Peds ch 26
A nurse is reinforcing teaching with the caregiver of an infant who has a prescription for digoxin. Which of the following statements should the nurse make? A. "Do not offer your baby fluids after giving the medication." B. "Digoxin increased 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."
"Give the correct dose of medication at regularly scheduled times."
A nurse is told that a child with rheumatic fever (RF) will be arriving to the nursing unit for admission. Which question should the nurse ask the family to elicit information specific to the development of RF? A. "Has the child complained of back pain?" B. "Has the child complained of headaches?" C. "Has the child had any nausea or vomiting?" D. "Has the child had a sore throat or fever within the past 2 months?"
"Has the child had a sore throat or fever within the past 2 months?"
Which comment made by a parent of a 1-month-old infant would alert the nurse about the presence of a congenital heart defect? a. "He is always hungry." b. "He tires out during feedings." c. "He is fussy for several hours every day." d. "He sleeps all the time."
"He tires out during feedings."
The nurse has reinforced homecare instructions to the parent of a child who is being discharged after cardiac surgery. Which statement by the parent indicates the need for further teaching? A. "A balance of rest and exercise is important." B. "I can apply lotion or powder to the incision if it is itchy." C. "Activities during which the child could fall need to be avoided for 2 to 4 weeks." D. "Large crowds of people need to be avoided for at least 2 weeks after this surgery."
"I can apply lotion or powder to the incision if it is itchy."
The nurse is providing instructions to a parent of a child with patent ductus arteriosus (PDA). Which statement by the parent would indicate a need for further teaching? A. "I know that my child will outgrow this problem, just give him time." B. "I know that I need to be alert for signs of heart failure with this defect until it is repaired." C. "The doctors tell me that my child has a heart murmur caused by the ductus not closing after birth." D. "As I understand it, my child may have to have the defect closed, either during a catherization or by surgery."
"I know that my child will outgrow this problem, just give him time."
The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for the administration of digoxin. Which statement by a parent indicates the need for further teaching? A. "I will not mix the medication with food." B. "If more than one dose is missed, I will call the doctor." C. "I will take my child's pulse before administering the medication." D. "If my child vomits after medication administration, I will repeat the dose."
"If my child vomits after medication administration, I will repeat the dose."
The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions? a. "If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest." b. "If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body." c. "If the baby turns blue, I will immediately put the baby upright in an infant seat." d. "If the baby turns blue, I will put the baby in supine position with his head elevated."
"If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest."
Which symptoms are indicative of rheumatic fever (RF)? (Select all that apply.) A. Abdominal pain B. Migratory polyarthritis C. Peeling skin D. Chorea E. Vomiting
1. Abdominal pain 2. Migratory polyarthritis 3. Chorea
Which congenital cardiac defect(s) cause(s) increased pulmonary blood flow? (Select all that apply.) a. Atrial septal defects (ASDs) b. Tetralogy of Fallot c. Dextroposition of aorta d. Patent ductus arteriosus e. Ventricular septal defects (VSDs)
1. Atrial septal defects (ASDs) 2. Patent ductus arteriosus 3. Ventricular septal defects (VSDs)
The nurse is recording the vital signs of an infant admitted with signs of respiratory distress. Which of the following observations should be reported to the health care provider? (select all that apply) A. Blood pressure is higher in the legs than in the arms B. Blood pressure is lower in the legs than in the arms C. Cyanosis of the lips D. Respiratory rate of 35 breaths per minute
1. Blood pressure is lower in the legs than in the arms 2. Cyanosis of the lips
Which signs indicate congenital cardiac problems? (Select all that apply.) A. Greater than normal weight gain B. Clubbing of fingers C. Bradycardia D. Tachypnea E. Pulsations in neck veins F. Dyspnea
1. Clubbing of fingers 2. Tachypnea 3. Pulsations in neck veins 4. Dyspnea
A nurse is collecting data from 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
1. Cool extremities 2. Peripheral edema 3. Nasal flaring
A nurse is collecting data from a child who has rheumatic fever. Which of the following findings should the nurse expect? (select all that apply) A. Erythema marginatum (rash) B. Continuous joint pain of the digits C. Tender, subcutaneous nodules D. Decreased erythrocyte sedimentation rate E. Elevated C-reactive protein
1. Erythema marginatum (rash) 2. Elevated C-reactive protein
How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? (Select all that apply.) a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding d. Substituting glucose water for formula e. Offering high-caloric formula
1. Feeding more frequently with smaller feedings 2. Using a soft nipple with enlarged holes 3. Holding and cuddling the child during feeding 4. Offering high-caloric formula
A 16-year-old patient is diagnosed with primary hypertension. What risk factors does the nurse mention when providing education on this diagnosis to the patient and his family? (Select all that apply.) a. Heredity b. Stress c. Congenital defect d. Obesity e. Poor diet
1. Heredity 2. Stress 3. Obesity 4. Poor diet
What are the four structural heart anomalies that make up the tetralogy of Fallot? (Select all that apply.) a. Hypertrophied right ventricle b. Patent ductus arteriosus c. Ventral septal defect d. Narrowing of pulmonary artery e. Dextroposition of aorta
1. Hypertrophied right ventricle 2. Patent ductus arteriosus 3. Narrowing of pulmonary artery 4. Dextroposition of aorta
The nurse caring for an infant with congenital heart disease is monitoring the infant closely for signs of heart failure (HF). The nurse should observe for which early sign of HF? (select all that apply) A. Cough B. Irritability C. Scalp diaphoresis D. Tachypnea, tachycardia E. Slow and shallow breathing
1. Irritability 2. Scalp diaphoresis 3. Tachypnea, tachycardia
What assessment(s) in a child with tetralogy of Fallot would indicate the child is experiencing a paroxysmal hypercyanotic episode? (Select all that apply.) a. Spontaneous cyanosis b. Dyspnea c. Weakness d. Dry cough e. Syncope
1. Spontaneous cyanosis 2. Dyspnea 3. Weakness 4. Syncope
Which defects are associated with tetralogy of Fallot? (Select all that apply.) A. Atrial septal defect B. Ventricular septal defect C. Dextroposition of the aorta D. Pulmonary artery stenosis E. Hypertrophy of the right ventricle F. Patent ductus arteriosus
1. Ventricular septal defect 2. Dextroposition of the aorta 3. Pulmonary artery stenosis 4. Hypertrophy of the right ventricle
A nurse is collecting data from 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
1. Weak femoral pulses 2. Cool skin of lower extremities 3. Low blood pressure
Digoxin (Lanoxin) is withheld if the pulse of a newborn is lower than ______ bpm. A. 120 B. 110 C. 100 D. 90
100
How long should a 4-year-old child recovering from rheumatic fever need to receive monthly injections of penicillin G? a. 1 year b. 2 years c. 5 years d. 10 years
5 years
Which assessment would lead the nurse to suspect that a newborn infant has a ventricular septal defect? a. A loud, harsh murmur with a systolic thrill b. Cyanosis when crying c. Blood pressure higher in the arms than in the legs d. A machinery-like murmur
A loud, harsh murmur with a systolic thrill
The nurse is monitoring the daily weight of an infant with heart failure (HF). Which finding alerts the nurse to suspect fluid accumulation and thus the need to notify the registered nurse? A. Bradypnea B. Diaphoresis C. Decreased blood pressure (BP) D. A weight gain of 1 lb in 1 day
A weight gain of 1 lb in 1 day
Through what does the infant born with hypoplastic left heart syndrome acquire oxygenated blood? a. The patent ductus arteriosus b. A ventricular septal defect c. The closure of the foramen ovale d. An atrial septal defect
An atrial septal defect
Hyptertension is identified in a 10 year old child during routine screening. Which plan of care can the nurse expect to see implemented initially? A. The child is started on a diuretic B. Beta-adrengic blockers are prescribed C. An exercise and diet program is developed D. A blood pressure measurement is scheduled in 4 weeks
An exercise and diet program is developed
Which diagnostic test is a standardized diagnostic test for rheumatic fever? A. Sedimentation rate B. WBC count C. Antistreptolysin O titer D. Rubella titer
Antistreptolysin O titer
An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). What does the nurse understand regarding why dyspnea occurs? a. Blood is circulated through the lungs again, causing pulmonary circulatory congestion. b. Blood is shunted past the pulmonary circulation, causing pulmonary hypoxia. c. Blood is shunted past cardiac arteries, causing myocardial hypoxia. d. Blood is circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.
Blood is circulated through the lungs again, causing pulmonary circulatory congestion
What finding would the nurse expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta? a. Blood pressure higher on the right side b. Blood pressure higher on the left side c. Blood pressure lower in the arms than in the legs d. Blood pressure lower in the legs than in the arms
Blood pressure lower in the legs than in the arms
What does the nurse explain that a ventricular septal defect will allow? a. Blood to shunt left to right, causing increased pulmonary flow and no cyanosis b. Blood to shunt right to left, causing decreased pulmonary flow and cyanosis c. No shunting because of high pressure in the left ventricle d. Increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume
Blood to shunt left to right, causing increased pulmonary flow and no cyanosis
A nurse is assisting with the care of a 2 year old child who has a heart defect and is scheduled for cardiac catherization. Which of the following actions should the nurse take? A. Place on NPO status for 12 hr 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
Check for iodine or shellfish allergies prior to the procedure
The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, "Why do my child's fingertips look like that?" On what understanding does the nurse base a response? a. Clubbing occurs as a result of untreated congestive heart failure. b. Clubbing occurs as a result of a left-to-right shunting of blood. c. Clubbing occurs as a result of decreased cardiac output. d. Clubbing occurs as a result of chronic hypoxia.
Clubbing occurs as a result of chronic hypoxia.
A nurse assists with admitting a child with a diagnosis of acute-stage Kawasaki disease. When obtaining the child's medical history, which clinical manifestation is likely to be reported? A. Cracked lips B. A normal appearance C. Conjunctival hyperemia D. Desquamation of the skin
Conjunctival hyperemia
An infant with congestive heart failure would most likely experience A. Excessive or rapid weight gain B. Difficulty breathing C. Bradypnea D. Erythema
Difficulty breathing
A pediatric patient is scheduled for a noninvasive procedure to determine if his heart is structurally normal and to localize a murmur. What diagnostic test does the nurse anticipate? a. Barium swallow b. Chest x-ray c. Electrocardiogram d. Echocardiogram
Echocardiogram
The nurse reviews the record of a child who was just seen by the primary health care provider (PHCP). The PHCP has documented a diagnosis of suspected aortic stenosis. Which specific sign/symptom of aortic stenosis should the nurse anticipate? A. Pallor B. Hyperactivity C. Exercise intolerance D. Gastrointestinal disturbances
Exercise intolerance
What is the best method for feeding an infant with congestive heart failure from a large ventricular septal defect? A. Space feedings at least every 3-4 hours B. Give frequent, large feedings C. Feed intravenously D. Feed smaller amounts more frequently
Feed smaller amounts more frequently
Prevention of rheumatic fever can best be accomplished by A. Keeping children with fever home B. Sending children with sore throats home from school C. Having sore throats cultured as soon as possible D. Treating all colds with antibiotics
Having sore throats cultured as soon as possible
A child develops carditis from rheumatic fever. Which areas of the heart are affected by carditis? a. Coronary arteries b. Heart muscle and the mitral valve c. Aortic and pulmonic valves d. Contractility of the ventricles
Heart muscle and the mitral valve
The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, "How does Kawasaki disease affect my child's heart and blood vessels?" On what understanding is the nurse's response based? a. Inflammation weakens blood vessels, leading to aneurysm. b. Increased lipid levels lead to the development of atherosclerosis. c. Untreated disease causes mitral valve stenosis. d. Altered blood flow increases cardiac workload with resulting heart failure.
Inflammation weakens blood vessels, leading to aneurysm
An infant with tetralology of Fallot is experiencing a tet spell involving cyanosis and dyspnea. In which position should the infant be placed? A. Fowler's B. Knee-chest C. Trendenlenburg's D. Prone
Knee-chest
When an infant is receiving digoxin (Lanoxin), the nurse would be alert to which finding as a sign of toxicity? A. A nurse's responsibility when a child is receiving diuretics is to B. Monitor serum electrolyte levels C. Place on seizure precautions D. Check the dosage with another nurse before administering
Monitor serum electrolyte levels
What are the priority nursing actions when administering Diuril (chlorothiazide) to a child diagnosed with congestive heart failure (CHF)? A. Intake and output and periods of rest B. Measure pulse for 1 minute and review ECG C. Monitor serum electrolytes and daily weight D. Hold dose if patient vomits and until doctors write order to repeat dose
Monitor serum electrolytes and daily weight Correct *This medication can cause potassium depletion, so serum electrolytes must be monitored, and daily weight identifies and measures the effectiveness of the medication.
A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever? a. Subcutaneous nodules and fever b. Painful, tender joints, and carditis c. Erythema marginatum and arthralgia d. Chorea and elevated sedimentation rate
Painful, tender joints, and carditis
The nurse is planning a hypertension-prevention program. What should be the main focus of the nurse when presenting information? a. Pharmacological treatment b. Surgical interventions available c. Patient education d. Reduction of aerobic exercise
Patient education
The nurse was caring for an infant who had come to the nursing unit for observation and treatment of tetralogy of Fallot. The child suddenly becomes cyanotic and the oxygen saturation reading drops to 60%. The nurse should perform which action first? A. Assist to administer morphine sulfate B. Place the child in a knee-chest position C. Administer 100% oxygen by face mask D. Prepare to administer intravenous fluids
Place the child in a knee-chest position
A father asks why his child with tetralogy of Fallot seems to favor a squatting position. What is the nurse's best response? a. Squatting increases the return of venous blood back to the heart. b. Squatting decreases arterial blood flow away from the heart. c. Squatting is a common resting position when a child is tachycardic. d. Squatting increases the workload of the heart.
Squatting increases the return of venous blood back to the heart.
A child with rheumatic fever begins involuntary, purposeless movements of her limbs. What does the nurse recognize that this indicates? a. Seizure activity b. Hypoxia c. Sydenham's chorea d. Decreasing level of consciousness
Sydenham's chorea
Which disorder causes unoxygenated blood to enter the systemic arterial circulation? A. Patent ductus arteriosus B. Tetralogy of Fallot C. Coarctation of the aorta D. Atrial stenosis
Tetralogy of Fallot *cyanotic heart disease. the rest are acyanotic
A congenital heart defect that results in decreased pulmonary flow is A. Tetrology of Fallot B. Atrial septal defect C. Ventricular Septal defect D. Patent ductus arteriosus
Tetrology of Fallot
Which observation indicates that an infant with congestive heart failure (CHF) is carefully following the prescribed medical regimen? A. The child takes antibiotics daily. B. The child exhibits normal weight for age. C. The child has an elevated RBC. D. The child's pulse rate is less than 50 beats/minute.
The child exhibits normal weight for age.
What is accurate about the characteristics of high-density lipoproteins (HDLs)? a. They have high amounts of triglycerides. b. They have only small amounts of protein. c. They have little cholesterol. d. They aid in steroid production.
They have little cholesterol
What is the most common congenital heart defect occurring in children? A. Ventricular septal defect B. Coarctation of the aorta C. Atrial septal defect D. Patent ductus arteriosus
Ventricular septal defect
An infant with congestive heart failure is receiving digoxin (Lanoxin). What does the nurse recognize as a sign of digoxin toxicity? a. Restlessness b. Decreased respiratory rate c. Increased urinary output d. Vomiting
Vomiting
A health care provider has prescribed oxygen as needed for a 10-month-old infant with heart failure (HF). In which situation should the nurse administer the oxygen to the child? A. When the child is sleeping B. When changing the child's diapers C. When the mother is holding the child D. When drawing blood for electrolyte levels
When drawing blood for electrolyte levels
Which is the most appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant? a. Counting the apical rate for 30 seconds before administering the medication b. Withholding a dose if the apical heart rate is less than 100 beats/minute c. Repeating a dose if the child vomits within 30 minutes of the previous dose d. Checking respiratory rate and blood pressure before each dose
Withholding a dose if the apical heart rate is less than 100 beats/minute
The nurse measuring an infant's blood pressure finds it is higher in the arms than the legs. The finding is associated with which congenital heart defect A. Tetrology of Fallot B. Coarctation of the aorta C. Patent ductus arteriosus D. Hypoplastic left heart syndrome
coarctation of the aorta
A child who has had heart surgery returns to the pediatric unit with a chest tube and drainage bottles in place. What is a priority nursing responsibility when caring for a child with chest tubes? A.) empty the chest tube drainage bottles each shift B.) clamp the chest tubes when turning the patient C.) place the drainage bottles on the bed when moving the bed D.) keep the drainages bottle below the chest level at all times
keep the drainages bottle below the chest level at all times
An infant with tetralogy of Fallot becomes hypercyanotic. The nurse would place an infant in the ________ position. A. High Fowler's B. Trendelenburg C. Side-lying D. Knee chest
knee chest
The nurse is assessing a child admitted with possible Kawasaki disease. A characteristic sign of symptom that the nurse should observe and document would be A. cardiac dysrhythmia B. decreased urine output C. peeling skin on fingers D. decreased level of consciousness
peeling skin on fingers
When administering digoxin (Lanoxin) to an infant, the medication should be withheld and the health care provider notified if the A. pulse rate is below 60 beats/min B. infant is dyspneic C. pulse rate is below 100 beats/min D. respiratory rate is above 40 breaths/min
pulse rate is below 100 beats/min
The nurse is caring for a child receiving digoxin (Lanoxin) for the diagnosis of heart failure. Which manifestation does the nurse recognize as a cardinal sign of digoxin toxicity? A. Respiratory distress B. Sudden change in pulse C. Constipation D. Headache
sudden change in pulse *Symptoms of toxicity include nausea, vomiting, anorexia, irregularity in rate and rhythm of the pulse, and a sudden change in the pulse.
