Pediatrics: Cardio Questions
In the electrical conduction system of the heart, where does the initial impulse start?
SA node
What neurological manifestations expected in a patient with rheumatic fever should be reported to the provider by the nurse?
Stroke due to thrombotic emboli, syncope due to Sydenham's Chorea, and seizures due to Sydenham's Chorea
Child presents to hospital. During assessment murmur is heard during S2 and a HR of 90 bpm. The nurse notes that the child is below average height. What is the cause?
Structural defect
What does the nurse teach the parents who are concerned and fearful of their child's bluish color? "The child has very low partial pressure of oxygen." "The bluish color can be reduced by fluid restriction." "The color change implies a lack of oxygen to the brain." "The child has cyanosis associated with a lack of oxygen."
"The child has cyanosis associated with a lack of oxygen." The nurse teaches the parents that the child has a bluish color because of reduced oxygen saturation. This condition, called cyanosis, occurs when blood has deoxygenated hemoglobin at a concentration of 5g/dL or more. Despite a near-normal partial pressure of oxygen, patients with polycythemia have a high concentration of deoxygenated hemoglobin, and may appear cyanotic. In cyanotic children, fluid restriction can cause dehydration and increase the risks of cerebrovascular accidents. The nurse must reassure the parents that the bluish color of the skin or mucous membrane does not imply a lack of oxygen to the brain.
Which key diagnostic findings help to differentiate infective endocarditis from rheumatic heart disease?
Increased ASO (antistreptolysin O) titer in rheumatic heart disease, Bacterial (infective) endocarditis can be identified by serial blood cultures, and Positive throat culture for group A beta hemolytic streptococci in rheumatic fever.
Tachycardia, potentiates HF in the long term. What is the relationship between the two?
Increased HR increases metabolic demand and decreases filling and resting time for the heart. These changes lead to HF
What is the relationship between right-sided heart failure and pulmonary artery stenosis?
Increased pressure developed in the right ventricle can cause hypertrophy and eventually failure of the right side of the heart
The nurse should explain to the parents that their child is receiving furosemide for severe congestive heart failure because of which effect? A diuretic A β-blocker An ACE inhibitor A form of digitalis
A diuretic Furosemide is a diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated with congestive heart failure. Furosemide is not a β-blocker. Furosemide is not a form of digitalis. Furosemide is not an ACE (angiotensin-converting enzyme) inhibitor.
A patient with asymptomatic hypertrophic cardiomyopathy is prescribed beta-blocker prophylaxis. The parents would like to know why their child is receiving a medication when no symptoms are evident. What explanation describes the function of the beta-blocker prophylaxis?
Beta blockers are used to prevent the development of abnormal heart rhythms that can be life threatening.
What change in the neonate is directly responsible for the closure of foramen ovale?
Increased pressure in the left ventricle
A patient with CHD is hospitalized for suspected infective endocarditis. The patient has a history of heart murmur, and during assessment an alteration in the murmur is heard. What is the nurse's priority response?
Notify the HCP
A neonate has cyanosis and increased pulmonary blood flow. The family is confused about how increased blood flow to the lungs would decreae oxygen levels in the body. What can the nurse say to explain this?
Anatomical features present in this child prevent blood from becoming fully loaded with oxygen in the lungs before going out to the body. The body appears cyanotic due to the lower than normal oxygen levels.
Which manifestation may be reduced if the vasculitis (inflammation of blood vessels) of Kawasaki disease is limited?
Aneurysm
A patient with Kawasaki disease shows signs of cardiac involvement. Why does the nurse need to emphasize the importance of maintaining cardiology check-ups throughout life?
Aneurysms formed during the subacute phase of the disease can rupture late in life or cause stenosis and eventual myocardial infarction.
Which statement explains the development of pulmonary hypertension in an infant with a large left to right defect?
Any congenital shunt can increase blood volume in the heart affecting both the pulmonary vein and pulmonary artery in delivering blood to the lungs and from the lungs to the heart respectively. The pulmonary vasculature responds to this increased load by vasoconstriction leading to pulmonary HTN.
Which heart defect causes narrowing of the aortic valve? Aortic stenosis Atrial septal defect Coarctation of the aorta Patent ductus arteriosus
Aortic stenosis Aortic stenosis causes narrowing of the aortic valve, which in turn results in resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Atrial septal defect is an abnormal opening between the atria that allows blood from the higher-pressure left atrium to flow into the lower-pressure right atrium. Coarctation of the aorta is an obstructive defect in which there is narrowing near the insertion of the ductus arteriosus. Patent ductus arteriosus is the failure of the fetal ductus arteriosus to close during the first few weeks of life.
A child receiving antihypertensive therapy presents with a cough and angioedema. Which drug does the health care provider need to discontinue? Losartan Atenolol Captopril Amlodipine
Captopril is an angiotensin converting enzyme (ACE) inhibitor. Side effects include a cough and angioedema. The health care provider needs to discontinue captopril if these side effects are noticed. Angiotensin receptor blockers such as losartan may cause an increase in potassium levels. Atenolol is a beta blocker. Such drugs may cause fatigue, a decrease in exercise tolerance, weakness, and cold extremities. They can possibly cause impotence too. Amlodipine is a calcium channel blocker that may cause peripheral edema and constipation.
What is indicated when the point of maximal impulse (PMI) is found in a lower location than expected during the cardiac assessment?
Cardiac hypertrophy (heart takes up more space)
The nurse is caring for patient suffering from a cyanotic heart lesion and has inserted an IV line. Moments later the child appears to be in moderate distress and action is required. Which clinical manifestation should require the MOST immediate action?
Changes in neurologic status
What nursing intervention is the most important in preventing complications of digoxin administration? Assessing blood pressure in all extremities Assessing blood pressure with the patient lying, sitting, and standing Checking the apical pulse for 60 seconds before administering the medication Checking the carotid pulse for 30 seconds before administering the medication
Checking the apical pulse for 60 seconds before administering the medication The child's apical pulse should be assessed for 60 seconds before the medication is administered; the medication should be held if the apical pulse is below 90 to 110 beats per minute in infants and young children or below 70 beats per minute in older children. Assessing the blood pressure or the carotid pulse before giving digoxin is not necessary.
Closure of the ductus arteriosus occurs shortly after birth. Children born with right-to left shunts begin to experience an increase in cyanosis with this closure. Which explanation describes the pathophysiology of this clinical manifestation?
Closure of ductus arteriosus decreases the volume of blood going to the lungs for oxygenation
Which term describes the thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia? Clubbing Polycythemia Hypercyanotic spells Raynaud phenomenon
Clubbing Clubbing is a thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia and polycythemia. Polycythemia is an increased number of red blood cells. Hypercyanotic, or "blue," spells are often seen in infants with tetralogy of Fallot; the affected infant becomes acutely cyanotic and hyperpneic. Raynaud phenomenon is an autoimmune disease.
The mother of a child with tetralogy of Fallot states that over the past two weeks the child has been experiencing periodic episodes of increased cyanosis, irritability, and moments of deep breathing in the morning. After child is assessed and vitals appear stable what is the most important action for the nurse to take?
Contact HCP b/c the child is in need of surgery
A child has been diagnosed with hypoplastic left heart syndrome. Which action by the nurse will be a priority for providing long term management of this child?
Contact provider as surgical consult is needed
What pathophysiological changes in the patient with Kawasaki disease that increase the risk of myocardial infarction in the patient?
Coronary artery damage that leads to stenosis and severe thrombosis that occurs in the second stage can block coronary artery blood flow at the site of coronary aneurysm.
When a dysrhythmia is suspected, what is the nurse's first action? Notifying the heart catheterization lab Administering an antidysrhythmic medication Counting the radial pulse every minute for 5 minutes Counting the apical rate for 1 full minute and comparing it with the radial rate
Counting apical rate for 1 full minute and comparing it with the radial rate is the nurse's first action. If a dysrhythmia is occurring, the radial pulse may be lower than the apical rate. Notifying the catheterization lab is not the first action until a thorough assessment is completed to determine what type of dysrhythmia is present. A complete assessment needs to be conducted before any medications are administered. Radial pulse needs to be compared with apical. It is the nurse's responsibility to check both rates, radial and apical.
Which statement explains the appearance of cyanosis in an individual with polycythemia secondary to congenital heart disease (CHD)?
Cyanosis will appear in the presence of higher oxygen saturation levels (less desaturated) than normal
What physiological changes are augmented by strenuous exercise and high altitudes in the patient with pulmonary arterial hypertension (PAH)?
Cyanosis, peripheral edema, and right sided heart hypertrophy
During development, pulmonary veins may aberrantly attach to the superior vena cava. What are the possible outcomes or clinical manifestations of the anomaly?
Cyanosis, tachycardia, peripheral edema, and mixed blood will be delivered to systemic circulation.
In which procedure for cardiac diagnosis are radiopaque catheters placed in a peripheral blood vessel and advanced into the heart? Echocardiography Electrophysiology Electrocardiography Cardiac catheterization
In cardiac catheterization, radiopaque catheters are placed in a peripheral blood vessel and advanced into the heart as a means of measuring pressures and oxygen levels in heart chambers and visualizing heart structures and blood flow patterns.
Pulmonary artery stenosis can precipitate regurgitation and prevent the closure of the foramen ovale. Which manifestations can occur if the formen ovale remains patent in a patient with pulmonary stenosis?
Decreased oxygenation of blood entering systemic circulation
A child with aortic stenosis may experience symptoms of myocardial infarction (MI). How can these symptoms occur in a patient without vascular disease?
Decreased pressure in the aorta results in decreased elastic recoil. Subsequently, less blood is delivered to the coronary arteries.
If aortic valvular insufficiency results from infective endocarditis, which cardiac problem can result if valvular surgery is not performed?
Development of heart failure.
How should the nurse describe dilated cardiomyopathy to an adolescent patient?
Dilated cardiomyopathy means the heart chambers have increased volume but not in strength of the muscle. More volume fills the ventricular chambers but the muscle is not strong enough to properly eject the volume.
In doing the respiratory assessment in a patient with heart failure (HF), which assessment findings should the nurse expect to see?
Distinictive cough, abnormal lung sounds, deep breaths with activity
Which cardiac complication should cause changes in cardiac output (CO) after catheterization?
Dyshythmias
Which diagnostic test can be used for real-time visualization of both heart structures and function?
Echocardiography (ECHO)
In what procedure are high-frequency sound waves directed through a transducer to produce an image of cardiac structures? Electrophysiology Echocardiography Electrocardiography Cardiac catheterization
Echocardiography involves the use of high-frequency sound waves. The child undergoing this procedure must lie completely still. With improvements in technology a diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is an electrical tracing of the depolarization of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart, a contrast medium is injected, and the heart and its vessels are visualized. Electrophysiology is an invasive procedure in which catheters with electrodes record the impulses of the heart directly from the conduction system.
What information can be obtained by observing the integumentary system during a cardiac assessment?
Evidence of cyanosis
What are some of the clinical manifestations associated with left-sided obstructive lesions?
Exercise intolerance, pulmonary hypertension, and left ventricular hypertrophy
A mother is concerned that her child suffering from heart failure (HF) has started to experience abdominal pain. What explanation by the nurse can be provided to the mother to help her understand this coexisting condition?
Fluid overload causing congestion can lead to abdominal pain
The nurse is auscultating the chest of a pediatric patient and identifies a clear heart murmur. Palpation does not identify a thrill. The nurse should note this as which grade of murmur?
Grade 3
Which diagnostic test should be most efficient for evaluating an active child who has cardiac symptoms that do not currently interfere with daily activites?
Holter monitor
Coarctation of the aorta increases afterload and cardiac workload. Which form of cardiomyopathy may develop related to the increased afterload and how would the nurse describe the progression to the family?
Hypertrophic; cardiac hypertrophy develops to match the afterload and maintain cardiac output.
The nurse is assessing a pediatric patient with rhythm disturbance and decreased cardiac output. What action should the nurse take?
Immediately notify the HCP
Pulmonary arterial hypertension (PAH) management is designed to treat the symptoms of heart failure (HF). How does treating HF symptoms facilitate the management of PAH?
Improving right sided heart function and fluid management will decrease the symptoms of PAH, increasing afterload will force the heart to increase contractility and therefore decrease PAH
What should the nurse teach the parents of a child who has a history of bacterial infective endocarditis (IE)? Institute prophylactic antibiotic therapy. Treat with short-term oral drug therapy. Treat a cold with over-the-counter drugs. Take blood culture before dental work.
Institute prophylactic antibiotic therapy. The parents must take adequate measures to prevent infection. The child must be administered prophylactic antibiotic therapy 1 hour before certain procedures, such as dental work. Treatment of IE requires long-term parenteral drug therapy. Intravenous antibiotics may be administered at home with nursing supervision. Any unexplained fever, weight loss, lethargy, malaise, or anorexia must be reported to the health care provider. Such symptoms should not be self-diagnosed as a cold or flu, nor should they be treated with over-the-counter drugs. Early diagnosis and treatment are important in preventing further cardiac damage, embolic complications, and growth of resistant organisms. Blood cultures must be taken periodically to evaluate the response to antibiotic therapy.
What is the advantage of the cardiac catheterization test over the echocardiography test? It can determine the size of the heart. It can measure the electrical activity of the heart. It can detect anomalies in the anatomical structure of the heart. It can measure the oxygen saturation of blood in the chambers of the heart.
It can measure the oxygen saturation of blood in the chambers of the heart. Unlike an echocardiography test, cardiac catheterization provides information about the oxygen saturation of blood within the chambers of the heart and the great vessels. It is an invasive procedure, in which a radiopaque catheter is inserted through a peripheral blood vessel into the heart. Echocardiography can determine the size of the heart. Neither cardiac catheterization nor echocardiography measures the electrical activity of the heart, which is measured with the help of an electrocardiogram (ECG). Both cardiac catheterization and echocardiography can detect anomalies in the anatomical structure of the heart. Echocardiography can help detect the presence or absence of the structures of the heart and their relationship to one another. Cardiac catheterization can determine anatomical abnormalities such as septal defects or obstruction to the flow of blood.
A child with heart failure has been prescribed digoxin and enalapril. How does the action of digoxin differ from that of enalapril? It reduces blood pressure due to vasodilation. It reduces pulmonary and systemic vascular resistance. It reduces cardiac preload by preventing volume expansion. It reduces cardiac afterload by improving contractility of the heart.
It reduces cardiac afterload by improving contractility of the heart. Both digoxin and angiotensin converting enzyme inhibitors (ACE inhibitors) such as enalapril enhance the myocardial function in heart failure. Digoxin does this by improving the contractility of the heart. Enalapril blocks the formation of angiotensin II, which results in vasodilation. This results in a decrease in blood pressure and a decrease in pulmonary and systemic resistance. ACE inhibitors reduce the secretion of aldosterone, which reduces preload by preventing volume expansion from fluid retention.
The parent of a patient with aortic stenosis would like more information about a new diagnosis of pulmonary venous hypertension. What information should the nurse provide regarding treatment and outcomes?
Keep regular follow up appointments for observation and interventional correction of the stenotic valve will improve cardiac output and decrease the pulmonary hypertension
What position does the nurse caring for a young child with tetralogy of Fallot see the child assuming in an attempt to compensate for the congenital heart defect? Prone Supine Knee-chest Low Fowler
Knee-chest The squatting position, otherwise known as the knee-chest position, decreases the amount of blood returning to the heart and allows the child time to compensate. The prone and supine positions do not offer any advantages to the child with cardiac compromise. The low Fowler position would assist with respiratory issues but not with cardiac compensation.
Which statements would a nurse use while educating a teenager recently diagnosed with HCM?
Limit exertion and competitive sports to reduce strain on the heart, prophylactic beta blockers medicine will be used to reduce the risk of abnormal heart rhythms, and a Holter monitor will help determine if you have an abnormal heart rhythm, even without symptoms.
What is a major concern associated with transposition of the great vessels when the patient has patent ductus arteriosus (PDA) but no additional septal defect?
Limited areas for mixing of blood
What is the function of low-dose treatment for patients recovering from KD with coronary artery involvement?
Low-dose aspirin treatment is used to reduce platelet aggregation
What is the relationship between increased lymphocyte infiltration, edema, and inflammation in the progression of pathophysiology in Kawasaki disease?
Lymphocytes initiate an immune response against smooth muscle cells of the vasculature causing inflammation and edema; this leads to the development of aneurysms.
A newborn infant has pulmonary atresia with intact ventricular septum. The parents want to know why the health care provider said it was important to keep fetal structures open. How can the nurse explain the rationale for maintaining fetal structures in the newborn infant?
Maintaining open fetal structures will allow blood to make its way to the lungs. This will allow for oxygenation of the blood for the baby
Which cardiac valve is responsible for regulating the flow of oxygenated blood between ventricle and atrium?
Mitral valve
What is the name for defects in which blood exiting the heart meets an area of anatomic narrowing? Mixed Cyanotic Acyanotic Obstructive
Obstructive defects are those in which blood exiting the heart meets an area of anatomic narrowing, causing obstruction to blood flow. Acyanotic defect is a classification of heart defects in which children do not have symptoms of cyanosis. Cyanotic defect is a classification of heart defects in which children have symptoms of cyanosis. Mixed defect is the term used to describe cardiac defects in which saturated and desaturated blood flow mixes.
How can a nurse distinguish between a patient with hypoplastic left heart syndrome and truncus arteriosus?
Oxygenated blood flows to left atrium in hypoplastic left heart syndrome, wheeas oxygenated blood flows into left ventricle where blood mixing occurs in truncus arteriosus
What is the benefit of maintaining a patent ductus arteriosus (PDA) for a child with tetralogy of Fallot?
PDA will help to maintain the pulmonary blood flow
Following cardiac catheterization, what nursing assessments are necessary?
Palpate pulses, inspect catheter insertion site
What is the relationship between the formation of vegetation on the cardiac valves and neurological symptoms in the patient with infective endocarditis?
Part of the vegetation can break free becoming an embolus, The vegetation can limit flow through a cardiac valve resulting in decreased blood flow to the brain.
What is the relationship between the fetal cardiac anatomical features and the survivability of complex cardiac lesions in the early neonatal stage?
Patent fetal structures maintain pathways for the movement of blood and allow for mixing of oxygenated and deoxygenated blood
At birth, clamping of the umbilical cord and the first breath generates pressure changes in the neonate's circulation. This results in major changes in which aspects of the heart?
Path of blood flow, blood oxygenation, and vascular resistance
What conclusions can be drawn regarding clinical manifestations for a patient with a left-to-right ventricular shunt and decreased pulmonary blood flow?
Patient may have polycythemia, patient may be hypoxemic, resulting in cyanosis, and patient may have increased cardiac workload and ventricular strain
Which statement helps to explain why a patient with Down syndrome might have a marked increase in pulmonary blood flow?
Patients with Down syndrome often have cardiac defects associated with the genetic syndrome. The patient may have an atrioventricular septal defect (AVSD)
Atrial septal defects are conservatively treated as many spontaneously close. What assumptions can be made regarding the possible outcomes if the defect does not close?
Right sided pressures will increase, right side of heart will be volume overloaded, there will be increased pulmonary blood flow, and there will be increased oxygen saturation on right side of the heart.
What is the greatest risk factor for development of infective endocarditis?
Poor oral hygiene
What findings during the cardiac assessment provide information about possible cardiac dysfunction?
Poor weight gain, decreased feeding, and respiratory pattern alterations
Which physiologic factors must be taken into consideration when determining cardiac output (CO)?
Preload, afterload, and heart rate
The nurse is caring for a child with incomplete closure of the aortic semilunar valve. How does the nurse describe the normal function of this valve to the patient's family?
Prevents blood from flowing back into the ventricle
Congenital heart defects have traditionally been divided into acyanotic and cyanotic defects. What does the nurse know about this system in clinical practice? Helpful because it explains the hemodynamics involved Problematic because cyanosis is rarely present in children Helpful because children with cyanotic defects are easily identified Problematic because children with acyanotic heart defects may experience cyanosis
Problematic because children with acyanotic heart defects may experience cyanosis This classification is problematic. Children with traditionally named acyanotic defects may become cyanotic, and children with traditionally classified cyanotic defects may be pink at times. The classification does not reflect the blood flow within the heart. Cardiac defects are best described by their actual pathophysiologic processes and mechanisms. Children with cyanosis may be easily identified, but that does not aid diagnosis. Cyanosis is present when children have defects in which there is mixing of oxygenated and unoxygenated blood.
Nurse is measuring BP in a patient with stenotic lesion. What should the nurse expect when comparing blood pressures proximal and distal to the lesion?
Proximal to the lesion, pressure will be high; distal to the lesion, pressure will be decreased or absent.
What should the nurse expect to see regarding pulmonary blood flow if an infant had a ventricular left to right shunt?
Pulmonary artery thickening, increased pulmonary blood flow, and pulmonary arterial HTN
Which statement describes the relationship between the ductus arteriosus and blood flow in the fetus?
Pulmonary circulation pressure is high; the ductus arteriosus directs blood away from the lungs and into the aorta
A child joins the soccer team and experiences dyspnea and some chest pain but assumes he is out of shape. That night he sleeps sitting up in the recliner because he can breathe better. After three days of this routine, his mother takes him to the clinic and he is diagnosed with hypertrophic cardiomyopathy. What pathophysiological event will the nurse need to manage in this patient?
Pulmonary venous congestion
Which factor influence the amount of blood that fills the ventricle immediately before contraction?
Rate of venous return
The nurse, preparing to give digoxin to a 9-month-old infant, checks the dosage and sees that 4 mL of the drug is to be drawn up. What is the most appropriate action by the nurse, drawing on knowledge of this medication and safe pediatric dosages? Mix the dose with juice to disguise its taste Refrain from drawing up dose because there is an error in the dosage Checks the heart rate and administers the dose by letting the infant suck it through a nipple Checks the heart rate and administers the dose by placing it at the back and side of the mouth
Refrain from drawing up dose because there is an error in the dosage Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. As a potentially dangerous drug, digoxin has precise administration guidelines. Some institutions require that digoxin dosages be checked with another professional before administration. The nurse has drawn up too much medication and should not give it to the child. Administering the dose through a nipple is the correct procedure, but too much medication has been prepared, so it should not be given to the child. Administering the dose by placing it at the back and side of the mouth is the correct procedure, but too much medication has been prepared, so it should not be given to the child.
The mother of a patient with RF asks the nurse why her child must be on antibiotics. What statement clearly explains the use of prophylactic antibiotics after rheumatic fever?
Repeated streptococcal infections can further damage the cardiac valves. Prevention is essential.
In doing assessments on patients with IE and rheumatic fever, which systems will be a priority for the nurse in treating patients with both IE and rheumatic fever?
Respiratory system, neurological, cardiovascular, and immunological system.
What statement describes the prominent concern regarding rheumatic fever with long-term health effects?
Rheumatic heart disease, which is the development of permanent damage to the cardiac valves
In response to the pathophysiology of heart failure (HF), there is activation of the sympathetic nervous system and the release of hormones in an effort to maintain cardiac output (CO). How do these two systems synergistically increase cardiac output?
Sympathetic nervous system activity increases heart rate, sympathetic nervous system activity increases stroke volume and endocrine function of the hormones of renin angiotensin aldosterone system leads to increased intravascular volume
What clinical evidence suggests carditis in a patient with suspected RF?
Tachycardia, pericardial friction rub, and development or change in cardiac murmur.
What is an early sign of congestive heart failure that the nurse should recognize? Tachypnea Bradycardia Inability to sweat Increased urine output
Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child with congestive heart failure may be diaphoretic and exhibit decreased urine output.
After cardiac catheterization of a child, which assessment finding is a cause of concern to the nurse? The pulse distal to the catheterization site is weak. The affected extremity feels cool when touched. The child has resumed oral intake with clear liquids. The child is in bed with the affected extremity straight.
The affected extremity feels cool when touched. If the affected extremity feels cool when touched, arterial obstruction may be present. The health care provider must be notified immediately. A weak pulse distal to the site for the first few hours after catheterization is not a cause for concern. However, the pulse should gradually increase in strength. The child's usual diet can be resumed as soon as tolerated, beginning with sips of clear liquids and advancing as the condition allows. The child must take in enough fluids to ensure adequate hydration. Blood loss, nothing by mouth (NPO) status, and diuretic actions of dyes used during the procedure increase the risk for hypovolemia and dehydration. The child must be kept in bed, with the affected extremity maintained straight for several hours, to promote healing of the cannulated vessel.
Why both the bell and the diaphragm of the stethoscope are used?
The bell is used to identify low-pitched sounds; the diaphragm is used to identify high-pitched sounds (S1 is lower pitch; S2 is higher pitch)
How do pressures in the fetal heart and pulmonary vasculature compare to neonatal?
The fetal heart has lower left ventricular pressure, the fetal heart has higher right ventricular pressure, and the pulmonary vasculature has increased pressure
Which statement best summarizes the differences between the fetal and neonatal heart in terms of oxygen saturation?
The fetal heart has moderate oxygen saturation throughout, whereas the neonatal heart has low oxygen saturation on the right side and high oxygen saturation on the left side.
A student athlete with a normal physical exam collapses during practice. The athlete's brother states that their uncle passed away at 19-years-old while playing soccer. What assumption regarding cardiac pathology could be made based on this data?
The patient has hypertrophic cardiomyopathy
During assessment, the nurse notes shortness of breath and severe chest pain in a patient with suspected Kawasaki disease. What conclusion should be drawn based on these manifestations?
The patient is experiencing symptoms related to myocardial infarction
Which is the most important laboratory test result that must be evaluated before administering digoxin to a child with congestive heart failure? Serum sodium level Serum chloride level Serum potassium level Serum bicarbonate level
The serum potassium level is the most important test to consider when preparing to administer digoxin. Hypokalemia enhances the effects of digoxin, thereby increasing the risk of digoxin toxicity. Hyperkalemia diminishes the effect of digoxin. The use of certain diuretics in heart failure patients may also cause loss of sodium, chloride, and bicarbonate ions. Although the serum levels of sodium, chloride, and bicarbonate are important during heart failure therapy, their monitoring is not essential specifically during digoxin therapy.
The nurse notes that QP/QS ratio (pulmonary-to-systemic ratio) is normal, however the right side of the heart has increased saturation. What conclusion can be drawn from this data?
There is a left to right shunt
For what reasons is it essential to assess all four extremities while performing a cardiac assessment?
To determine temperature differences, to asses capillary filling in the extremeties, to determine differences between the central and peripheral pulses, and to determine differences in blood pressure between upper and lower extremeties
In patients with coarctation of the aorta, infusion of prostaglandin E1 may be used to keep the ductus arteriosus open. What is the rationale for facilitating patent ductus arteriosus (PDA) when the patient has coarctation of the aorta?
To increase blood flow to descending aorta by allowing deoxygenated blood from pulmonary trunk to mix with blood distal to lesion
What is the rationale for administering potent vasoconstriction agents to a child experiencing a hypercyanotic episode?
To increase systemic vascular resistance, to decrease the degree of right to left shunting, and to increase blood flow into the pulmonary circulation
When caring for a child with a right-to-left shunt, what precaution is essential when obtaining IV access?
Use meticulous attention to avoid introducing air bubbles in tubing of IV line
Which treatment is given priority for the prevention of subsequent cardiac valve damage in rheumatic fever?
Use of antibiotic prophylaxis to prevent infection
What is the relationship between left-to-right shunt congenital heart defects and increased pulmonary blood flow?
Volume overload results in the right side of the heart and this increases pulmonary blood flow
A nurse caring for a child suspects a dysrhythmia. What is the nurse's first action? Administering oxygen Setting up cardiac monitoring Assessing the child's blood pressure Counting the apical rate for 1 full minute
count apical for one minute
