Chapter 19: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Care of the Child with a Cardiovascular Disorder

The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant's heart rate? a) 70 to 80 bpm b) 90 to 160 bpm c) 60 to 68 bpm d) 80 to 105 bpm

90 to 160 bpm The normal infant heart rate averages 90 to 160 beats per minute (bpm); the toddler's or preschooler's is 80 to 115, the school-age child's is 60 to 100 bpm.

A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify what as a major Jones criterion? a) Subcutaneous nodules b) Erythema marginatum c) Arthralgia d) Carditis

Arthralgia Arthralgia is considered a minor criterion. Carditis , Erythema marginatum, and Subcutaneous nodules are considered a major criterion.

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which of the following assessment findings would the nurse expect to note?

Bounding pulse Explanation: A bounding pulse is characteristic of patent ductus arteriosis or aortic regurgitation. Narrow or thready pulses may occur in children with heart failure or severe aortic stenosis. A normal pulse would not be expected with aortic regurgitation.

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?

Face Explanation: 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.

Tetralogy of Fallot consists of the following four anomalies: aortic stenosis, atrial septal defect, dextroposition (overriding) of the aorta, and hypertrophy of the left ventricle. a) False b) True

False Correct Explanation: Tetralogy of Fallot consists of four anomalies: pulmonary stenosis, ventricular septal defect (usually large), dextroposition (overriding) of the aorta, and hypertrophy of the right ventricle.

The nurse performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a: a) Grade IV. b) Grade I. c) Grade III. d) Grade II.

Grade IV. A heart murmur characterized as loud with a precordial thrill is classified as Grade IV. Grade II is soft and easily heard. Grade I is soft and hard to hear. Grade III is loud without thrill.

A nurse is administering digoxin to a 3-year-old. Which of the following would be a reason to hold the dose of digoxin? a) Ataxia b) Fever and tinnitus c) Nausea and vomiting d) Hypertension

Nausea and vomiting Explanation: Nausea and vomiting are signs of digoxin toxicity. The other symptoms listed here are not necessarily signs of a digoxin toxicity.

Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? 1. Previous streptococcal throat infection. 2. History of open heart surgery at 5 years of age. 3. Playing too much soccer and not getting enough rest. 4. Exposure to a sibling with pneumonia.

Previous streptococcal throat infection.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?

This is a test that will check how blood is flowing through the heart. Echocardiograms can determine the size of the heart and how the heart is pumping blood. An echocardiogram does not check the electrical impulses or the size of the heart. This is a non-invasive test.

A child is being placed on a cardiopulmonary bypass machine. The nurse understands the heart will pump again on its own when which of the following occurs?

The child starts getting warm again. Explanation: The child is placed in a hypothermic state when placed on a cardiopulmonary bypass. When the child is warmed, the heart starts pumping again.

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

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

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which of the following reactions? a) Wheezing b) Stomach upset c) Nausea with diarrhea d) Abdominal distress

Wheezing Correct Explanation: The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset is common with oral antibiotics and is not something that needs to be reported immediately. Nausea with diarrhea is common with oral antibiotics and does not need to be reported immediately. Abdominal distress is common with oral antibiotics and does not need to be reported immediately.

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children?

• 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse • 16-year-old child with a heart rate of 54 beats per minute • 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning 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 assessing a child with aortic stenosis. Which findings would the nurse most likely assess? Select all that apply. a) Dizziness with prolonged standing b) Blood pressure in arms significantly higher than in legs c) Moderately loud systolic murmur at the base of the heart d) Thrill palpated at base of heart e) Chest pain with activity

• Chest pain with activity • Dizziness with prolonged standing • Thrill palpated at base of heart A moderately loud systolic murmur at the base of the heart and blood pressure that is significantly higher in the arms than in the legs, possibly 20 mm Hg or higher, suggests coarctation of the aorta

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. Which of the following would the nurse expect to find? Select all that apply. a) Shortness of breath when playing b) Crackles on lung auscultation c) Hypertension d) Bradycardia e) Tiring easily when eating

• Shortness of breath when playing • Crackles on lung auscultation • Tiring easily when eating Correct Explanation: Manifestations of heart failure include difficulty feeding or eating or becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension.

The young child had a chest tube placed during cardiac surgery. Which findings may indicate the development of cardiac tamponade? Select all that apply. a) The child's apical heart rate is strong and easily auscultated. b) The child is resting quietly. c) The child's heart rate has increased from 88 beats per minute to 126 beats per minute. d) The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube. e) The child's right atrial filling pressure has decreased.

• The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube. • The child's heart rate has increased from 88 beats per minute to 126 beats per minute.

You would teach the mother of a boy with tetralogy of Fallot that if he suddenly becomes cyanotic and dyspneic to

place him in a knee-chest position. Correct Explanation: Placing a child in a knee-chest or squatting position traps blood in the legs, allowing the child to better oxygenate that remaining in the trunk.

An infant girl is prescribed digoxin. You would teach her parents that the action of this drug is to a) slow and strengthen her heartbeat. b) increase her heart rate. c) prevent subacute bacterial endocarditis. d) thicken the walls of the myocardium.

slow and strengthen her heartbeat. Correct Explanation: Digoxin is a cardiac glycoside that slows and strengthens the heartbeat.

The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond?

"It's great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain." Small, frequent feedings will reduce the amount of energy required to feed or eat and prevents overtiring the child. Questioning if the parents are making nutritious foods or foods the child likes does not address the issue of energy expenditure when eating 3 larger meals per day. Just stating that it is "hard to get your child to eat enough" also does not address the situation

You take an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant? a) 150 beats per minute b) 60 beats per minute c) 80 beats per minute d) 100 beats per minute

100 beats per minute

You take an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant?

100 beats per minute Explanation: Because digoxin slows the heart rate, it is important that it is not already beating at a slow rate before administration.

You take an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant? a) 150 beats per minute b) 100 beats per minute c) 80 beats per minute d) 60 beats per minute

100 beats per minute Explanation: Because digoxin slows the heart rate, it is important that it is not already beating at a slow rate before administration.

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

Administer analgesics before procedure. Removal of chest tubes can be an uncomfortable, frightening experience. Analgesics should be used. Children are forewarned that they will feel a sharp, momentary pain. A petrolatum-covered gauze dressing is immediately applied over the wound and securely taped to the skin on all four sides to form an airtight seal. No drainage is anticipated on the dressing.

The nurse is assessing a child with a cardiac problem. The child's extremities are cool with thready pulses, and urinary output is diminished. This is most suggestive of which of the following? A. Increased afterload B. Decreased contractility C. Increased stroke volume D. Decreased cardiac output

B. Decreased Contractility Decreased contractility is suspected if the extremities are cool with thready pulses and urinary output is diminished. Certain states (e.g., hypoxia, acidosis) are known to depress contractility. Increased blood pressure is indicative of higher afterload. Increased stroke volume and decreased cardiac output will not produce the symptoms described.

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

Softening of the nail beds

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding? a) Softening of the nail beds b) Intact rooting reflex c) Steady weight gain since birth d) Appropriate mastery of developmental milestones

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

A nurse is caring for a child who is experiencing heart failure. Which of the following assessment data was most likely seen when initially examined? a) Splenomegaly b) Polyuria c) Bradycardia d) Tachycardia

Tachycardia If a child were experiencing heart failure, the most likely sign of this would be tachycardia, not bradycardia. The child may also experience hepatomegaly or oliguria, but not splenomegaly or polyuria.

A nurse is providing education to a family about cardiac catheterization. Which of the following would be included in the education? a) The child will be able to move their leg again immediately after the procedure. b) The procedure will be performed even if the child has a fever. c) The catheter will be placed in the brachial artery. d) The catheter will be placed in the femoral artery.

The catheter will be placed in the femoral artery. Correct Explanation: The femoral artery is the correct placement of the cardiac catheter. The child will need to lie still for several hours after the procedure. The procedure is usually postponed if the child has a fever.

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) Patent ductus arteriosus d) Pulmonary stenosis e) Coarctation of the aorta

• Ventricular septal defect • Patent ductus arteriosus • Atrioventricular canal defect

The primary therapy for secondary hypertension in children is A. a low-salt diet. B. weight reduction. C. increased exercise and fitness. D. treatment of underlying cause.

D. treatment of underlying cause. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved. A low-salt diet, weight reduction, and increased exercise and fitness therapies are usually effective for essential hypertension.

The nurse is collecting data on a 5 year old child admitted with the diagnosis of congestive heart failure. Which of the following clinical manifestations 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

Failure to gain weight Explanation: 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.

Which nursing diagnosis would best apply to a child with rheumatic fever?

Activity intolerance related to inability of heart to sustain extra workload Children with rheumatic fever need to reduce activity to relieve stress during the course of the illness

Which of the following would be included in discharge teaching by the nurse of a child that had a patch placed surgically for an ASD? a) Antibiotics should be administered before invasive procedures. b) Need for frequent rest periods at home c) Intake of 80 ounces of fluid daily d) Teaching about how to take daily blood pressures

Antibiotics should be administered before invasive procedures.

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which of the following signs and symptoms would the infant most likely be exhibiting? a) Rapid weight gain b) Yellowish color c) Bradycardia d) Feeding problems

Feeding problems Explanation: The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. The heart beats faster in an attempt to increase blood flow. Failure to gain weight, weakness, and an enlarged liver and heart are other possible indicators of CHF but are not as common as tachycardia and may take

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child? a) Hands b) Lower extremities c) Face d) Presacral region

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

The nurse is conducting a physical examination of a 7-year-old girl prior to a cardiac catheterization. The nurse knows to pay particular attention to assessing the child's pedal pulses. How can the nurse best facilitate their assessment after the procedure?

Mark the child's pedal pulses with an indelible marker, then document Explanation: The nurse should pay particular attention to assessing the child's peripheral pulses, including pedal pulses. Using an indelible pen, the nurse should mark the location of the child's pedal pulses as well as document the location and quality in the child's medical records.

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) Administer propranolol (0.1 mg/kg IV). d) Place the child in a knee-to-chest position.

Place the child in a knee-to-chest position. Correct Explanation: 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.

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 prolonged preprocedure fasting state places the child at risk for dehydration. c) blood loss during the procedure can be significant. d) the insertion of the catheter into the heart stimulates a diuretic response.

The contrast material used has a diuretic effect. Explanation: 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 nurse is interviewing a mother who is about to deliver her baby. Which of the following responses would alert the nurse for a higher potential for a heart defect in the infant? a) The mother states she slept all the time while pregnant. b) The mother states she took acetaminophen while pregnant. c) The mother has seizures, but did not take medication while pregnant. d) The mother states she has lupus.

The mother states she has lupus. Correct Explanation: Having lupus while pregnant could contribute to a congenital heart defect. Acetaminophen and sleeping do not have an effect on a child developing a heart defect. The seizure medication can have an impact on the child having a heart defect, but not necessarily a history of seizures in the mother.

A parent asks about the risk of a congenital heart defect being passed on to another child since they already have one child that has it, but no one else in the family has one. What is the best response by the nurse? a) There is a less than 7% chance a sibling would inherit a heart defect. b) These occur related to medication the mother was taking while pregnant. c) This was probably caused by environmental factors, not genetics. d) There is no chance this will be passed to another child since we do not know what caused it.

There is a less than 7% chance a sibling would inherit a heart defect. Correct Explanation: The risk to subsequent siblings of a child with CHD is approximately 2% to 6% so genetics can play a role in the child having a cardiac defect.

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the a) child will have to remain NPO for 6 to 8 hours after the procedure to prevent vomiting. b) child will return with a bulky pressure dressing over the catheter insertion area. c) child will require a general anesthetic and needs to be prepared for this. d) procedure is noninvasive and not frightening for children.

child will return with a bulky pressure dressing over the catheter insertion area. Correct Explanation: Cardiac catheterization is typically performed with the child awake but using conscious sedation. A dressing will be placed on the catheter insertion site.

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

• Painless nodules located on the wrists • Pericarditis with the presence of a new heart murmur

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia? a) Child B with a total cholesterol level of 175 mg/dL and LDL of 105 mg/dL. b) Child C with a total cholesterol level of 190 mg/dL and LDL of 125 mg/dL. c) Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. d) Child D with a total cholesterol level of 220 mg/dL and LDL of 138 mg/dL.

Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. Explanation: Total cholesterol levels below 170 mg/dL and LDL levels less than 100 mg/dL are considered within the acceptable range. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels greater than or equal to 200 mg/dL and LDL levels greater than or equal to 130 mg/dL are considered elevated and place this child at greatest risk.

A school nurse is caring for a child with a severe sore throat and fever. Which of the following would be the best recommendation by the nurse to the parent? a) Have the child drink fluids that contain electrolytes. b) Have the child go to the emergency room. c) Give acetaminophen for the fever and pain, and have the child rest. d) Have the child be seen by the primary care provider.

Have the child be seen by the primary care provider. Correct Explanation: Children with sore throats and fevers should be seen by their primary care provider to rule out strep throat. This is extremely important due to the fact they may contract an acquired heart disease called rheumatic fever. Taking acetaminophen, resting, and drinking fluids are all good recommendations, but the best recommendation is to see the provider. Going to the emergency room is not necessary at this time.

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. Which of the following should the nurse mention in explaining how this diagnostic test works? a) A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video b) High-frequency sound waves are directed toward the heart c) A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy d) X-rays are directed toward the heart

High-frequency sound waves are directed toward the heart Correct Explanation: Echocardiography, or ultrasound cardiography, has become the primary diagnostic test for congenital heart disease. For this, high-frequency sound waves, directed toward the heart, are used to locate and study the movement and dimensions of cardiac structures, such as the size of chambers, thickness of walls, relationship of major vessels to chambers, and the thickness, motion, and pressure gradients of valves. You can remind parents echocardiography does not use x-rays so it can be repeated at frequent intervals without exposing their child to the possible risk of radiation. The other answers refer to other types of diagnostic tests, including X-ray studies, radioangiocardiography, and phonocardiography.

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

Obstruction of blood flow to the lungs Explanation: 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.

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. Which of the following should the nurse instruct the parents to do in the event that the child becomes cyanotic? a) Perform hands-on CPR b) Administer prescribed amoxicillin c) Place him in a knee-chest position d) Administer low-dose aspirin

Place him in a knee-chest position Explanation: Before parents leave the hospital with a newborn who has a congenital heart disorder, be certain they have the name and number of the health professional to call if they have a question about their infant's health. Review with them the steps to take if their child should become cyanotic, such as placing the child in a knee-chest position. "Hands on" CPR is not recommended for children as it is for adults. Remind parents that children with many types of congenital heart disorders or rheumatic fever need prophylactic low-dose aspirin therapy to avoid blood clotting; although becoming a controversial practice, they may be prescribed antibiotic therapy such as oral amoxicillin before oral surgery.

A nursing instructor is preparing for a class about the structural and functional differences in the cardiovascular system of infants and children as compared to adults. Which of the following would the instructor include in the class discussion? a) The heart's apex is higher in the chest in children younger than the age of 7 years. b) Blood pressure is initially high at birth but gradually decreases to adult levels. c) The heart is about four times the birth size between the ages of 6 and 12 years. d) Left ventricular function predominates immediately after birth.

The heart's apex is higher in the chest in children younger than the age of 7 years. Correct Explanation: In infants and children younger than age 7 years, the heart lies more horizontally, resulting in the apex lying higher in the chest. Right ventricular function predominates at birth, and over the first few months of life, left ventricular function becomes dominant. A normal infant's blood pressure is about 80/40 mm Hg and increases over time to adult levels. Between the ages of 1 and 6 years, the heart is four times the birth size; between 6 and 12 years of age, the heart is 10 times its birth size.

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

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

A parent asks why their infant with a cyanotic heart defect turns blue. What is the best response by the nurse? a) This is a sign of heart failure. b) This is due to a decreased amount of oxygen to the peripheral tissue. c) This is considered a medical emergency and needs immediate surgery. d) This is due to the lack of oxygen to the brain.

This is due to a decreased amount of oxygen to the peripheral tissue. Correct Explanation: Cyanosis associated with certain congenital heart defects is due to the body naturally compensating and decreasing the amount of oxygen to the peripheral tissue. This keeps the oxygen with the vital organs to sustain life. The lack of oxygen is not in the brain; it is in the systemic flow of the body. Cyanosis is a common finding with these types of heart defects and in general, does not usually need immediate surgery or is a sign of heart failure.

The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy the process of digitalization is done for which of the following reasons? a) To decrease the pain to a tolerable level b) To build the blood levels to a therapeutic level c) To establish a maintenance dose of the drug d) To increase the heart rate

To build the blood levels to a therapeutic level Explanation: The use of large doses of digoxin at the beginning of therapy, administered to build up the blood levels of the drug to a therapeutic level, is known as digitalization. A maintenance dose is given, usually daily, after digitalization. Digoxin is used to improve the cardiac efficiency by slowing the heart rate and strengthening the cardiac contractility. Digoxin is not indicated for relief of pain.

The nurse is caring for a pediatric client diagnosed with tetralogy of Fallot. After speaking with the physician, the parents state to the nurse, "The doctor said something about our child having too many red blood cells. We don't understand how that could happen?" What is the best response by the nurse?

Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder." To compensate for low blood oxygen levels, the kidneys produce the hormone erythropoietin to stimulate the bone marrow to produce more red blood cells (RBCs). This increase in RBCs is called polycythemia. Polycythemia can lead to an increase in blood volume and possibly blood viscosity, further taxing the workload of the heart. The correct response is the clearest and easiest description for the parents to understand. Telling the parents the doctor was discussing polycythemia with them doesn't answer their question.

The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse?

• "Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." This response best explains the meaning of the nursing diagnosis and it's cause. Although there are standardized care plans as a guide, each care plan must be individualized to the client. Stating, "The heart is a pump and it isn't pumping effectively" does not explain the nursing diagnosis. Telling the parents not to worry does not help in educating them.

The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements?

• "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed." • "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." • "We will be sure to not allow our child to ride a bicycle for at least 2 weeks." With the Gore® Helex device, strenuous activity should be avoided for 2 weeks after the procedure, so neither soccer or bicycle riding would be allowed. Children should be monitored for the possible presence of atrial arrhythmias (lifelong) after surgical closure for the defect. Infection is a complication that must be monitored for and reported to the physician, and medications must be given as prescribe

The nurse is caring for a child diagnosed with rheumatic fever. The nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse? a) Provide age-appropriate diversional activities b) Instruct the child's family about the long term need for treatment c) Encourage the child to have frequent rest periods between activities d) Carefully handle the child's knees, ankles, elbows and wrists when moving the child. e) Administer salicylates after meals or with milk

• Carefully handle the child's knees, ankles, elbows and wrists when moving the child. • Administer salicylates after meals or with milk Explanation: Pain control and relief are the highest priorities for the child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever and relieve joint inflammation and pain

A child is having surgery for a congenital heart defect. The parent asks about their 1-year-old's growth and developmental delays and what they can expect after surgery. What is the best response by the nurse? a) "After surgery, most children will catch up." b) "You can expect to continue to see delays." c) "This was caused by the lack of oxygen and it is usually permanent." d) "As long as you decrease external stimuli, the child should catch up."

"After surgery, most children will catch up." Correct Explanation: A child with a congenital heart defect who has growth and developmental delays will usually catch up after the defect is fixed. There is no way of predicting exactly what each child will do and it is not appropriate to tell a parent that these delays are permanent when that is unknown until the defect is corrected by surgery.

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 short of breath." b) "He gets sweaty when he eats." c) "He does not seem sick." d) "He seems to have a normal appetite."

"He gets sweaty when he eats."

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching? a) "We need to watch for changes in skin color or difficulty breathing." b) "Strenuous activity should be limited for the next 3 days." c) "We need to avoid a tub bath for the next 3 days." d) "The feeling of the heart skipping a beat is common."

"The feeling of the heart skipping a beat is common." Explanation: Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. This statement is appropriate because tub baths should be avoided for about 3 days. This statement is appropriate because strenuous activity is limited for about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported.

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

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

The nurse is 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) 94 to 112/56 to 60 mm Hg b) 80 to 90/40 to 64 mm Hg c) 80 to 100/64 to 80 mm Hg d) 100 to 120/70 to 80 mm Hg

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

When caring for a child with Kawasaki Disease, the nurse would know which of the following? a) Joint pain is a permanent problem. b) Steroid creams are used for the hand peeling. c) Management includes administration of aspirin and IVIG. d) Antibiotics should be administered exactly every 8 hours by IV.

Management includes administration of aspirin and IVIG. Correct Explanation: 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.

When educating the family of an ill infant with an atrioventricular canal defectseptic defect, what information would be included in the education if the doctor is planning on performing palliative care until the infant is healthier? a) VSD patching surgery should be performed immediately. b) Palliative pulmonary artery banding should help the infant grow. c) The medication indomethacin is used to try to close the hole. d) Most infants do not need surgical repair for this if palliative procedures are performed.

Palliative pulmonary artery banding should help the infant grow. Explanation: Palliative pulmonary artery banding should help the infant grow enough so that the large VSD can be repaired. The pulmonary artery banding will help, but the defect will still need to be fixed. Most infants will need surgery for a large, symptomatic VSD. The medication indomethacin is used for a PDA.

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

Pulses weaker in lower extremities compared to upper extremities Explanation: An infant with coarctation of the aorta has decreased systemic circulation causing this problem. The cyanosis would be associated with tetralogy of Fallot.

A nurse is caring for a newborn with congenital heart disease (CHD). Which of the following would the nurse interpret as indicating distress? a) Feeding lasting for 15-20 minutes b) Subcostal retraction at the time of feeding c) Perspiration on body after feeding d) Reduced respiratory rate during feeding

Subcostal retraction at the time of feeding Subcostal retraction during feeding is indicative of distress associated with feeding in newborn infants with CHD. Feeding can be a stress to newborns with CHD who are seriously compromised. Additional features indicating distress in infants with CHD include increased respiratory rate, perspiration along the hairline during feeding and feeding time longer than 30 minutes.

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure? a) Bradycardia b) Inability to sweat c) Tachycardia d) Splenomegaly

Tachycardia Correct Explanation: Tachycardia is one of the signs of heart failure. Bradycardia, inability to sweat, and splenomegaly are not necessarily signs of heart failure.

The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. Which of the following would be included in the intervention strategies? a) The nurse would review the child's 24-hour diet recall. b) The child should not be allowed to participate in sports. c) Blood pressures should be measured daily. d) Beta blocker education should be given to the parents.

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

A nurse is caring for a child that just had open-heart surgery and the parents are asking why there are wires coming out of the chest of the infant. What is the best response by the nurse? a) These wires are connected to the heart and will detect if your child's heart gets out of rhythm. b) The wires will administer ongoing electrical shocks to the heart to maintain rhythm. c) The wires are left in the heart one month after surgery for potential arrhythmias. d) The wires are measuring the fluid level in the heart.

These wires are connected to the heart and will detect if your child's heart gets out of rhythm. Correct Explanation: The wires may be connected to a pacemaker. Connection to the temporary pacemaker is usually until the child is out of danger for arrhythmia.

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

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

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. Which of the following should the nurse mention to this patient? a) "There is really nothing you can do. b) "Make sure you are fully immunized." c) "Make sure that you encourage your child to exercise as he grows up." d) "Make sure you encourage a low-sodium diet in your child as he grows up."

"Make sure you are fully immunized."

The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents ask the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the the nurse?

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

A nurse is caring for an infant who is experiencing heart failure. Which of the following would be the most appropriate care for this infant? a) Restrict fluids. b) Provide large, less frequent feedings. c) Administer oxygen. d) Administer antidiuretic.

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

The nurse is caring for a 10-year-old boy following a cardiac catheterization. Four hours after the procedure, the nurse notes some minor bleeding at the site. Which action would be most appropriate? a) Apply pressure 1 inch above the site. b) Change the dressing. c) Contact the physician. d) Ensure that the child's leg is kept straight.

Apply pressure 1 inch above the site. Explanation: If bleeding occurs after a cardiac catheterization, apply pressure 1 inch above the site to create pressure over the vessel, thereby reducing the blood flow to the area. The nurse should first apply pressure and then notify the physician if this measure is ineffective or the bleeding increases. The child should maintain the leg in a straight position for about 4 to 8 hours. However, this would not address the bleeding assessed at the site. Changing the dressing would not be effective.

In caring for the child with rheumatic fever which medication would the nurse likely administer? a) Aspirin b) Tylenol c) Insulin d) Dilantin

Aspirin Explanation: Salicylates are administered in the form of aspirin to reduce fever and to relieve joint inflammation and pain in the child with rheumatic fever. Although salicylates as a general rule are not given to children, they continue to be the treatment of choice for rheumatic fever. Tylenol is not effective for the inflammation. Insulin would be given for diabetes and dilantin for seizure disorders.disorders.

The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? 1. Allow early ambulation to encourage activity participation. 2. Check pulses above the catheter insertion site for strength and quality. 3. Assess extremity distal to the insertion site for temperature and color. 4. Change the dressing to evaluate the site for infection.

Assess extremity distal to the insertion site for temperature and color.

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

Assess the affected extremity for temperature and color. The involved extremity is carefully assessed for signs of complications. Pulses below the catheterization site are monitored for equality and symmetry. Temperature and color are also monitored. The child is maintained on bed rest or in parent's lap for 4 to 6 hours after the procedure. Initially, vital signs are taken every 15 minutes. Pulses are checked distal to the catheterization site.

After assessing a child, the nurse suspects coarctation of the aorta based on which of the following? a) Hepatomegaly b) Narrow pulse c) Femoral pulse weaker than brachial pulse d) Bounding pulse

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

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. The nurse should tell the mother which of the following? a) No treatment is necessary, as the defect will resolve spontaneously b) Surgical closure by ductal ligation c) Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions d) Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions Correct Explanation: Balloon angioplasty by way of cardiac catheterization is the procedure of choice for pulmonary stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed valve. As the balloon is inflated, it breaks valve adhesions and relieves the stenosis. The other answers refer to interventions related to patent ductus arteriosus, not pulmonary stenosis.

A client's newborn is diagnosed with Tetralogy of Fallot. When explaining this condition to the client, which of the following defects would the nurse's description include? a) Atrial septal defect b) Overriding of the aorta c) Stenosis of the aorta d) Left ventricular hypertrophy

Overriding of the aorta Explanation: One of the components in the Tetralogy of Fallot is overriding of the aorta. Tetralogy of Fallot is a congenital heart disease with 4 components. The defects in the Tetralogy of Fallot include ventricular septal defect, overriding of the aorta, pulmonary stenosis, and right ventricular hypertrophy. Atrial septal defect, stenosis of the aorta and left ventricular hypertrophy are not components of Tetralogy of Fallot.

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress which of the following? A. Be extremely concerned about cyanotic spells. B. Relax discipline and limit setting to prevent crying. C. Reduce caloric intake to decrease cardiac demands. D. Promote normality within the limits of the child's condition.

Promote normality within the limits of the child's condition. The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. Because cyanotic spells occur in children with some defects, the parents need to be taught how to manage these. The child needs discipline and appropriate limits. The child needs increased caloric intake.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor? a) Erythrocyte sedimentation rate b) Serum sodium level c) Oxygen saturation level d) Serum potassium level

Serum potassium level Correct Explanation: Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug. Serum sodium levels may be obtained in children with heart failure to ensure that an increased sodium level is not causing edema. The erythrocyte sedimentation rate identifies inflammation and is unrelated to the use of diuretics and digoxin. Oxygen saturation levels may be done to evaluate for hypoxemia, but these results would be unrelated to the use of digoxin and diuretics.

At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important? a) Allowing the child to adapt to the light room gradually b) Assuring the child that the procedure is now over c) Taking pedal pulses for the first 4 hours d) Allowing the child to talk about the procedure

Taking pedal pulses for the first 4 hours Correct Explanation: Insertion of a catheter into the femoral vein can cause vessel spasm, interfering with blood circulation in the leg. Assessing pedal pulses ensures circulation is adequate.

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

There are several reasons a baby can have a heart defect, let's talk about those causes. Correct Explanation: Focus on the therapeutic communication in this situation, while still obtaining more information. This will help the nurse explore various options for the cause of the defect with the parent.

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

This type of shunting causes an increase of blood to the lungs. Explanation: 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.

You would teach the mother of a boy with tetralogy of Fallot that if he suddenly becomes cyanotic and dyspneic to a) lie him supine with the head turned to one side. b) lie him prone, being sure he can breathe easily. c) place him in a semi-Fowler's position in an infant seat. d) place him in a knee-chest position.

place him in a knee-chest position. Explanation: Placing a child in a knee-chest or squatting position traps blood in the legs, allowing the child to better oxygenate that remaining in the trunk.

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

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

Therapeutic management of the child with rheumatic fever includes A. administration of penicillin. B. avoidance of salicylates (aspirin). C. strict bed rest for 4 to 6 weeks. D. administration of corticosteroids if chorea develops.

A. administration of penicillin. Penicillin remains the drug of choice (oral or intramuscular injections), with macrolides or cephalosporins as a substitute in penicillin-sensitive children. Initial therapy includes a full 10-day course of penicillin or an alternative antibiotic. Salicylates may be used to reduce the inflammatory process after diagnosis. Bed rest is not indicated. Children can resume regular activities after the febrile stage is over. The chorea is transient, and pharmacologic intervention is not indicated.

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

Most infants do not need surgical repair for this." Explanation: 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.

While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? 1. Provide supplemental oxygen by face mask. 2. Administer a dose of IV morphine sulfate. 3. Begin cardiopulmonary resuscitation. 4. Place the infant in a knee-to-chest position.

Place the infant in a knee-to-chest position.

Which of the following heart defects causes hypoxemia and cyanosis because desaturated venous blood is entering the systemic circulation? A. Coarctation of the aorta B. Atrial septal defect C. Patent ductus arteriosus D. Tetralogy of Fallot

Tetralogy of Fallot Tetralogy of Fallot is a cardiac defect that has a mixed blood circulation. Coarctation of the aorta is an obstructive defect. There is no mixing of oxygenated and unoxygenated blood. Atrial septal defect and patent ductus arteriosus have increased flow of blood to the pulmonary system. The pressure gradient allows for oxygenated blood to return to the lungs.

Parents are told their infant has a hypoplastic left heart. What is the type of education that would be included for this family? a) This is a problem where the left side of the heart did not develop properly. b) This is a problem where the right side of the heart did not develop properly. c) The infant will have immediate surgery to completely correct the heart defect. d) There are no surgeries that can help the child live with this heart defect.

This is a problem where the left side of the heart did not develop properly. Correct Explanation: This is a problem where the left side of the heart did not develop properly. There is a three-step palliative surgery that can be implemented or the child will need a heart transplant.

The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?

"He likes to stop and squat wherever he walks." The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance. Constant movement and quick walking are normal for a toddler. Activity level with a daily nap is typical of a toddler. Difficulty breathing would suggest a problem.

A nurse is taking the history of a 4-year-old boy who will undergo a cardiac catheterization. Which of the following statements by his mother may necessitate rescheduling of the procedure? a) "He is very scared and nervous about the procedure." b) "He is not taking any medication." c) "He is allergic to iodine and shellfish." d) "He seems listless and slightly warm."

"He seems listless and slightly warm." Correct Explanation: Fever and other signs and symptoms of infection may necessitate rescheduling the procedure. Although information about allergies is important, not all contrast media contain iodine as a base. The nurse should address the child's fears in a developmentally appropriate way, but fear of the procedure does not warrant rescheduling. Not using any medication would not be a reason for rescheduling the procedure.

The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding? a) 100/60 mm Hg b) 110/60 mm Hg c) 90/64 mm Hg d) 80/40 mm Hg

90/64 mm Hg Explanation: The toddler's or preschooler's blood pressure averages 80 to 100/64 mm Hg. The normal infant's blood pressure is about 80/40 mm Hg. The school-age child's blood pressure averages 94 to 112/56 mm Hg. An adolescent's blood pressure averages 100 to 120/50 to 70 mm Hg.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? a) This is a test that will check how blood is flowing through the heart. b) This is a test that will check the electrical impulses in the heart. c) This test can only determine the size of the heart. d) This test is an invasive test that will measure the blockage in the heart.

A Echocardiograms can determine the size of the heart and how the heart is pumping blood. An echocardiogram does not check the electrical impulses or the size of the heart. This is a non-invasive test.

The nurse is auscultating heart sounds of a child with a mitral valve prolapse. The nurse should expect which assessment finding? a) Abnormal splitting of S2 sounds b) Intensifying of S2 sounds c) Mild to late ejection click at the apex d) Clicks on the upper left sternal border

A mild to late ejection click at the apex Correct Explanation: A mild to late ejection click at the apex is typical of a mitral valve prolapse. Abnormal splitting or intensifying of S2 sounds occurs in children with r heart problems, not mitral valve prolapse. Clicks on the upper left sternal border are related to the pulmonary area

The nurse is explaining possible side effects of corticosteroids to the caregiver of a child diagnosed with rheumatic fever. The caregiver comments, "I don't understand what hirsutism means." The nurse would be correct in explaining that hirsutism is which of the following? a) Facial grimaces b) Repetitive movements c) A "moon face" appearance d) Abnormal hair growth

Abnormal hair growth Correct Explanation: The child whose pain is not con trolled with salicylates may be ad ministered corticosteroids. Side effects such as hirsutism (abnormal hair growth) and "moon face" may be noted. Facial grimaces and repetitive involuntary movements are symptoms of chorea.

The nurse is conducting a physical examination of an infant with a suspected cardiovascular disorder. Which assessment finding is suggestive of sudden ventricular distention? a) Accentuated third heart sound b) Decreased blood pressure c) Heart murmur d) Cool, clammy, pale extremities

Accentuated third heart sound Explanation: An accentuated third heart sound is suggestive of sudden ventricular distention. Decreased blood pressure, cool, clammy, and pale extremities, and a heart murmur are all associated with cardiovascular disorders; however, these findings do not specifically indicate sudden ventricular distention.

Which of the following nursing diagnoses would best apply to a child with rheumatic fever? a) Disturbed sleep pattern related to hyperexcitability b) Activity intolerance related to inability of heart to sustain extra workload

Activity intolerance related to inability of heart to sustain extra workload Explanation: Children with rheumatic fever need to reduce activity to relieve stress during the course of the illness.

The nurse is caring for a 10-year-old girl with a suspected heart arrhythmia. The nurse would expect to prepare the child for which test to identify and quantitate the arrhythmia? a) Ambulatory electrocardiographic monitoring b) Arteriogram c) Echocardiogram d) Chest radiograph

Ambulatory electrocardiographic monitoring Correct Explanation: Ambulatory electrocardiographic monitoring is indicated to identify and quantitate arrhythmias in a 24-hour period during normal daily activities. An echocardiogram is done to provide a specific diagnosis of structural defects, to determine hemodynamics, and to detect valvular defects. A chest radiograph is indicated to detect abnormalities of structures within the chest. An arteriogram is ordered to observe blood flow to parts of the body and detect lesions and confirm a diagnosis.

A group of nurses is reviewing the cardiovascular system and its function. Which of the following statements 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) At birth the right and left ventricle are about the same size. c) The heart matures and functions like an adult's between 12 and 15 years of age. d) Between the ages of 5 and 6 the left ventricle grows to about two times the size of the right.

At birth the right and left ventricle are about the same size. Correct Explanation: 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.

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. Which of the following interventions should the nurse take to prevent infection? a) Keep the child NPO for 2 to 4 hours before the procedure b) Record pedal pulses c) Apply EMLA cream to the catheter insertion site d) Avoid drawing a blood specimen from the right femoral vein before the procedure

Avoid drawing a blood specimen from the right femoral vein before the procedure Correct Explanation: Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine.

Which of the following would be included in the care of an infant in heart failure? a) Maintain child in the supine position. b) Encourage larger, less frequent feedings. c) Begin formulas with increased calories. d) Administer digoxin even if the infant is vomiting.

Begin formulas with increased calories. Correct Explanation: Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often times are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering.

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 which of the following? a) Chorea b) Arthralgia c) Carditis d) Polyarthritis

Chorea Correct Explanation: 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.

When caring for a child that has just had a cardiac catheterization, which of the following would indicate a sign of hypotension? a) Decreased heart rate and dizziness b) Syncope and tachypnea c) Diaphoresis and tachycardia d) Cold clammy skin and increased heart rate

Cold clammy skin and increased heart rate Explanation: Cold, clammy skin, increased heart rate, and dizziness are signs of hypotension that may be a complication after a cardiac catheterization. Decreased heart rate, syncope, and tachypnea would also be very concerning, but not necessarily a sign of hypotension.

Which of the following is an important nursing responsibility when a dysrhythmia is suspected? A. Order an immediate electrocardiogram. B. Count the radial rate every 1 minute for 5 minutes. C. Count the apical rate for 1 full minute and compare with radial rate. D. Have someone else take the radial rate simultaneously with the apical rate.

Count the apical rate for 1 full minute and compare with radial rate. Counting the apical rate for 1 full minute and compare with radial rate is the nurse's first action. If a dysrhythmia is occurring, the radial pulse may be lower than the apical rate. Ordering an immediate electrocardiogram may be indicated after conferring with the practitioner. Radial pulse needs to be compared with the apical. It is the nurse's responsibility to check both rates, radial and apical.

The nurse is performing an ECG on a 12-year-old boy. On completion, she notices that boy's P-R interval is lengthened. Which of the following does this finding indicate? a) Difficulty with coordination between the SA and AV nodes (first-degree heart block) b) Ventricular hypertrophy c) Hypertrophied atria d) Ventricles not fully contracting (pericarditis)

Difficulty with coordination between the SA and AV nodes (first-degree heart block) Explanation: On an ECG tracing, a longer-than-usual P wave suggests the atria are hypertrophied making it take longer than usual for the electrical conduction to spread over the atria. A lengthened P-R interval suggests there is a difficulty with coordination between the SA and AV nodes (first-degree heart block). A heightened R wave indicates ventricular hypertrophy is present. An R wave which is decreased in height suggests the ventricles are not contracting fully, as happens if they are surrounded by fluid (pericarditis). Elongation of the T wave occurs in hyperkalemia; depression of the T wave is associated with anoxia; depression of the ST segment is associated with abnormal calcium levels.

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed? a) Indomethacin b) Digoxin c) Alprostadil d) Furosemide

Digoxin Correct Explanation: Digoxin is indicated for atrial fibrillation. It increases the contractility of the heart muscle by decreasing conduction and increasing force. Alprostadil is indicated for temporary maintenance of ductus arteriosus patency in infants with ductal-dependent congenital heart defects. Furosemide is used for the management of edema associated with heart failure. Indomethacin is used to close a patent ductus arteriosus.

The nurse is administering medications to the child with congestive heart failure. Large doses of which of the following medications are used initially in the treatment of CHF to attain a therapeutic level? a) Ferrous sulfate b) Digoxin (Lanoxin) c) Furosemide (Lasix) d) Albuterol sulfate

Digoxin (Lanoxin) Correct Explanation: The use of large doses of digoxin, at the beginning of therapy, to build up the blood levels of the drug to a therapeutic level is known as digitalization.

Which of the following procedures uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? A. Echocardiography B. Electrophysiology C. Electrocardiography D. Cardiac catheterization

Echocardiography Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, diagnosis can sometimes be made without cardiac catheterization. Electrophysiology is an invasive procedure in which catheters with electrodes are used to record the impulses of the heart directly from the conduction system. Electrocardiography is a tracing of the electrical path of the depolarization action of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart.

The care provider has ordered the drug furosemide (Lasix) to treat a child diagnosed with congestive heart failure. The nurse knows that this drug will be used to:

Eliminate excess fluids Explanation: Diuretics, such as furosemide (Lasix), thiazide diuretics, or spironolactone (Aldac tone), and fluid restriction in the acute stages of CHF help to eliminate excess fluids in the child with congestive heart failure. Vasodilators are used to dilate the blood vessels. Digoxin is used to improve the cardiac efficiency by slowing the heart rate and strengthening the cardiac contractility.

A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? 1. Gallop and rales. 2. Blood pressure discrepancies in the extremities. 3. Right ventricular hypertrophy on ECG. 4. Heart murmur.

Heart murmur.

On assessment immediately following cardiac surgery, which condition would the nurse expect to find in an infant? a) Hypertension b) Hypovolemia c) Hyperexcitability d) Hypothermia

Hypothermia Explanation: Cardiac surgery is often performed under hypothermia to decrease the child's oxygen needs during surgery.

A nurse is reviewing blood work on a patient with a cyanotic heart defect. Which of the following results would most likely be seen in a patient experiencing polycythemia? a) Increased WBC b) Increased RBC c) Decreased RBC d) Decreased WBC

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

An 8-month-old has a ventricular septal defect. Which nursing diagnosis below would best apply? a) Impaired skin integrity related to poor peripheral circulation b) Ineffective tissue perfusion related to inefficiency of the heart as a pump c) Ineffective airway clearance related to altered pulmonary status d) Impaired gas exchange related to a right-to-left shunt

Ineffective tissue perfusion related to inefficiency of the heart as a pump Correct Explanation: A ventriculoseptal defect permits blood to flow across a septum, creating an ineffective pump.

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. Which of the following is the best response from the nurse? a) It will show if blood is being shunted. b) This image will clarify the structures within the heart. c) It will determine if the heart is enlarged. d) It will determine disturbances in heart conduction.

It will determine if the heart is enlarged. Correct Explanation: Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI.

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

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

The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess? 1. Obesity from overeating. 2. Clubbing of the nail beds. 3. Squatting during play activities. 4. Exercise intolerance.

Obesity from overeating.

Nursing care of the infant and child with heart failure would include which of the following? A. Force fluids appropriate to age. B. Monitor respirations during active periods. C. Organize activities to allow for uninterrupted sleep. D. Give larger feedings less often to conserve energy.

Organize activities to allow for uninterrupted sleep. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to minimize the child's energy expenditure. The child who has heart failure has an excess of fluid. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? a) Irritability and dry mucous membranes b) Decreased heart rate and impalpable pulse c) Low blood pressure and decreased heart rate d) Peeling hands and feet and fever

Peeling hands and feet and fever Explanation: One of the signs of Kawasaki disease is the peeling hands and feet. The other symptoms are not necessarily characteristic of Kawasaki disease.

A child is diagnosed with tetralogy of Fallot and during a temper tantrum turns blue. Which of the following would the nurse do first? a) Assess for an increased respiratory rate. b) Place child in the knee-to-chest position. c) Assess for an irregular heart rate. d) Explain to the child the need to calm down since it is affecting the heart.

Place child in the knee-to-chest position. Correct Explanation: Place child in the knee-to-chest position. This position is the first priority of the child with tetralogy of Fallot. Cyanosis is caused by the heart defect and placing the child in this position will decrease the cyanosis.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority? a) Start an IV for fluids. b) Prepare the infant for surgery. c) Raise the head of the bed. d) Place the infant in the knee-chest position.

Place the infant in the knee-chest position. Correct Explanation: Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position.

Which of the following would be most important to implement for an infant who develops heart failure? a) Restricting milk intake daily b) Keeping her supine and playing quiet games c) Placing her in a semi-Fowler's position d) Planning ways to reduce salt intake

Placing her in a semi-Fowler's position Correct Explanation: Placing an infant with heart failure in a semi-Fowler's position reduces the pressure of abdominal contents against the chest and gives the heart the opportunity to function more effectively.

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

Polycythemia Correct Explanation: Children who cannot oxygenate red cells well often produce excess red blood cells or develop polycythemia.

Which of the following is an early sign of heart failure that the nurse should recognize? A. Tachypnea B. Bradycardia C. Inability to sweat D. Increased urinary output

Tachypnea Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child may be diaphoretic. Urinary output usually will be decreased.

A newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis? a) Coarctation of aorta b) Aortic stenosis c) Pulmonary stenosis d) Tetralogy of Fallot

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

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

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

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

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

Infants with congenital heart disease should not be allowed to become dehydrated because this makes them prone to a) cerebrovascular accident. b) jaundice. c) tachycardia. d) seizures.

cerebrovascular accident Children who have polycythemia from cardiovascular disease can develop thrombi if they become dehydrated.

The nurse is reviewing nutritional recommendations with the parents of a teen diagnosed with hyperlipidemia. Which statements indicate an understanding of the recommended diet for this condition?

• "I should plan to have vegetables with each evening meal served." • "Adding fresh fruits to my child's lunch is a good idea." • "My child loves chicken and I can still serve it but I need to remove the skin." Hyperlipidemia refers to high levels of lipids (fats/cholesterol) in the blood. High lipid levels are a risk factor for the development of atherosclerosis, which can result in coronary artery disease, a serious cardiovascular disorder occurring in adults. Dietary management is the first step in the prevention and management of hyperlipidemia in children older than 2 years of age. The diet should consist primarily of fruits, vegetables, low-fat dairy products, whole grains, beans, lean meat, poultry, and fish. As in adults, fat should account for no more than 30% of daily caloric intake. Fat intake may vary over a period of days, as many young children are picky eaters. Limit saturated fats by choosing lean meats, removing skin from poultry before cooking, and avoiding palm, palm kernel, and coconut oils as well as hydrogenated fats

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

• Involuntary limb movement • Macular rash on trunk • Tender swollen joints Explanation: Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.

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

• LDL level of 140 md/dL • Total cholesterol level of 220 mg/dL Correct Explanation: 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.

The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatments would the nurse expect to administer if ordered? Select all that apply. a) Intravenous immunoglobulin b) Nonsteroidal anti-inflammatory drugs c) Digoxin d) Corticosteroids e) Penicillin

• Nonsteroidal anti-inflammatory drugs • Penicillin • Corticosteroids Explanation: A full 10-day course of penicillin or equivalent is used. Corticosteroids are used as part of the treatment for acute rheumatic fever. Nonsteroidal anti-inflammatory drugs are used as part of the treatment for acute rheumatic fever. Digoxin is used to treat heart failure, atrial fibrillation, atrial flutter, and supraventricular tachycardia. Intravenous immunoglobulin is used to treat Kawasaki disease.

The child has returned to the nurse's unit following a cardiac catheterization. The insertion site is located at the right groin. Peripheral pulses were easily palpated in bilateral lower extremities prior to the procedure. Which finding should be reported to the child's physician? a) The child is reporting nausea. b) The child has a runny nose. c) The right groin is soft without edema. d) The child's right foot is cool with a pulse assessed only with the use of a Doppler. e) The child has a temperature of 102.4° F (39.1° C).

• The child's right foot is cool with a pulse assessed only with the use of a Doppler. • The child has a temperature of 102.4° F (39.1° C). • The child is reporting nausea. The following information should be reported to the physician following a cardiac catheterization because they are indicative of possible complications: Negative changes to the child's peripheral vascular circulatory status (cool foot with poor pulse), a fever over 100.4° F (37.8° C), and nausea or vomiting.