Exam 4: Cardiovascular Dysfunction NCLEX Questions
c e
Which statement by the mother of a child with rheumatic fever shows she has good understanding of the care of her child? Select all that apply a. "I will apply heat to his swollen joints to promote circulation" b. "I will have him do gentle stretching exercises to prevent contractures" c. "I will give him his ordered anti-inflammatory medication for pain and inflammation" d. "I will apply cold packs to his swollen joints to reduce pain" e. "I will take my child every month to the health care provider's office for his penicillin shot"
d
Chronic hypoxemia is manifested clinically by which of the following signs? a. fatigue b. polycythemia c. clubbing d. all of the above
c
In which congenital heart defect would the nurse need to take upper and lower extremity blood pressures? a. transposition of the great vessels b. aortic stenosis c. coarctation of the aorta d. tetralogy of Fallot
d
What 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
a
What is an early sign of heart failure that would be recognized by the nurse? a. Tachypnea b. Bradycardia c. Inability to sweat d. Increased urinary output
a
What procedure use high-frequency sound waves obtained by a transducer to produce an image of cardiac structures? a. Echocardiography b. Electrophysiology c. Electrocardiography d. Cardiac catheterization
b
A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition? a. Cyanosis b. Heart failure c. Decreased pulmonary blood flow d. Bounding pulses in upper extremities
a
A child has had open heart surgery to repair a tetralogy of Fallot with a patch. The nurse should instruct the parents to a. notify all HCPs before invasive procedures for the next 6 months b. maintain adequate hydration of at least 10 glasses of water each day c. provide for frequent rest periods and naps during the first 4 weeks d. restrict the ingestion of bananas and citrus fruit
b d
A child with Kawasaki disease is receiving low dose aspirin. The mother calls the clinic and states the child has been exposed to influenza. Which recommendations should the nurse make? Select all that apply a. increase fluid intake b. stop the aspirin c. keep the child home from school d. watch for fever e. weigh the child daily
c
A nurse is planning care for a 12 year old with rheumatic fever. The nurse should teach the parents to a. observe the child closely b. allow the child to participate in activities that will not tire him c. provide for adequate periods of rest between activities d. encourage someone in the family to be with the child 24 hours a day
d
During the well-child checkup for an infant with tetralogy of Fallot, the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to a. lay the child flat to promote hemostasis b. lay the child flat with legs elevated to increase blood flow to the heart c. sit the child on the parent's lap, with legs dangling, to promote venous pooling d. hold the child in knee-chest position to decrease venous blood return
c
Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease states a. "the arthritis in her knees is permanent. She will need knee replacements" b. "I will give her diphenhydramine (benadryl) for her peeling palms and soles of her feet" c. "I know she will be irritable for 2 months after her symptoms started" d. "I will continue high doses of Tylenol for her inflammation"
a b c d f
Hypoxic spells in the infant with a congenital heart defect can cause which of the following? Select all that apply a. polycythemia b. blood clots c. CVA d. developmental delays e. viral pericarditis f. brain damage
d
If bleeding occurs at the insertion site after a cardiac catheterization, the nurse should apply a. warmth to the unaffected extremity b. pressure 1 inch below the insertion site c. warmth to the affected extremity d. pressure 1 inch above the insertion site
d
Pulmonary congestion in an infant may be identified by a. inability to feed b. mild cyanosis c. costal retractions d. all of the above
a
The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication? a. Pulmonary hypertension b. Right-to-left shunt of blood c. Pulmonary embolism d. Left ventricular hypertrophy
b
The nurse is teaching parents about administering digoxin (Lanoxin). What instructions should the nurse tell the parents? a. If the child vomits, give another dose. b. Give the medication at regular intervals. c. If a dose is missed, give a give an extra dose. d. Give the medication mixed with the childs formula.
b
The peak age for the incidence of Kawasaki disease is in the a. infant age group b. toddler age group c. school age group d. adolescent age group
b
What clinical manifestation is a common sign of digoxin toxicity? a. Seizures b. Vomiting c. Bradypnea d. Tachycardia
b
What sign/symptom is a major clinical manifestation of rheumatic fever (RF)? a. Fever b. Polyarthritis c. Osler nodes d. Janeway spots
c
After returning from cardiac catheterization, the nurse determines that the pulse distal to the catheter insertion site is weaker. How should the nurse respond? a. Elevate the affected extremity. b. Notify the practitioner of the observation. c. Record data on the assessment flow record. d. Apply warm compresses to the insertion site.
c
After returning from cardiac catheterization, the nurse monitors the childs vital signs. The heart rate should be counted for how many seconds? a. 15 b. 30 c. 60 d. 120
b
When developing the plan of care for a newly admitted 2 year old child with the diagnosis of Kawasaki disease, which intervention should be the priority? a. taking vital signs every 6 hours b. monitoring intake and output every hour c. minimizing skin discomfort d. providing passive ROM exercises
a
Coarctation of the aorta should be suspected when a. the blood pressure in the arms is different from the blood pressure in the legs b. the blood pressure in the right arm is different than in the left arm c. apical pulse is stronger than the radial pulse d. point of maximum impulse is shifted to the left
c
Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infants status, which finding is indicative of achieving this goal? a. Irritability when awake b. Capillary refill of more than 5 seconds c. Appropriate weight gain for age d. Positioned in high Fowler position to maintain oxygen saturation at 90%
a d f
Discharge teaching for a 3 month old infant with a cardiac defect who is to receive digoxin should include which information? Select all that apply a. give the medication at regular intervals b. mix the medication with a small volume of breast milk or formula c. repeat the dose one time if the child vomits immediately after administration d. notify the healthcare provider of poor feeding or vomiting e. make up any missed doses as soon as realized f. notify the HCP if more than 2 consecutive doses are missed
c
During play, a toddler with a history of tetrology of Fallot might assume which position? a. sitting b. supine c. squatting d. standing
c
Evaluation of the infant for edema is different from that of the older child in that a. weight is not reliable as an early sign b. pedal edema is most pronounced in the newborn c. edema is usually generalized and difficult to detect d. distended neck veins are the most reliable sign
a
Nursing care of the child with Kawasaki disease is challenging because of which occurrence? a. The childs irritability b. Predictable disease course c. Complex antibiotic therapy d. The childs ongoing requests for food
c
On assessment of a child admitted with a diagnosis of acute stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? a. cracked lips b. normal appearance c. conjunctival hyperemia d. desquamation of the skin
a
One of the most important factors in preventing bacterial endocarditis in high risk patients is a. administration of prophylactic antibiotic therapy b. surgical repair of the defect c. administration of routine childhood immunizations d. administration of antibiotics after dental work
d
Parents of the child with a congenital heart defect should know the signs of heart failure, which include a. poor feeding b. sudden weight gain c. increased efforts to breathe d. all of the above
a
The most painful part of cardiac surgery for the child is usually the a. thoracotomy incision site b. graft site on the leg c. sternotomy incision site d. intravenous insertion site
c
The nurse finds that a 6-month-old infant has an apical pulse of 166 beats/min during sleep. What nursing intervention is most appropriate at this time? a. Administer oxygen. b. Record data on the nurses notes. c. Report data to the practitioner. d. Place the child in the high Fowler position.
b
The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement by the parent indicates a need for further instruction? a. "A balance of rest and exercise is important" b. "I can apply lotion or powder to the incision if it is itchy" c. "Activities in which my child could fall need to be avoided for 2 to 4 weeks" d. "Large crowds of people need to be avoided for at least 2 weeks after surgery"
b
The nurse is assessing a child with a cardiac history. The child's extremities are cool with thready pulses, and urinary output is diminished. What do the assessment findings suggest for this child? a. Increased afterload b. Decreased contractility c. Increased stroke volume d. Decreased cardiac output
d
The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to a. call the interventional cardiologist b. notify the cardiac catheterization laboratory that the child will be returning c. apply a bulky pressure dressing over the present dressing d. apply direct pressure 1 inch above the puncture site
b c e
The nurse is caring for a child with Kawasaki disease in the acute phase. What clinical manifestations should the nurse expect to observe? Select all that apply a. Osler nodes b. Cervical lymphadenopathy c. Strawberry tongue d. Chorea e. Erythematous palms f. Polyarthritis
b
The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. What strategy is an important objective to decrease this risk? a. Minimize seizures. b. Prevent dehydration. c. Promote cardiac output. d. Reduce energy expenditure.
d
The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is too wet. The nurse finds the bandage and bed soaked with blood. What nursing action is most appropriate to institute initially? a. Notify the physician. b. Place the child in Trendelenburg position. c. Apply a new bandage with more pressure. d. Apply direct pressure above the catheterization site.
b
The nurse is caring for an 8 year old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while sleeping. The nurse questions the parents about which illness? a. Kawasaki disease b. Rheumatic fever c. Malignant hypertension d. Atrial fibrillation
a
The nurse is closely monitoring 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? a. weighing the diapers b. inserting a urinary catheter c. comparing intake with output d. measuring the amount of water added to formula
b
The nurse is giving discharge instructions to the parent of a 6-year-old child who had a cardiac catheterization 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? a. My child should not attend school for the next 5 days. b. I should change the bandage every day for the next 2 days. c. My child can take a tub bath but should avoid taking a shower for the next 4 days. d. I should expect the site to be red and swollen for the next 3 days.
c
The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure. The nurse should assess the infant for which early sign of HF? a. pallor b. cough c. tachycardia d. slow and shallow breathing
d
A child diagnosed with tetralogy of Fallot becomes upset, cries, and thrashes around when a blood specimen is obtained. The child becomes cyanotic, and the respiratory rate increases to 44. Which action should the nurse do first? a. obtain a prescription for sedation for the child b. assess for an irregular heart rate and rhythm c. explain to the child that it will only hurt for a short time d. place the child in a knee-chest position
b
A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which? a. Serum sodium b. Serum potassium c. Serum glucose d. Serum chloride
d
A child with rheumatic fever will be arriving to the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? a. "has the child complained of back pain?" b. "has the child complained of headaches?" c. "has the child had any nausea or vomiting?" d. "did the child have a sore throat or fever within the last 2 months?"
a
A common finding on physical examination of the child with acute rheumatic fever heart disease is a. a systolic murmur b. a pleural friction rub c. an ejection click d. a split S2
a b e
A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? Select all that apply a. weak femoral pulses b. cool skin of lower extremities c. severe cyanosis d. clubbing of the fingers e. low blood pressure
b c e
A nurse is assessing an infant who has heart failure. Which of the following findings should the nurse expect? Select all that apply a. bradycardia b. cool extremities c. peripheral edema d. increased urinary output e. nasal flaring
b
A nurse is caring for a 2 year old child who has a heart defect and is scheduled for a cardiac catheterization. Which of the following actions should the nurse take? a. place on NPO status for 12 hours 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 e
A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following findings should the nurse expect? 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
c
A nurse is providing teaching to the caregiver of an infant who has a prescription for digoxin. 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 the correct amount is received"
a
A nursing action that promotes ideal nutrition in an infant with congestive heart failure is a. feeding formula that is supplemented with additional calories b. allowing the infant to nurse at each breast for 20 minutes c. providing large feedings every 5 hours d. using firm nipples with small openings to slow feedings
d
The nurse provides home care instructions to the parents of a child with heart failure regarding the administration of digoxin. Which statement made by the parent indicates the need for further teaching? a. "I will not mix the medication with food" b. "I will take my child's pulse before administering the medication" c. "If more than 1 dose is missed, I will call the health care provider" d. "If my child vomits after medication administration, I will repeat the dose"
d
The nutritional needs of the infant with heart failure are usually a. the same as an adult's b. less than a healthy infant's c. the same as a healthy infant's d. greater than a healthy infant's
d
Bacterial infective endocarditis (IE) should be treated with which protocol? a. Oral antibiotics for 6 months b. Oral antibiotics (penicillin) for 10 full days c. IV antibiotics, diuretics, and digoxin d. IV antibiotics (penicillin type) for 2 to 8 weeks
c
Because of the medication used for long term therapy, children with Kawasaki disease are at increased risk for a. chickenpox b. influenza c. Reye syndrome d. myocardial infarction
a
Children who will undergo cardiac surgery should be informed about a. the location of the IV lines b. the pain at the intravenous insertion lines c. the need to lie still at all times after surgery d. all of the above
b
The parents of a 3 month old ask why their baby will not have an operation to correct a ventrical septal defect. The nurse's best response is a. "it is always helpful to get a second opinion about any serious condition like this" b. "your baby's defect is small and will likely close on its own by 1 year of age" c. "it is common for health care providers to wait until an infant develops respiratory distress before they do the surgery" d. "with a small defect like this, they wait until the child is 10 years old to do the surgery"
b
The parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. How should the nurse reply to this concern? a. The parents should meet all the childs needs. b. The child needs opportunities to play with peers. c. Constant parental supervision is needed to avoid overexertion. d. The child needs to understand that peers activities are too strenuous.
d
The parents of a young child with heart failure (HF) tell the nurse that they are nervous about giving digoxin. The nurses response should be based on which knowledge? a. It is a safe, frequently used drug. b. Parents lack the expertise necessary to administer digoxin. c. It is difficult to either overmedicate or undermedicate with digoxin. d. Parents need to learn specific, important guidelines for administration of digoxin.
d
The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication? a. Hypoxemia b. Right-to-left shunt of blood c. Decreased workload on the left side of the heart d. Pulmonary vascular congestion
b
The presence of poor ventricular function and atrial arrhythmias increases the risk for a. infection b. CVA c. fever d. air embolism
b
The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122//85, and her radial pulses are bounding. The nurse suspects she has a. transposition of the great vessels b. coarctation of the aorta c. aortic stenosis d. pulmonic stenosis
a
The standard treatment for Kawasaki disease is a. aspirin and immune globulin b. aspirin and cryoprecipitate c. meperidine hydrochloride and immune gobulin d. meperidine hydrochloride and cryoprecipitate
c
What action by the school nurse is important in the prevention of rheumatic fever (RF)? a. Encourage routine cholesterol screenings. b. Conduct routine blood pressure screenings. c. Refer children with sore throats for throat cultures. d. Recommend salicylates instead of acetaminophen for minor discomforts.
b
What blood flow pattern occurs in a ventricular septal defect? a. Mixed blood flow b. Increased pulmonary blood flow c. Decreased pulmonary blood flow d. Obstruction to blood flow from ventricles
a
What cardiovascular defect results in obstruction to blood flow? a. Aortic stenosis b. Tricuspid atresia c. Atrial septal defect d. Transposition of the great arteries
d
What information would a nurse counseling parents on the home care of the child with a cardiac defect before corrective surgery include? 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.
a
What is included in the therapeutic management of the child with rheumatic fever? a. Administration of penicillin b. Avoidance of salicylates (aspirin) c. Strict bed rest for 4 to 6 weeks d. Administration of corticosteroids if chorea developsa
d
What nursing consideration is important when suctioning a young child who has had heart surgery? a. Perform suctioning at least every hour. b. Suction for no longer than 30 seconds at a time. c. Expect symptoms of respiratory distress when suctioning. d. Administer supplemental oxygen before and after suctioning.
d
What nutritional component should be altered in the infant with heart failure (HF)? a. Decrease in fats b. Increase in fluids c. Decrease in protein d. Increase in calories
b
What preparation should the nurse consider when educating a school-age child and the family for heart surgery? a. Unfamiliar equipment should not be shown. b. Let the child hear the sounds of a cardiac monitor, including alarms. c. Explain that an endotracheal tube will not be needed if the surgery goes well. d. Discussion of postoperative discomfort and interventions is not necessary before the procedure.
b
What statement best identifies the cause of heart failure (HF)? a. Disease related to cardiac defects b. Consequence of an underlying cardiac defect c. Inherited disorder associated with a variety of defects d. Result of diminished workload imposed on an abnormal myocardium
a
What structural defects constitute tetralogy of Fallot? a. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy c. Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy d. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy
c
What would be included in nursing care of an infant with heart failure? 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.
c
What would be included in nursing interventions for a child after a cardiac catheterization? a. Allow ambulation as tolerated. b. Monitor vital signs every 2 hr. c. Assess the affected extremity for temperature and color. d. Check pulses above the catheterization site for equality and symmetry.
b
When assessing a child after heart surgery to correct tetralogy of Fallot, which finding should alert the nurse to suspect a low cardiac output? a. bounding pulses and mottled skin b. altered level of consciousness and thready pulses c. capillary refill of 2 seconds and BP of 96/67 d. extremities warm to the touch and pale skin
d
When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care? a. Aspirin is contraindicated. b. The principal area of involvement is the joints. c. The childs fever is usually responsive to antibiotics within 48 hours. d. Therapeutic management includes administration of gamma globulin and salicylates.
b
When obtaining a history from the parents of an infant suspected of having altered cardiac function, the nurse would expect a. specific concerns related to palpitations the infant is having b. feeding difficulty, sweating with activity, and poor weight gain c. specific concerns about the infant's shortness of breath d. concerns related to the infant's lack of crying
a b d f
Which signs and symptoms would lead the nurse to suspect a child has tetralogy of Fallot? Select all that apply a. murmur b. history of squatting c. bounding pulses d. cyanosis e. faint pulse f. tachypnea
b
While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2. The nurse suspects that the newborn has a. pulmonary hypertension b. patent ductus arteriosus c. ventricular septal defect d. bronchopulmonary dysplasia
b
While looking through the chart of an infant with a congenital heart defect of decreased pulmonary blood flow, the nurse would expect which laboratory finding? a. decreased platelet count b. polycythemia c. decreased ferritin level d. shift to the left
b
A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate? a. 60 beats/min b. 90 beats/min c. 100 beats/min d. 120 beats/min
d
After cardiac surgery, fluid intake calculations for a child would include a. intravenous fluids b. arterial and CVP line flushes c. fluid used to dilute medications d. all of the above
d
A 3-month-old infant has a hypercyanotic spell. What should be the nurses first action? a. Assess for neurologic defects. b. Prepare the family for imminent death. c. Begin cardiopulmonary resuscitation. d. Place the child in the kneechest position.
c
A 16 month old child diagnosed with Kawasaki disease is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. What should the nurse to first? a. apply lotion to the hands and feet b. offer foods the toddler likes c. place the toddler in a quiet environment d. encourage the parents to get some rest
a
A 12 year old with rheumatic fever has a history of long term aspirin use. Which client statement most indicates that the client is experiencing a serious adverse reaction to aspirin? a. "I hear ringing in my ears" b. "I put lotion on my itchy skin" c. "my stomach hurts after I take the medicine" d. "these pills make me cough"
a b c
An adolescent is being placed on a beta-blocker. What should the nurse inform the adolescent with regard to this medication? Select all that apply a. Medication may cause fatigue. b. Side effects may include impotence. c. Side effects may include bradycardia. d. Take the medication 1 hour before meals. e. Side effects may include peripheral edema.
a c e
An adolescent is being placed on an ACE inhibitor. What should the nurse inform the adolescent with regard to this medication? Select all that apply a. Stay well hydrated. b. Increase intake of potassium. c. Avoid rapid position changes. d. Take the medication with meals. e. Side effects may include a cough.
a
As part of the preoperative teaching for the family of a child undergoing a tetralogy of Fallot repair, the nurse tells the family upon returning to the pediatric floor that the child may a. be placed on a reduced sodium diet b. have an activity restriction for several days c. be assigned to an isolation room d. have visits limited to a select few
c
Surgical intervention is usually necessary in the first few months of life when an infant is born with a. atrial septal defect b. ventricular septal defect c. transposition of the great vessels d. patent ductus arteriosus
d
Which action should the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? a. maintain the joints in an extended position b. apply gentle traction to the child's affected joints c. support proper alignment with rolled pillows d. use a bed cradle to avoid the weight of the bed linens on the joints
a b c
Which are the most serious complications for a child with Kawasaki disease? a. coronary thrombosis b. coronary stenosis c. coronary artery aneurysm d. hypocoagulability e. decreased sedimentation rate f. hypoplastic left heart syndrome
b
Which finding might delay a cardiac catheterization procedure on a 1 year old? a. 30th percentile for weight b. severe diaper rash c. allergy to soy d. oxygen saturation of 91% on room air
b
Which information should the nurse include when completing discharge instructions for the parents of a 12 month old child diagnosed with Kawasaki disease and being discharged home? a. offer the child extra fluids every 2 hours for 2 weeks b. take the child's temperature daily for several days c. check the child's BP daily until the follow up appointment d. call the HCP if the irritability lasts for 2 more weeks
a
Which initial physical finding indicates the development of carditis in a child with rheumatic fever? a. heart murmur b. low BP c. irregular pulse d. anterior chest wall pain
a
Which physiologic changes occur as a result of hypoxemia in congestive heart failure? a. polycythemia and clubbing b. anemia and barrel chest c. increased WBC and low platelets d. elevated erythrocyte sedimentation rate and peripheral edema
c
Which plan would be appropriate in helping to control congestive heart failure in an infant? a. promoting fluid restriction b. feeding a low-salt formula c. feeding in semi-fowler's position d. encouraging breast milk
b
A 10 year old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess a. pain b. pulses c. hemoglobin and hematocrit levels d. catheterization report
d
A 12-year-old child with Down syndrome is admitted to the hospital for surgical correction of a heart defect. The boys mental age is that of a 3-year-old child. The nurse should prepare the child and family for surgery by what method? a. Extend preoperative teaching over several days. b. Explain the surgery to the child and the parents in detail. c. Exclude the child from preoperative teaching; teach only the parents. d. Provide teaching to the parents, keeping the information to the child simple
b
A 4 year old has been scheduled for a cardiac catheterization. To help prepare the family, the nurse should a. advise the family to bring the child to the hospital for a tour a week in advance b. explain that the child will need a large bandage after the procedure c. discourage bringing favorite toys that might become associated with pain d. explain that the child may get up as soon as the vital signs are stable
d
A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what? a. Tetralogy of Fallot b. Coarctation of the aorta c. Pulmonary stenosis d. Ventricular septal defect
b
A 6-year-old child is scheduled for a cardiac catheterization. What consideration is most important in planning preoperative teaching? a. Preoperative teaching should be directed at his parents because he is too young to understand. b. Preoperative teaching should be adapted to his level of development so that he can understand. c. Preoperative teaching should be done several days before the procedure so he will be prepared. d. Preoperative teaching should provide details about the actual procedures so he will know what to expect.
b
An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented? a. Leukopenia b. Polycythemia c. Anemia d. Increased platelet level
a c d
You are discharging a 5 week old infant with a congenital heart defect who will be going home on digoxin. Which of the following statements by the father indicate the need for further teaching? Select all that apply a. "I know I give the drug carefully by slowly directing it to the side and back of the mouth" b. "I give the medication every 12 hours, and I can place it in a bit of formula so I know the baby will take it" c. "If I miss a dose, I don't give an extra dose, but I give the next dose as ordered" d. "If the baby vomits, I should give a second dose" e. "If more than two doses have been missed, I should call the doctor"
b d
You are working in the pediatric clinic and a child presents with symptoms that are suspicious of the acute phase of Kawasaki disease. Which of the following symptoms are included? Select all that apply a. periungual desquamation of the hands and feet is present b. the bulbar conjuctivae of the eyes become reddened, with clearing around the iris c. a temporary arthritis is evident, which may affect larger weight-bearing joints" d. "Inflammation of the pharynx and oral mucosa develops, with red, cracked lips and the characteristic "straw-berry tongue"
a
You are working with a family with a child who has a congenital heart defect. Future surgery is planned, and you are teaching the parent how to reduce cardiac demands. The parent needs more teaching when she says which of the following? a. "I will wake my child for feeding every 2 hours so he can get enough calories to gain weight" b. "when I give the digoxin, I will listen to the pulse for 1 full minute" c. "I should protect my child from people who have respiratory infections" d. "I will count the number of wet diapers to be sure my child is not getting too much or too little fluid"
a d
You are working with a new graduate on the pediatric unit and your patient is returning from the cardiac catheterization lab. You feel the graduate student understands the important nursing interventions when she says which of the following? Select all that apply a. "check pulses especially below the catheterization site, for equality and symmetry" b. "check vital signs, which may be taken as frequently as every 30-45 minutes, with special emphasis on the heart rate, which is counted for 1 full minute for evidence of dysrythmias or bradycardia" c. "special attention needs to be given to the BP, especially for hypertension, which may indicate hemorrhage or bleeding from the catheterization site" d. "check the dressing for evidence of bleeding or hematoma formation in the femoral or antecubital area" e. "allow the child to ambulate because this will prevent skin breakdown from lying so long in one place"