Nursing Care of the Child with a Cardiovascular Disorder
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?
"After surgery, most children will catch up." 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 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?
"Children who have this diagnosis may have had strep throat." 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 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?
"He seems listless and slightly warm." 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 past medical history of an infant with a suspected cardiovascular disorder. Which of the following responses by the mother warrants further investigation?
"I am on a low dose of steroids" Explanation: Some medications, like corticosteroids, taken by pregnant women may be linked with the development of congenital heart defects. Reports of nausea during pregnancy and an Apgar score of eight would not trigger further questions. Febrile illness during the first trimester, not the third, may be linked to an increased risk of congenital heart defects.
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?
"Make sure you are fully immunized." Explanation: The cause of congenital heart disease often cannot be documented, although it is associated with familial patterns of inheritance and possibly triggers such as rubella (German measles) and varicella (chickenpox) infection during pregnancy. Women need to enter pregnancy fully immunized to help prevent infection during pregnancy. Encouraging the child to eat a low-sodium diet and exercise as he grows up will help prevent acquired heart disease, not congenital heart disease
When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), which of the following would be included in the education?
"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.
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?
"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?
"We can stop the penicillin when her symptoms disappear." 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.
An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize?
"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.
An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize?
"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.
A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which of the following should the nurse say to the girl's mother in response to these findings?
"Your daughter has an innocent heart murmur, which is nothing to worry about." Explanation: The symptoms described indicate an innocent heart murmur. Although innocent murmurs are of no consequence, parents need to be told when their child has one because this finding will undoubtedly be discovered again at a future health assessment or during a febrile illness, anxiety, or pregnancy. Activities need not be restricted when a child has an innocent murmur and the child requires no more frequent health appraisals than other children. If a murmur is present as the result of heart disease or a congenital disorder, it is an organic heart murmur.
The infant has been hospitalized and develops hypercyanosis. The physician has ordered the nurse to administer 0.1 mg of morphine sulfate per every kilogram of the infant's body weight. The infant weighs 15.2 pounds. Calculate the infant's morphine sulfate dose. Round your answer to the nearest tenth.
0.7 Explanation: The infant weighs 15.2 pounds (2.2 pounds = 1 kg.) 15.2 pounds x 1 kg/2.2 pounds = 6.818 kg The infant weighs 6.818 kg. For each kilogram of body weight, the infant should receive 0.1 mg of morphine sulfate. 6.818 kg x 0.1 mg/1 kg = 0.6818 mg Rounded to the tenth place = 0.7 mg The infant will receive 0.7 mg of morphine sulfate.
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.
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?
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.
The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding?
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.
The nurse is auscultating heart sounds of a child with a mitral valve prolapse. The nurse would expect which assessment finding?
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?
Abnormal hair growth 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 a baby with a suspected cardiovascular disorder. Which of the following assessment findings is suggestive of sudden ventricular distention?
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?
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.
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?
Administer oxygen. Explanation: 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?
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.
A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify which of the following as a major Jones criterion?
Arthralgia Explanation: Arthralgia is considered a minor criterion. Carditis is a major criterion. Erythema marginatum is considered a major criterion. Subcutaneous nodules are considered a major criterion.
In caring for the child with rheumatic fever which medication would the nurse likely administer?
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.
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?
At birth the right and left ventricle are about the same size. 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?
Avoid drawing a blood specimen from the right femoral vein before the procedure 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?
Begin formulas with increased calories. 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.
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 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?
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.
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?
Chorea 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?
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.
A child is diagnosed with tetralogy of Fallot and during a temper tantrum turns blue. Which of the following would the nurse do first?
Place child in the knee-to-chest position. 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.
The nurse performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a:
Grade IV Explanation: 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
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?
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?
Digoxin 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?
Digoxin (Lanoxin) 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.
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.
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.
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?
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.
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?
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 longer to develop
After assessing a child, the nurse suspects coarctation of the aorta based on which of the following?
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 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?
Have the child be seen by the primary care provider. 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?
High-frequency sound waves are directed toward the heart 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.
On assessment immediately following cardiac surgery, which of the following conditions would you expect to find in an infant?
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?
Increased RBC 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?
Ineffective tissue perfusion related to inefficiency of the heart as a pump Explanation: A ventriculoseptal defect permits blood to flow across a septum, creating an ineffective pump.
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?
Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions 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.
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?
It will determine if the heart is enlarged. 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.
When caring for a child with Kawasaki Disease, the nurse would know which of the following?
Management includes administration of aspirin and IVIG. 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.
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.
A nurse is administering digoxin to a 3-year-old. Which of the following would be a reason to hold the dose of digoxin?
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.
A nurse suspects a child is experiencing cardiac tamponade after heart surgery. Which of the following would be the priority nursing intervention?
Notify the doctor immediately. 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.
When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of which of the following as the major mechanism involved?
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 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?
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.
When educating the family of an ill infant with a large, symptomatic ventricular septic defect (VSD), which of the following would be included in the education if the doctor is planning on performing palliative care until the infant is healthier?
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 nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?
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 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?
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.
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?
Place the child in a knee-to-chest position. 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.
An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?
Place the infant in the knee-chest position. 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?
Placing her in a semi-Fowler's position 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?
Polycythemia Explanation: Children who cannot oxygenate red cells well often produce excess red blood cells or develop polycythemia.
A parent brings an infant in for poor feeding. Which of the following assessment data would most likely indicate a coarctation of the aorta?
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 child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?
Serum potassium level 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.
A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?
Serum potassium level 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.
An infant girl is prescribed digoxin. You would teach her parents that the action of this drug is to
Slow and strengthen her heartbeat. Explanation: Digoxin is a cardiac glycoside that slows and strengthens the heartbeat.
A nurse is caring for a newborn with congenital heart disease (CHD). Which of the following would the nurse interpret as indicating distress?
Subbcostal retraction at the time of feeding Explanation: 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.
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?
Tachycardia Explanation: 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.
When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?
Tachycardia Explanation: Tachycardia is one of the signs of heart failure. Bradycardia, inability to sweat, and splenomegaly are not necessarily signs of heart failure.
At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important?
Taking pedal pulses for the first 4 hours 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 newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis?
Tetralogy of Fallot 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 nurse is providing education to a family about cardiac catheterization. Which of the following would be included in the education?
The catheter will be placed in the femoral artery. 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.
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 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?
The child will need the blood pressure checked two more times. 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
After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding of which of the following?
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 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?
The heart's apex is higher in the chest in children younger than the age of 7 years. 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.
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.
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?
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 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?
The mother states she has lupus. 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.
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?
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 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?
There are several reasons a baby can have a heart defect, let's talk about those causes. 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 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?
There is a less than 7% chance a sibling would inherit a heart defect. 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
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?
These wires are connected to the heart and will detect if your child's heart gets out of rhythm. 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.
Parents are told their infant has a hypoplastic left heart. What is the type of education that would be included for this family?
This is a problem where the left side of the heart did not develop properly. 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.
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. Explanation: 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 parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education?
This is caused by an opening that usually closes by 1 week of age. 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.
A parent asks why their infant with a cyanotic heart defect turns blue. What is the best response by the nurse?
This is due to a decreased amount of oxygen to the peripheral tissue. 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
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?
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.
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?
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 has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which of the following reactions?
Wheezing 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.
Infants with congenital heart disease should not be allowed to become dehydrated because this makes them prone to
cerebrovascular accident. Explanation: Children who have polycythemia from cardiovascular disease can develop thrombi if they become dehydrated.
When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the
child will return with a bulky pressure dressing over the catheter insertion area. Explanation: Cardiac catheterization is typically performed with the child awake but using conscious sedation. A dressing will be placed on the catheter insertion site.
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? Select all that apply.
• 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
The nurse is assessing a child with suspected rheumatic fever. Which of the following would the nurse expect to find? Select all that apply.
• 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.
The nurse is implementing the plan of care for a child with acute rheumatic fever. Which of the following would the nurse expect to administer if ordered? Select all that apply.
• 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 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.
• 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 pediatric nurse has digoxin ordered for each of the five children. The nurse will withhold digoxin for which of the following children? Select all that apply.
• The 16-year-old child has a heart rate of 54 beats per minute • The 5-year-old child has developed vomiting, diarrhea and is difficult to arouse • The 2-year-old child has a digoxin level of 2.4 ng/mL from a blood draw this morning Correct Explanation: 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
