d. New, frequent coughing e. Turning blue or bluer than normal

ANS: C, D, E The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C; new, frequent coughing; and any episodes of the infant turning blue or bluer than normal. A respiratory rate of 36 at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1104 | Patient-Centered Teaching Box OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

The nurse caring for a child diagnosed with acute rheumatic fever should assess the child for which of the following? a. Sore throat b. Elevated blood pressure c. Desquamation of the fingers and toes d. Tender, warm, inflamed joints

ANS: D Arthritis, characterized by tender, warm, erythematous joints, is one of the major manifestations of acute rheumatic fever in the first 1 to 2 weeks of the illness. The child may have had a sore throat previously associated with a group A beta-hemolytic streptococcal infection a few weeks earlier. A sore throat is not a manifestation of rheumatic fever. Hypertension is not associated with rheumatic fever. Desquamation of the fingers and toes is a manifestation of Kawasaki syndrome. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1109 OBJ: Nursing Process: Assessment MSC:Client Needs: Physiologic Integrity

A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic? a. Place the infant in a knee-chest position. b. Administer oxygen. c. Administer morphine sulfate. d. Calm the infant.

ANS: D Calming the crying infant is the first response. An infant with unrepaired tetralogy of Fallot who is crying and agitated may eventually lose consciousness. Placing the infant in a knee-chest position will decrease venous return so that smaller amounts of highly saturated blood reach the heart. This should be done after calming the infant. Administering oxygen is indicated after placing the infant in a knee-chest position. Administering morphine sulfate calms the infant and depresses respirations. It may be indicated sometime after the infant has been calmed. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1088 OBJ: Nursing Process: Implementation MSC:Client Needs: Physiologic Integrity

A common, serious complication of rheumatic fever is a. seizures. b. cardiac dysrhythmias. c. pulmonary hypertension. d. cardiac valve damage.

ANS: D Cardiac valve damage is the most significant complication of rheumatic fever. The other three are not common complications of rheumatic fever. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1109 OBJ: Nursing Process: Assessment MSC:Client Needs: Physiologic Integrity

Which statement suggests that a parent understands how to correctly administer digoxin? a. "I measure the amount I am supposed to give with a teaspoon." b. "I put the medicine in the baby's bottle." c. "When she spits up right after I give the medicine, I give her another dose." d. "I give the medicine at 8 in the morning and evening every day."

ANS: D For maximum effectiveness, the medication should be given at the same time every day. The maintenance dose is given in two divided doses daily. To ensure the correct dosage, the medication should be measured with a syringe. To prevent toxicity, the parent should not repeat the dose without contacting the child's physician. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1083 OBJ: Nursing Process: Evaluation MSC:Client Needs: Physiologic Integrity

Nursing care for the child in congestive heart failure includes which of the following activities? a. Counting the number of saturated diapers b. Putting the infant in the Trendelenburg position c. Removing oxygen while the infant is crying d. Organizing care to provide rest periods

ANS: D Nursing care should be planned to allow for periods of undisturbed rest. Diapers must be weighed for an accurate record of output. The head of the bed should be raised to decrease the work of breathing. Oxygen should be administered during stressful periods such as when the child is crying if needed. PTS: 1 DIF: Cognitive Level: Application REF: p. 1084 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

Which statement made by a parent indicates understanding of restrictions for a child after cardiac surgery? a. "My child needs to go to bed early for a few weeks." b. "My son is really looking forward to riding his bike next week." c. "I'm so glad we can attend religious services as a family this coming Sunday." d. "I am going to keep my child out of day care for 6 weeks."

ANS: D Settings where large groups of people are present should be avoided for 4 to 6 weeks after discharge, including day care and other public places such as churches. The child should resume his regular bedtime and sleep schedule after discharge. Due to fatigue, the child may initially need some naps during the day. PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating REF: p. 1104 | Patient-Centered Teaching Box OBJ: Nursing Process: Evaluation MSC:Client Needs: Physiologic Integrity

Which information should be included in the nurse's discharge instructions for a child who underwent a cardiac catheterization earlier in the day? a. Pressure dressing is changed daily for the first week. b. The child may soak in the tub beginning tomorrow. c. Contact sports can be resumed in 2 days. d. The child can return to school on the third day after the procedure.

ANS: D The child can generally return to school on the third day after the procedure. The day after the cardiac catheterization, the pressure dressing is removed and replaced with a Band-Aid. Bathing is limited to a shower, a sponge bath, or a brief tub bath (no soaking) for the first 1 to 3 days after the procedure. Strenuous exercise such as contact sports, swimming, or climbing trees is avoided for up to 1 week after the procedure. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 1092 OBJ: Nursing Process: Implementation MSC:Client Needs: Physiologic Integrity

Which postoperative intervention should be questioned for a child after a cardiac catheterization? a. Continue intravenous (IV) fluids until the infant is tolerating oral fluids. b. Check the dressing for bleeding. c. Assess peripheral circulation on the affected extremity. d. Keep the affected leg flexed and elevated.

ANS: D The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure. The other interventions are appropriate. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 1092 OBJ: Nursing Process: Implementation MSC:Client Needs: Physiologic Integrity

What is an expected assessment finding in a child with coarctation of the aorta? a. Orthostatic hypotension b. Systolic hypertension in the lower extremities c. Blood pressure higher on the left side of the body d. Disparity in blood pressure between the upper and lower extremities

ANS: D The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities. Orthostatic hypotension is not present with coarctation of the aorta. Systolic hypertension may be detected in the upper extremities. The left arm may not accurately reflect systolic hypertension because the left subclavian artery can be involved in the coarctation. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 1091 | Table 46.2 OBJ: Nursing Process: Assessment MSC:Client Needs: Physiologic Integrity