pediatric final
What type of defect is Tetrology of Fallot
Cyanotic
What interventions are you going to implement for tetrology of fallot
Make sure O2 is available and apply if needed Make pt squat or bend knees to chest Calm the pt Possibly sedation
The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is: 1. Immunoglobulin G and aspirin. 2. Immunoglobulin G and ACE inhibitors. 3. Immunoglobulin E and heparin. 4. Immunoglobulin E and ibuprofen.
1. Immunoglobulin G and aspirin. Rationale: High-dose immunoglobulin G and salicylate therapy for inflammation are the current treatment for KD
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 join pain of the digits C. tender, subcutaneous nodules D. decreased erythrocyte sedimentation rate E. elevated C-reactive protein
A. erythema marginatum (rash) E. elevated C-reactive protein
What will it look like if the patient is experiencing a negative side effect of digoxin
N & V Abd. Pain Vision changes (halos) Bradycardia
Defects of decreased pulmonary blood flow have which type of shunt?
R-L
Are there any complications you need to be prepared to treat in tetrology of fallot
Tet spells ( hypercyanotic spells)
Why do we give alprostadil (PGE1)
To keep the ductus arteriosis open when pt is experiencing a Cyanotic defect or decreases in CO
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. cool extremities C. peripheral edema E. nasal flaring
A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? A. gallop and rales B. blood pressure discrepancies in the extremities C. right ventricular hypertrophy on ECG D. heart murmur
d. Heart Murmur Rationale: Typically, children with aortic stenosis have a murmur that is best heard along the left sternal border. They do not commonly exhibit a gallop, rales, or right ventricular hypertrophy. Blood pressure and pulse discrepancies between the upper and lower extremities occur with coarctation of the aorta, not aortic stenosis.
The nurse is assessing a child for cardiac disorders and documents the presence of clubbing of the fingers and toes. Which of the following conditions might this indicate? a. Infection b. Cyanosis c. Edema d. Hypoxia
d. Hypoxia. Rationale: Clubbing (which usually does not appear until after 1 year of age) implies chronic hypoxia due to congenital heart disease.Rationale: The sign of an infection is fever. Cyanosis is a bluish tint to the skin due to decreased oxygenation. Edema is swelling or bloating due to fluid imbalance.
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? A. obesity from overeating B. clubbing of the nail beds C. squatting during play activities D. exercise intolerance
a. obesity from overeating Rationale: Children with CHD causing chronic cyanosis are likely to demonstrate failure to thrive, not obesity. They frequently develop clubbing of the nail beds and exercise intolerance, and those with tetralogy of Fallot or pulmonary stenosis may display hypercyanotic spells (squatting).
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? A. previous streptococcal throat infection B. history of open-heart surgery at 5 years of age C. playing too much soccer and not getting enough rest D. exposure to a sibling with pneumonia
a. previous streptococcal throat infection Rationale: Rheumatic fever occurs as a sequela to group A streptococcal infection.
The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? A. Allow early ambulation to encourage activity participation. B. Check pulses above the catheter insertion site for strength and quality. C. Assess extremity distal to the insertion site for temperature and color. D. Change the dressing to evaluate the site for infection.
c. Assess extremity distal to the insertion site for temperature and color. Rationale: Vessel spasm or hematoma may occur after the catheterization, occluding circulation. The extremity may become pale, feel cool to the touch, and have diminished pulses distal to the insertion site.
Corarct of the Aorta is what type of defect? 1. Cyanotic 2.acyanotic 3.obstructive
3. Obstructive
The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel? A. Ambulate the children twice daily to promote mobility. B. Encourage commode use to promote bowel function. C. Provide diversionary activities, as the children must stay flat on their backs. D. Assist with log-rolling the children every 2 hours.
D. Assist with log-rolling the children every 2 hours.
A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. he has an effective cough. lung auscultation reveals diminished breath sounds. what is the priority nursing intervention? A. Apply supplemental oxygen. B. Notify the respiratory therapist. C. Monitor pulse oximetry. D. Position for adequate airway clearance.
D. Position for adequate airway clearance.
How do we know if digoxin isn't working?
High heart rate Arrhythmias
Botulinum toxin
Inhibits ACh release, relief for spasticity often in cerebral palsy patients
4. Defects of increased pulmonary blood flow have which type of shunt?
L-R
A Patent Ductus Arteriosus has which type of shunt?
L-R
Which defect decreases cardiac output?
Obstructive coarction of the aorta
What 4 defects make up the congenital defect Tetratology of Fallot?
Pulmonary stenosis VSD Right ventricle hypertrophy Overriding AORTA
List 2 ways the nurse can screen for an obstructive congenital defect in an infant.
Pulse ox on hand in foot (pulses on UE &LE) Blood pressure on UE& LE (assess perfusion between UE & LE)
a. What assessments will the nurse make prior to the administration of digoxin
Take apical heart rate for full minute Infant and toddler<100 Preschool <80 Adolescent <60 Don't give if heart rate under min
Which congenital cardiac defect is a cyanotic defect?
Tetrology of fallot
How will we know if digoxin is working
The heart rate will slow Improvement in CO
How do we know if alprostadil (PGE1) it's working
A focused assessment would not have improvement in perfusion to low portion of the body Improvement of O2
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
A. weak femoral pulses B. cool skin of lower extremities E. low blood pressure
The nurse is caring for a 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? A. Routine catheterization will decrease the risk of infection from urine staying in the bladder. B. I know it will be important for me to catheterize my child for the rest of her life C. I will make sure that I always use latex-free catheters. D. I will wash the catheter with warm soapy water after each use.
B. I know it will be important for me to catheterize my child for the rest of her life.
A nurse is caring for a 2-year-old child who has a heart defect and is scheduled for cardiac catheterization. Which of the following actions should the nurse take? A. place on NPO status for 12 hrs 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
B. check for iodine or shellfish allergies prior to the procedure
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"
C. "give the correct dose of medication at regularly scheduled times"
The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality? A. Encourage follow-through with physical therapy exercises. B. Restrict the child to a special needs classroom. C. Encourage after-school activities within the limits of the child's abilities. D. Ensure the school is aware of the child's capabilities.
C. Encourage after-school activities within the limits of the child's abilities.
A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history? A. Age that the child learned to walk B. Parents' expectations of the child's development C. Functional status related to eating and mobility D. Birth history to identify cause of cerebral palsy
C. Functional status related to eating and mobility
Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply 1. Allow parents to hold and rock their child. 2. Feed only when the infant is crying. 3. Keep the child uncovered to promote low body temperature. 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities.
1. Allow parents to hold and rock their child 4. Make frequent position changes. 5. Feed the child when sucking the fists. 6. Change bed linens only when necessary. 7. Organize nursing activities. Rationale: Rocking by the parents will comfort the infant and decrease demands, Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for skin breakdown. An infant sucking the fists could indicate hunger, Change bed linens only when necessary to avoid disturbing the child, Organize nursing activities to avoid disturbing the child
A child born with Down syndrome should be evaluated for which associated cardiac manifestation? 1. Congenital heart defect (CHD). 2. Systemic hypertension. 3. Hyperlipidemia. 4. Cardiomyopathy
1. Congenital heart defect (CHD). Rationale: CHD is found often in children with Down syndrome
Which are the most serious complications for a child with Kawasaki disease (KD)? Select all that apply. 1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. 4. Hypocoagulability. 5. Decreased sedimentation rate. 6. Hypoplastic left heart syndrome.
1. Coronary thrombosis. 2. Coronary stenosis. 3. Coronary artery aneurysm. Rationale: Thrombosis, stenosis, and aneurysm affect blood vessels. The child with KD has hypercoagulability and an increased sedimentation rate due to inflammation
Tetralogy of Fallot (TOF) involves which defects? SATA 1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. Pulmonic stenosis (PS). 5. Pulmonic atresia. 6. Overriding aorta. 7. Patent ductus arteriosus (PDA)
1. Ventricular septal defect (VSD). 2. Right ventricular hypertrophy 4. Pulmonic stenosis (PS). 6. Overriding aorta Rationale: TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta.
The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect (VSD). The nurse's best response is: 1. "It is always helpful to get a second opinion about any serious condition like this." 2. "Your baby's defect is small and will likely close on its own by 1 year of age." 3. "It is common for physicians to wait until an infant develops respiratory distress before they do the surgery." 4. "With a small defect like this, they wait until the child is 10 years old to do the surgery."
2. "Your baby's defect is small and will likely close on its own by 1 year of age." Rationale: Usually a VSD will close on its own within the first year of life
A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has: 1. Ventricular septal defect (VSD). 2. Aortic stenosis (AS). 3. Mitral valve prolapse. 4. Tricuspid atresia.
2. Aortic stenosis (AS). Rationale: AS can progress, and the child can develop exercise intolerance that can be better when resting.
What should the nurse assess prior to administering digoxin? 1. Sclera. 2. Apical pulse rate. 3. Cough. 4. Liver function test.
2. Apical pulse rate. Rationale: The apical pulse rate is assessed because digoxin decreases the HR, and if the HR is <60, digoxin should not be administered.
2. A Ventral Septal Defect has which type of shunt? 1. R-L 2. L-R 3. No Shunt
2. L-R
An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff? 1. Soy. 2. Latex. 3. Penicillin. 4. Dairy.
2. Latex. Rationale: Children with spina bifida (myelo-meningocele) often have a latex allergy. The catheter balloon is often made of latex, and all personnel caring for the patient should be made aware of the allergy.
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: 1. Pulmonary hypertension. 2. Patent ductus arteriosus (PDA). 3. Ventricular septal defect (VSD). 4. Bronchopulmonary dysplasia.
2. Patent ductus arteriosus (PDA). Rationale: The main identifier in the stem is the machine-like murmur, which is the hallmark of a PDA.
Which statement by the mother of a child with rheumatic fever (RF) shows she has good understanding of the care of her child? 1. "I will apply heat to his swollen joints to promote circulation." 2. "I will have him do gentle stretching exercises to prevent contractures." 3. "I will give him the aspirin that is ordered for pain and inflammation." 4. "I will apply cold packs to his swollen joints to reduce pain."
3. "I will give him the aspirin that is ordered for pain and inflammation." Rationale: Aspirin is the drug of choice for treatment of RF.
Family discharge teaching has been effective when the parent of a toddler diagnosed with Kawasaki disease (KD) states: 1. "The arthritis in her knees is permanent. She will need knee replacements." 2. "I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet." 3. "I know she will be irritable for 2 months after her symptoms started." 4. "I will continue with high doses of Tylenol for her inflammation."
3. "I know she will be irritable for 2 months after her symptoms started. Rationale: Children can be irritable for 2 months after the symptoms of the disease start
On examination, a nurse hears a murmur at the left sternal border (LSB) in a child with diarrhea and fever. The parent asks why the pediatrician never said anything about the murmur. The nurse explains: 1. "The pediatrician is not a cardiologist." 2. "Murmurs are difficult to detect, especially in children." 3. "The fever increased the intensity of the murmur." 4. "We need to refer the child to an interventional cardiologist."
3. "The fever increased the intensity of the murmur." Rationale: The increased CO of the fever increases the intensity of the murmur, making it easier to hear
During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position? 1. Sitting. 2. Supine. 3. Squatting. 4. Standing.
3. Squatting. Rationale: The toddler will naturally assume this position to decrease preload by occluding venous flow from the lower extremities and increasing afterload. Increasing SVR in this position increases pulmonary blood flow.
Which statement by a parent of an infant with congestive heart failure (CHF) who is being sent home on digoxin indicates the need for further education? 1. "I will give the medication at regular 12-hour intervals." 2. "If he vomits, I will not give a make-up dose." 3. "If I miss a dose, I will not give an extra dose" 4. "I will mix the digoxin in some formula to make it taste better."
4. "I will mix the digoxin in some formula to make it taste better." Rationale: If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate
During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to: 1. Lay the child flat to promote hemostasis. 2. Lay the child flat with legs elevated to increase blood flow to the heart. 3. Sit the child on the parent's lap, with legs dangling, to promote venous pooling. 4. Hold the child in knee-chest position to decrease venous blood return.
4. Hold the child in knee-chest position to decrease venous blood return. Rationale: The increase in the SVR would increase afterload and increase blood return to the pulmonary artery.
Patent Ductus Arteriosus is what type of defect?
Ayanotic
What is the hallmark sign of tetrology of fallot
Squatting in the corner
Baclofen (Lioresal)
skeletal muscle relaxant, treats spasms often used in cerebral palsy patients
Which statement by the mother of a child with rheumatic fever (RF) shows she has an understanding of prevention for her other children? 1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." 2. "There is no treatment. It must run its course." 3. "If their culture is positive for group A streptococcus, I will give them their antibiotic." 4. "If their culture is positive for staphylococcus A, I will give them their antibiotic."
1. "Whenever one of them gets a sore throat, I will give that child an antibiotic." Rationale: Do not use an antibiotic if the disease is not bacterial in origin. Most sore throats are viral.
The following are examples of acquired heart disease. Select all that apply. 1. Infective endocarditis. 2. Hypoplastic left heart syndrome. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD). 6. Transposition of the great vessels.
1. Infective endocarditis. 3. Rheumatic fever (RF). 4. Cardiomyopathy. 5. Kawasaki disease (KD) Rationale: Infective endocarditis is an example of an acquired heart problem, RF is an acquired heart problem, Cardiomyopathy is an acquired heart problem, KD is an acquired heart problem
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: 1. Transposition of the great vessels. 2. Coarctation of the aorta (COA). 3. Aortic stenosis (AS). 4. Pulmonic stenosis (PS)
2. Coarctation of the aorta (COA) Rationale: In the older child, COA causes dizziness, headache, fainting, elevated blood pressure, and bounding radial pulses.
Aspirin has been ordered for the child with rheumatic fever (RF) in order to: 1. Keep the patent ductus arteriosus (PDA) open. 2. Reduce joint inflammation. 3. Decrease swelling of strawberry tongue. 4. Treat ventricular hypertrophy of endocarditis
2. Reduce joint inflammation. Rationale: Joint inflammation is experienced in RF; aspirin therapy helps with inflammation and pain.
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 recent illness? 1. Kawasaki disease (KD). 2. Strep throat. 3. Malignant hypertension. 4. Atrial fibrillation.
2. Strep throat. Rationale: Chorea can be a manifestation of RF, with a higher incidence in females
In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs? 1. Transposition of the great vessels. 2. Aortic stenosis (AS). 3. Coarctation of the aorta (COA). 4. Tetralogy of Fallot (TOF).
3. Coarctation of the aorta (COA). Rationale: With COA there is narrowing of the aorta, which increases pressure proximal to the defect (upper extremities) and decreases pressure distal to the defect (lower extremities). There will be high BP and strong pulses in the upper extremities and lowerthan-expected BP and weak pulses in the lower extremities.
A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say: 1. "She will need to take the antibiotics until she is 18 years old." 2. "She will need to take the antibiotics for 5 years after the last attack." 3. "She will need to take the antibiotics for 10 years after the last attack." 4. "She will need to take the antibiotics for the rest of her life."
4. "She will need to take the antibiotics for the rest of her life." Rationale: Valvular involvement indicates significant damage, so antibiotics would be taken for the rest of her life
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: 1. Call the interventional cardiologist. 2. Notify the cardiac catheterization laboratory that the child will be returning. 3. Apply a bulky pressure dressing over the present dressing. 4. Apply direct pressure 1 inch above the puncture site.
4. Apply direct pressure 1 inch above the puncture site. Rationale: Applying direct pressure 1 inch above the puncture site will localize pressure over the vessel site.
While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? A. Provide supplemental oxygen by face mask. B. Administer a dose of IV morphine sulfate. C. Begin cardiopulmonary resuscitation. D. Place the infant in a knee-to-chest position.
d. Place the infant in a knee-to-chest position. Rationale: Hypercyanotic spells are a dangerous event. Placing the infant in a knee-to-chest position increases systemic vascular resistance, thereby improving pulmonary blood flow. It is the first action the nurse should take.
