Peds - Chapter 19: Nursing Care of the Child With a Cardiovascular Disorder

Ambulatory electrocardiographic monitoring

The nurse is caring for a 10-year-old girl with a suspected heart arrhythmia. The nurse would expect to prepare the child for which test to identify and quantitate the arrhythmia? a) Arteriogram b) Echocardiogram c) Chest radiograph d) Ambulatory electrocardiographic monitoring

Arthralgia Arthralgia is considered a minor criterion. Carditis , Erythema marginatum, and Subcutaneous nodules are considered a major criterion.

A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify what as a major Jones criterion? a) Subcutaneous nodules b) Erythema marginatum c) Arthralgia d) Carditis

Digoxin

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed? a) Indomethacin b) Digoxin c) Furosemide d) Alprostadil

Heart murmur.

A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? 1. Gallop and rales. 2. Blood pressure discrepancies in the extremities. 3. Right ventricular hypertrophy on ECG. 4. Heart murmur.

Tetralogy of Fallot

A newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis? a) Coarctation of aorta b) Pulmonary stenosis c) Aortic stenosis d) Tetralogy of Fallot

The heart's apex is higher in the chest in children younger than the age of 7 years.

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. What would the instructor include in the class discussion? a) The heart is about four times the birth size between the ages of 6 and 12 years. b) Blood pressure is initially high at birth but gradually decreases to adult levels. c) The heart's apex is higher in the chest in children younger than the age of 7 years. d) Left ventricular function predominates immediately after birth.

There is a less than 7% chance a sibling would inherit a heart defect.

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? a) There is a less than 7% chance a sibling would inherit a heart defect. b) This was probably caused by environmental factors, not genetics. c) These occur related to medication the mother was taking while pregnant. d) There is no chance this will be passed to another child since we do not know what caused it.

There are several reasons a baby can have a heart defect, let's talk about those causes.

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? a) No, heart defects are mainly caused by genetic factors. b) The studies show it is impossible to know what causes heart defects. c) There are several reasons a baby can have a heart defect, let's talk about those causes. d) Yes, there is a chance you caused this defect.

This is due to a decreased amount of oxygen to the peripheral tissue.

A parent asks why their infant with a cyanotic heart defect turns blue. What is the best response by the nurse? a) This is considered a medical emergency and needs immediate surgery. b) This is due to a decreased amount of oxygen to the peripheral tissue. c) This is due to the lack of oxygen to the brain. d) This is a sign of heart failure.

Pulses weaker in lower extremities compared to upper extremities

A parent brings an infant in for poor feeding. Which of the following assessment data would most likely indicate a coarctation of the aorta? a) Pulses weaker in upper extremities compared to lower extremities b) Cyanosis with feeding c) Pulses weaker in lower extremities compared to upper extremities d) Cyanosis with crying

Assessing for the presence of femoral pulses

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? a) Recording an upper extremity blood pressure b) Observing for excessive crying c) Auscultating for a cardiac murmur d) Assessing for the presence of femoral pulses

Obesity from overeating.

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? 1. Obesity from overeating. 2. Clubbing of the nail beds. 3. Squatting during play activities. 4. Exercise intolerance.

False

Tetralogy of Fallot consists of the following four anomalies: aortic stenosis, atrial septal defect, dextroposition (overriding) of the aorta, and hypertrophy of the left ventricle. a) False b) True

• Tiring easily when eating • Shortness of breath when playing • Crackles on lung auscultation

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply. a) Shortness of breath when playing b) Bradycardia c) Crackles on lung auscultation d) Hypertension e) Tiring easily when eating

Previous streptococcal throat infection.

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? 1. Previous streptococcal throat infection. 2. History of open heart surgery at 5 years of age. 3. Playing too much soccer and not getting enough rest. 4. Exposure to a sibling with pneumonia.

Place the infant in a knee-to-chest position.

While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? 1. Provide supplemental oxygen by face mask. 2. Administer a dose of IV morphine sulfate. 3. Begin cardiopulmonary resuscitation. 4. Place the infant in a knee-to-chest position.

Avoid drawing a blood specimen from the right femoral vein before the procedure

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? a) Keep the child NPO for 2 to 4 hours before the procedure b) Avoid drawing a blood specimen from the right femoral vein before the procedure c) Apply EMLA cream to the catheter insertion site d) Record pedal pulses

The child starts getting warm again

A child is being placed on a cardiopulmonary bypass machine. The nurse understands the heart will pump again on its own when what occurs? a) The child starts getting warm again b) When cardioplegia is administered c) When digoxin is administered d) When chest compressions are performed

Ineffective tissue perfusion related to inefficiency of the heart as a pump

An 8-month-old has a ventricular septal defect. Which nursing diagnosis below would best apply? a) Impaired skin integrity related to poor peripheral circulation b) Impaired gas exchange related to a right-to-left shunt c) Ineffective airway clearance related to altered pulmonary status d) Ineffective tissue perfusion related to inefficiency of the heart as a pump

Taking pedal pulses for the first 4 hours

At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important? a) Allowing the child to talk about the procedure b) Allowing the child to adapt to the light room gradually c) Taking pedal pulses for the first 4 hours d) Assuring the child that the procedure is now over

• Ventricular septal defect • Patent ductus arteriosus • Atrioventricular canal defect

Nursing students are reviewing information about the different types of congenital heart defects. They demonstrate understanding of the information when they identify which of these as disorders with increased pulmonary blood flow? Select all that apply. a) Ventricular septal defect b) Atrioventricular canal defect c) Patent ductus arteriosus d) Pulmonary stenosis e) Coarctation of the aorta

• The child's right foot is cool with a pulse assessed only with the use of a Doppler. • The child has a temperature of 102.4° F (39.1° C). • The child is reporting nausea.

The child has returned to the nurse's unit following a cardiac catheterization. The insertion site is located at the right groin. Peripheral pulses were easily palpated in bilateral lower extremities prior to the procedure. Which finding should be reported to the child's physician? a) The child is reporting nausea. b) The child has a runny nose. c) The right groin is soft without edema. d) The child's right foot is cool with a pulse assessed only with the use of a Doppler. e) The child has a temperature of 102.4° F (39.1° C).

100 beats per minute

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? a) 150 beats per minute b) 60 beats per minute c) 80 beats per minute d) 100 beats per minute

To build the blood levels to a therapeutic level

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? a) To decrease the pain to a tolerable level b) To build the blood levels to a therapeutic level c) To establish a maintenance dose of the drug d) To increase the heart rate

Softening of the nail beds

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding? a) Softening of the nail beds b) Intact rooting reflex c) Steady weight gain since birth d) Appropriate mastery of developmental milestones

Chorea

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? a) Arthralgia b) Polyarthritis c) Carditis d) Chorea

Accentuated third heart sound

The nurse is conducting a physical examination of an infant with a suspected cardiovascular disorder. Which assessment finding is suggestive of sudden ventricular distention? a) Accentuated third heart sound b) Decreased blood pressure c) Heart murmur d) Cool, clammy, pale extremities

Abnormal hair growth

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? a) A "moon face" appearance b) Repetitive movements c) Facial grimaces d) Abnormal hair growth

• Nonsteroidal anti-inflammatory drugs • Corticosteroids • Penicillin

The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatments would the nurse expect to administer if ordered? Select all that apply. a) Intravenous immunoglobulin b) Nonsteroidal anti-inflammatory drugs c) Digoxin d) Corticosteroids e) Penicillin

Subcostal retraction at the time of feeding

A nurse is caring for a newborn with congenital heart disease (CHD). Which finding would the nurse interpret as indicating distress? a) Reduced respiratory rate during feeding b) Perspiration on body after feeding c) Feeding lasting for 15-20 minutes d) Subcostal retraction at the time of feeding

Administer oxygen.

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? a) Administer oxygen. b) Restrict fluids. c) Provide large, less frequent feedings. d) Administer antidiuretic.

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions

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? a) Surgical closure by ductal ligation b) Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization c) Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions d) No treatment is necessary, as the defect will resolve spontaneously

Difficulty with coordination between the SA and AV nodes (first-degree heart block)

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? a) Difficulty with coordination between the SA and AV nodes (first-degree heart block) b) Ventricular hypertrophy c) Ventricles not fully contracting (pericarditis) d) Hypertrophied atria

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother? a) Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization b) No treatment is necessary, as the defect will resolve spontaneously c) Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions d) Surgical closure by ductal ligation

Place child in the knee-to-chest position.

A child is diagnosed with tetralogy of Fallot and during a temper tantrum turns blue. Which of the following would the nurse do first? a) Assess for an irregular heart rate. b) Assess for an increased respiratory rate. c) Place child in the knee-to-chest position. d) Explain to the child the need to calm down since it is affecting the heart.

"After surgery, most children will catch up."

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? a) "You can expect to continue to see delays." b) "This was caused by the lack of oxygen and it is usually permanent." c) "As long as you decrease external stimuli, the child should catch up." d) "After surgery, most children will catch up."

This is a test that will check how blood is flowing through the heart.

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? a) This is a test that will check how blood is flowing through the heart. b) This is a test that will check the electrical impulses in the heart. c) This test can only determine the size of the heart. d) This test is an invasive test that will measure the blockage in the heart.

• Total cholesterol level of 220 mg/dL • LDL level of 140 md/dL

A child with suspected dyslipidemia undergoes laboratory testing. The nurse is reviewing the results. Which finding would the nurse interpret as supporting the diagnosis? Select all that apply. a) Total cholesterol level of 180 mg/dL b) LDL level of 120 mg/dL c) Total cholesterol level of 220 mg/dL d) LDL level of 140 md/dL e) LDL level of 90 mg/dL f) Total cholesterol level of 150 mg/dL

Overriding of the aorta

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? a) Atrial septal defect b) Overriding of the aorta c) Stenosis of the aorta d) Left ventricular hypertrophy

At birth the right and left ventricle are about the same size.

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? a) At birth the right and left ventricle are about the same size. b) Between the ages of 5 and 6 the left ventricle grows to about two times the size of the right. c) The heart rate of the child decreases if the child has a fever. d) The heart matures and functions like an adult's between 12 and 15 years of age.

Feeding problems

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? a) Rapid weight gain b) Yellowish color c) Bradycardia d) Feeding problems

Nausea and vomiting

A nurse is administering digoxin to a 3-year-old. Which of the following would be a reason to hold the dose of digoxin? a) Hypertension b) Fever and tinnitus c) Nausea and vomiting d) Ataxia

Lower extremities

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child? a) Presacral region b) Lower extremities c) Hands d) Face

Tachycardia

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? a) Polyuria b) Tachycardia c) Bradycardia d) Splenomegaly

Peeling hands and feet and fever

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? a) Peeling hands and feet and fever b) Decreased heart rate and impalpable pulse c) Low blood pressure and decreased heart rate d) Irritability and dry mucous membranes

"Your daughter has an innocent heart murmur, which is nothing to worry about."

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? a) "Your daughter has a functional heart murmur; I recommend that you limit her physical activity so that her heart rate is not elevated for long periods of time." b) "Your daughter has an organic heart murmur, which indicates that she has some degree of heart disease. The doctor will provide a referral to a good cardiologist." c) Not say anything, as the girl has an insignificant heart murmur and there is no reason to alarm the mother or her. d) "Your daughter has an innocent heart murmur, which is nothing to worry about."

Place him in a knee-chest position

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. What should the nurse instruct the parents to do in the event that the child becomes cyanotic? a) Administer prescribed amoxicillin b) Administer low-dose aspirin c) Perform hands-on CPR d) Place him in a knee-chest position

The mother states she has lupus.

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? a) The mother has seizures, but did not take medication while pregnant. b) The mother states she slept all the time while pregnant. c) The mother states she took acetaminophen while pregnant. d) The mother states she has lupus.

Bounding pulse

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note? a) Appropriate mastery of developmental milestones b) Pitting periorbital edema c) Bounding pulse d) Preference to resting on the right side

Increased RBC

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? a) Increased WBC b) Increased RBC c) Decreased RBC d) Decreased WBC

"He seems listless and slightly warm."

A nurse is taking the history of a 4-year-old boy who will undergo a cardiac catheterization. Which statement by his mother may necessitate rescheduling of the procedure? a) "He is very scared and nervous about the procedure." b) "He is not taking any medication." c) "He seems listless and slightly warm." d) "He is allergic to iodine and shellfish."

"We can stop the penicillin when her symptoms disappear."

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? a) "She needs to take the drug for the full 14 days." b) "If she needs dental surgery, we might need additional medication." c) "We can stop the penicillin when her symptoms disappear." d) "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."

Notify the doctor immediately.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. Which of the following would be the priority nursing intervention? a) Observe vitals every two hours. b) Notify the doctor immediately. c) Administer epinephrine. d) Elevate the head of the bed.

This is caused by an opening that usually closes by 1 week of age.

A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education? a) Your child may need multiple surgeries to correct this defect. b) This is caused by an opening that usually closes by 1 week of age. c) This type of defect is caused by having a genetic predisposition for it. d) An IV for fluids will be started immediately.

"Make sure you are fully immunized."

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? a) "There is really nothing you can do. b) "Make sure you are fully immunized." c) "Make sure that you encourage your child to exercise as he grows up." d) "Make sure you encourage a low-sodium diet in your child as he grows up."

Have the child be seen by the primary care provider.

A school nurse is caring for a child with a severe sore throat and fever. What action would the nurse recommend to the parent? a) Give acetaminophen for the fever and pain, and have the child rest. b) Have the child go to the emergency room. c) Have the child drink fluids that contain electrolytes. d) Have the child be seen by the primary care provider.

the contrast material used has a diuretic effect.

After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding that: a) the contrast material used has a diuretic effect. b) the prolonged preprocedure fasting state places the child at risk for dehydration. c) blood loss during the procedure can be significant. d) the insertion of the catheter into the heart stimulates a diuretic response.

femoral pulse weaker than brachial pulse.

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: a) bounding pulse. b) narrow pulse. c) hepatomegaly. d) femoral pulse weaker than brachial pulse.

"You need to report any symptoms you are having during the test."

An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize? a) "You'll have to wear the monitor for 24 hours." b) "You get some medicine that will make you sleepy." c) "You need to report any symptoms you are having during the test." d) "You need to lie very still during this test."

slow and strengthen her heartbeat.

An infant girl is prescribed digoxin. The nurse would teach her parents that the action of this drug is to: a) prevent subacute bacterial endocarditis. b) increase her heart rate. c) thicken the walls of the myocardium. d) slow and strengthen her heartbeat.

It will determine if the heart is enlarged.

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? a) It will determine disturbances in heart conduction. b) It will show if blood is being shunted. c) This image will clarify the structures within the heart. d) It will determine if the heart is enlarged.

cerebrovascular accident (can develop thrombi if they become dehydrated)

Infants with congenital heart disease should not be allowed to become dehydrated because this makes them prone to a) cerebrovascular accident. b) jaundice. c) tachycardia. d) seizures.

0.681 = 0.7mg

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 lb (6.81 kg). Calculate the infant's morphine sulfate dose. Record your answer using one decimal place. ___________ mg

Softening of the nail beds

The nurse assesses a child for clubbing. What would the nurse identify as the initial sign? a) Shininess of the nail ends b) Softening of the nail beds c) Rounding of the fingers d) Thickening of the nail ends

Wheezing

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction? a) Abdominal distress b) Stomach upset c) Wheezing d) Nausea with diarrhea

Digoxin (Lanoxin)

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? a) Ferrous sulfate b) Digoxin (Lanoxin) c) Furosemide (Lasix) d) Albuterol sulfate

• Involuntary limb movement • Macular rash on trunk • Tender swollen joints

The nurse is assessing a child with suspected rheumatic fever. What findings would the nurse expect to assess? Select all that apply. a) Diastolic murmur b) Involuntary limb movement c) Tender swollen joints d) Macular rash on trunk e) Nonpalpable subcutaneous nodules

90/64 mm Hg

The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding? a) 80/40 mm Hg b) 110/60 mm Hg c) 100/60 mm Hg d) 90/64 mm Hg

100 to 120/70 to 80 mm Hg

The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy? a) 94 to 112/56 to 60 mm Hg b) 80 to 90/40 to 64 mm Hg c) 80 to 100/64 to 80 mm Hg d) 100 to 120/70 to 80 mm Hg

90 to 160 bpm

The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant's heart rate? a) 70 to 80 bpm b) 90 to 160 bpm c) 60 to 68 bpm d) 80 to 105 bpm

"I am on a low dose of steroids."

The nurse is assessing the past medical history of an infant with a suspected cardiovascular disorder. Which response by the mother warrants further investigation? a) "I was really nauseous throughout my whole pregnancy." b) "I am on a low dose of steroids." c) "His Apgar score was an 8." d) "I had the flu during my last trimester."

Mild to late ejection click at the apex

The nurse is auscultating heart sounds of a child with a mitral valve prolapse. The nurse should expect which assessment finding? a) Abnormal splitting of S2 sounds b) Intensifying of S2 sounds c) Mild to late ejection click at the apex d) Clicks on the upper left sternal border

Apply pressure 1 inch above the site.

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? a) Apply pressure 1 inch above the site. b) Change the dressing. c) Contact the physician. d) Ensure that the child's leg is kept straight.

Place the child in a knee-to-chest position.

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? a) Use a calm, comforting approach. b) Administer propranolol (0.1 mg/kg IV). c) Provide supplemental oxygen. d) Place the child in a knee-to-chest position.

Assess extremity distal to the insertion site for temperature and color.

The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? 1. Allow early ambulation to encourage activity participation. 2. Check pulses above the catheter insertion site for strength and quality. 3. Assess extremity distal to the insertion site for temperature and color. 4. Change the dressing to evaluate the site for infection.

• Carefully handle the child's knees, ankles, elbows and wrists when moving the child. • Administer salicylates after meals or with milk

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? a) Provide age-appropriate diversional activities b) Instruct the child's family about the long term need for treatment c) Encourage the child to have frequent rest periods between activities d) Carefully handle the child's knees, ankles, elbows and wrists when moving the child. e) Administer salicylates after meals or with milk

High-frequency sound waves are directed toward the heart

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? a) High-frequency sound waves are directed toward the heart b) A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy c) X-rays are directed toward the heart d) A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video

High-frequency sound waves are directed toward the heart

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? a) High-frequency sound waves are directed toward the heart b) A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video c) X-rays are directed toward the heart d) A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy

"The feeling of the heart skipping a beat is common."

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? a) "We need to avoid a tub bath for the next 3 days." b) "Strenuous activity should be limited for the next 3 days." c) "The feeling of the heart skipping a beat is common." d) "We need to watch for changes in skin color or difficulty breathing."

The nurse would review the child's 24-hour diet recall.

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? a) Blood pressures should be measured daily. b) The child should not be allowed to participate in sports. c) Beta blocker education should be given to the parents. d) The nurse would review the child's 24-hour diet recall.

Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL.

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? a) Child C with a total cholesterol level of 190 mg/dL and LDL of 125 mg/dL. b) Child D with a total cholesterol level of 220 mg/dL and LDL of 138 mg/dL. c) Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. d) Child B with a total cholesterol level of 175 mg/dL and LDL of 105 mg/dL.

"He gets sweaty when he eats."

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure? a) "He does not seem short of breath." b) "He gets sweaty when he eats." c) "He does not seem sick." d) "He seems to have a normal appetite."

"Children who have this diagnosis may have had strep throat."

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? a) "The onset and progression of this disorder is rapid." b) "Children who have this diagnosis may have had strep throat." c) "This disorder is caused by genetic factors." d) "Being up to date on immunizations is the best way to prevent this disorder."

Grade IV. 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 performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a: a) Grade IV. b) Grade I. c) Grade III. d) Grade II.

• 16-year-old child with a heart rate of 54 beats per minute • 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning • 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? Select all that apply. a) 12-year-old child whose digoxin level was 0.9 ng/ mL on a blood draw this morning b) 4-month-old child with an apical heart rate of 102 beats per minute c) 16-year-old child with a heart rate of 54 beats per minute d) 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse e) 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning

• The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube. • The child's heart rate has increased from 88 beats per minute to 126 beats per minute.

The young child had a chest tube placed during cardiac surgery. Which findings may indicate the development of cardiac tamponade? Select all that apply. a) The child's apical heart rate is strong and easily auscultated. b) The child is resting quietly. c) The child's heart rate has increased from 88 beats per minute to 126 beats per minute. d) The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube. e) The child's right atrial filling pressure has decreased.

child will return with a bulky pressure dressing over the catheter insertion area.

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the a) child will have to remain NPO for 6 to 8 hours after the procedure to prevent vomiting. b) procedure is noninvasive and not frightening for children. c) child will require a general anesthetic and needs to be prepared for this. d) child will return with a bulky pressure dressing over the catheter insertion area.

Cold clammy skin and increased heart rate

When caring for a child that has just had a cardiac catheterization, which of the following would indicate a sign of hypotension? a) Diaphoresis and tachycardia b) Cold clammy skin and increased heart rate c) Syncope and tachypnea d) Decreased heart rate and dizziness

Management includes administration of aspirin and IVIG.

When caring for a child with Kawasaki Disease, the nurse would know which of the following? a) Joint pain is a permanent problem. b) Management includes administration of aspirin and IVIG. c) Steroid creams are used for the hand peeling. d) Antibiotics should be administered exactly every 8 hours by IV.

Tachycardia

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure? a) Tachycardia b) Bradycardia c) Inability to sweat d) Splenomegaly

Obstruction of blood flow to the lungs

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of what factor as the major mechanism involved? a) Narrowing of the major vessel b) Obstruction of blood flow to the lungs c) Mixing of well-oxygenated and poorly oxygenated blood d) Increased pulmonary blood flow

Palliative pulmonary artery banding should help the infant grow.

When educating the family of an ill infant with an atrioventricular canal defectseptic defect, what information would be included in the education if the doctor is planning on performing palliative care until the infant is healthier? a) VSD patching surgery should be performed immediately. b) Palliative pulmonary artery banding should help the infant grow. c) The medication indomethacin is used to try to close the hole. d) Most infants do not need surgical repair for this if palliative procedures are performed.

"Most infants do not need surgical repair for this."

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education? a) "Most infants do not need surgical repair for this." b) "Surgery is usually performed in the first two months of life for this." c) "The medication indomethacin is used to try to close the hole." d) "The medication prostaglandin E1 is used to try to close the hole."

The liver increases in right-sided heart failure.

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? a) The spleen increases due to increased destruction of red blood cells. b) The liver increases due to cardiac medications. c) The spleen increases due to frequent infection. d) The liver increases in right-sided heart failure.

Polycythemia

When reviewing the record of a child with tetralogy of Fallot, which of the following would you expect to discover? a) Polycythemia b) Anemia c) Leukopenia d) Increased platelet level

• Painless nodules located on the wrists • Pericarditis with the presence of a new heart murmur

Which findings are major criteria used to help the physician diagnose acute rheumatic fever in a child? Select all that apply. a) Heart block with a prolonged PR interval b) Temperature of 101.2° F(38.4° C) c) Elevated erythrocyte sedimentation rate d) Painless nodules located on the wrists e) Pericarditis with the presence of a new heart murmur

Activity intolerance related to inability of heart to sustain extra workload

Which of the following nursing diagnoses would best apply to a child with rheumatic fever? a) Risk for self-directed violence related to development of cerebral anoxia b) Activity intolerance related to inability of heart to sustain extra workload c) Ineffective breathing pattern related to cardiomegaly d) Disturbed sleep pattern related to hyperexcitability

Antibiotics should be administered before invasive procedures.

Which of the following would be included in discharge teaching by the nurse of a child that had a patch placed surgically for an ASD? a) Antibiotics should be administered before invasive procedures. b) Need for frequent rest periods at home c) Intake of 80 ounces of fluid daily d) Teaching about how to take daily blood pressures

Begin formulas with increased calories.

Which of the following would be included in the care of an infant in heart failure? a) Begin formulas with increased calories. b) Encourage larger, less frequent feedings. c) Maintain child in the supine position. d) Administer digoxin even if the infant is vomiting

Placing her in a semi-Fowler's position

Which of the following would be most important to implement for an infant who develops heart failure? a) Placing her in a semi-Fowler's position b) Keeping her supine and playing quiet games c) Planning ways to reduce salt intake d) Restricting milk intake daily