Deck 29: The Child with Cardiovascular Dysfunction

Question 1

After returning from cardiac catheterization, the nurse determines that the pulse distal to the catheter insertion site is weaker. How should the nurse respond?

A) Elevate the affected extremity.
B) Notify the practitioner of the observation.
C) Record data on the assessment flow record.
D) Apply warm compresses to the insertion site.

Answer 1

Record data on the assessment flow record.

Question 2

The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication?

A) Hypoxemia
B) Right-to-left shunt of blood
C) Decreased workload on the left side of the heart
D) Pulmonary vascular congestion

Answer 2

Pulmonary vascular congestion

Question 3

What statement best identifies the cause of heart failure (HF)?

A) Disease related to cardiac defects
B) Consequence of an underlying cardiac defect
C) Inherited disorder associated with a variety of defects
D) Result of diminished workload imposed on an abnormal myocardium

Answer 3

Consequence of an underlying cardiac defect

Question 4

After returning from cardiac catheterization, the nurse monitors the child's vital signs. The heart rate should be counted for how many seconds?

A) 15
B) 30
C) 60
D) 120

Question 5

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. What strategy is an important objective to decrease this risk?

A) Minimize seizures.
B) Prevent dehydration.
C) Promote cardiac output.
D) Reduce energy expenditure.

Question 6

What clinical manifestation is a common sign of digoxin toxicity?

A) Seizures
B) Vomiting
C) Bradypnea
D) Tachycardia

Question 7

Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infant's status, which finding is indicative of achieving this goal?

A) Irritability when awake
B) Capillary refill of more than 5 seconds
C) Appropriate weight gain for age
D) Positioned in high Fowler position to maintain oxygen saturation at 90%

Question 8

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. What nursing action is most appropriate to institute initially?

A) Notify the physician.
B) Place the child in Trendelenburg position.
C) Apply a new bandage with more pressure.
D) Apply direct pressure above the catheterization site.

Question 9

What term is defined as the volume of blood ejected by the heart in 1 minute?

A) Afterload
B) Cardiac cycle
C) Stroke volume
D) Cardiac output

Question 10

The nurse finds that a 6-month-old infant has an apical pulse of 166 beats/min during sleep. What nursing intervention is most appropriate at this time?

A) Administer oxygen.
B) Record data on the nurses' notes.
C) Report data to the practitioner.
D) Place the child in the high Fowler position.

Question 11

A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate?

A) 60 beats/min
B) 90 beats/min
C) 100 beats/min
D) 120 beats/min

Question 12

What cardiovascular defect results in obstruction to blood flow?

A) Aortic stenosis
B) Tricuspid atresia
C) Atrial septal defect
D) Transposition of the great arteries

Question 13

A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition?

A) Cyanosis
B) Heart failure
C) Decreased pulmonary blood flow
D) Bounding pulses in upper extremities

Question 14

A 6-year-old child is scheduled for a cardiac catheterization. What consideration is most important in planning preoperative teaching?

A) Preoperative teaching should be directed at his parents because he is too young to understand.
B) Preoperative teaching should be adapted to his level of development so that he can understand.
C) Preoperative teaching should be done several days before the procedure so he will be prepared.
D) Preoperative teaching should provide details about the actual procedures so he will know what to expect.

Question 15

A chest radiography examination is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the x-ray show about the heart?" The nurse's response should be based on knowledge that the radiograph provides which information?

A) Shows bones of the chest but not the heart
B) Evaluates the vascular anatomy outside of the heart
C) Shows a graphic measure of electrical activity of the heart
D) Supplies information on heart size and pulmonary blood flow patterns

Question 16

What nutritional component should be altered in the infant with heart failure (HF)?

A) Decrease in fats
B) Increase in fluids
C) Decrease in protein
D) Increase in calories

Question 17

What blood flow pattern occurs in a ventricular septal defect?

A) Mixed blood flow
B) Increased pulmonary blood flow
C) Decreased pulmonary blood flow
D) Obstruction to blood flow from ventricles

Question 18

What drug is an angiotensin-converting enzyme (ACE) inhibitor?

A) Furosemide (Lasix)
B) Captopril (Capoten)
C) Chlorothiazide (Diuril)
D) Spironolactone (Aldactone)

Question 19

A 3-month-old infant has a hypercyanotic spell. What should be the nurse's first action?

A) Assess for neurologic defects.
B) Prepare the family for imminent death.
C) Begin cardiopulmonary resuscitation.
D) Place the child in the knee-chest position.

Question 20

The parents of a young child with heart failure (HF) tell the nurse that they are nervous about giving digoxin. The nurse's response should be based on which knowledge?

A) It is a safe, frequently used drug.
B) Parents lack the expertise necessary to administer digoxin.
C) It is difficult to either overmedicate or undermedicate with digoxin.
D) Parents need to learn specific, important guidelines for administration of digoxin.

Question 21

The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be the nurse's initial intervention?

A) Apply warming blankets.
B) Notify the practitioner of these findings.
C) Give additional pain medication per protocol.
D) Encourage child to cough, turn, and deep breathe.

Question 22

A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38° C (100.4° F), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother?

A) Immediately bring the child to the clinic for evaluation.
B) Come to the clinic next week on a scheduled appointment.
C) Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness.
D) Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.

Question 23

What preparation should the nurse consider when educating a school-age child and the family for heart surgery?

A) Unfamiliar equipment should not be shown.
B) Let the child hear the sounds of a cardiac monitor, including alarms.
C) Explain that an endotracheal tube will not be needed if the surgery goes well.
D) Discussion of postoperative discomfort and interventions is not necessary before the procedure.

Question 24

What nursing consideration is important when suctioning a young child who has had heart surgery?

A) Perform suctioning at least every hour.
B) Suction for no longer than 30 seconds at a time.
C) Expect symptoms of respiratory distress when suctioning.
D) Administer supplemental oxygen before and after suctioning.

Question 25

When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care?

A) Aspirin is contraindicated.
B) The principal area of involvement is the joints.
C) The child's fever is usually responsive to antibiotics within 48 hours.
D) Therapeutic management includes administration of gamma globulin and salicylates.

Question 26

What sign/symptom is a major clinical manifestation of rheumatic fever (RF)?

A) Fever
B) Polyarthritis
C) Osler nodes
D) Janeway spots

Question 27

What primary nursing intervention should be implemented to prevent bacterial endocarditis?

A) Counsel parents of high-risk children.
B) Institute measures to prevent dental procedures.
C) Encourage restricted mobility in susceptible children.
D) Observe children for complications, such as embolism and heart failure.

Question 28

What type of drug reduces hypertension by interfering with the production of angiotensin II?

A) Diuretics
B) Vasodilators
C) Beta-blockers
D) Angiotensin-converting enzyme (ACE) inhibitors

Question 29

The parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. How should the nurse reply to this concern?

A) The parents should meet all the child's needs.
B) The child needs opportunities to play with peers.
C) Constant parental supervision is needed to avoid overexertion.
D) The child needs to understand that peers' activities are too strenuous.

Question 30

What child has a cyanotic congenital heart defect?

A) An infant with patent ductus arteriosus
B) A 1-year-old infant with atrial septal defect
C) A 2-month-old infant with tetralogy of Fallot
D) A 6-month-old infant with repaired ventricular septal defect

Question 31

The nurse is giving discharge instructions to the parent of a 6-year-old child who had a cardiac catheterization 4 hours ago. What statement by the parent indicates a correct understanding of the teaching?

A) "My child should not attend school for the next 5 days."
B) "I should change the bandage every day for the next 2 days."
C) "My child can take a tub bath but should avoid taking a shower for the next 4 days."
D) "I should expect the site to be red and swollen for the next 3 days."

Question 32

What action by the school nurse is important in the prevention of rheumatic fever (RF)?

A) Encourage routine cholesterol screenings.
B) Conduct routine blood pressure screenings.
C) Refer children with sore throats for throat cultures.
D) Recommend salicylates instead of acetaminophen for minor discomforts.

Question 33

Selective cholesterol screening is recommended for children older than the age of 2 years with which risk factor?

A) Body mass index (BMI) = 95th percentile
B) Blood pressure = 50th percentile
C) Parent with a blood cholesterol level of 200 mg/dl
D) Recently diagnosed cardiovascular disease in a 75-year-old grandparent

Question 34

The diagnosis of hypertension depends on accurate assessment of blood pressure (BP). What is the appropriate technique to measure a child's BP?

A) Assess BP while the child is standing.
B) Compare left arm with left leg BP readings.
C) Use a narrow cuff to ensure that the readings are correct.
D) Measure BP with the child in the sitting position on three separate occasions.

Question 35

An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented?

A) Leukopenia
B) Polycythemia
C) Anemia
D) Increased platelet level

Question 36

A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which?

A) Serum sodium
B) Serum potassium
C) Serum glucose
D) Serum chloride

Question 37

What condition is the leading cause of death after heart transplantation?

A) Infection
B) Rejection
C) Cardiomyopathy
D) Heart failure

Question 38

What structural defects constitute tetralogy of Fallot?

A) Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
B) Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
C) Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy
D) Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

Question 39

Nursing care of the child with Kawasaki disease is challenging because of which occurrence?

A) The child's irritability
B) Predictable disease course
C) Complex antibiotic therapy
D) The child's ongoing requests for food

Question 40

Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4° C (101.1° F). What action should the nurse perform?

A) Report findings to the practitioner.
B) Apply a hypothermia blanket.
C) Keep the child warm with blankets.
D) Record the temperature on the assessment flow sheet.

Question 41

What medication used to treat heart failure (HF) is a diuretic?

A) Captopril (Capten)
B) Digoxin (Lanoxin)
C) Hydrochlorothiazide (Diuril)
D) Carvedilol (Coreg)

Question 42

A child is recovering from Kawasaki disease (KD). The child should be monitored for which?

A) Anemia
B) Electrocardiograph (ECG) changes
C) Elevated white blood cell count
D) Decreased platelets

Question 43

The nurse is caring for a child with secondary hypertension. What renal disorders are associated with secondary hypertension? (Select all that apply.)

A) Renal tumor
B) Hydronephrosis
C) Vesicoureteral reflux
D) Glomerulonephritis
E) Urinary tract infection

Question 44

An adolescent is being placed on a calcium channel blocker. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.)

A) The medication may cause fatigue.
B) The medication may increase heart rate.
C) The medication may cause constipation.
D) The medication may cause cold extremities.
E) The medication may cause peripheral edema.

Question 45

The nurse is caring for a child after cardiac surgery. What interventions should the nurse implement with regard to chest tubes placed to a water-seal drainage system? (Select all that apply.)

A) Maintain sterility.
B) Check for tube patency.
C) Do not interrupt the water-seal drainage system.
D) Clamp the chest tube when ambulating the child.
E) Measure the drainage by emptying the collection chamber every shift.

Question 46

An adolescent is being placed on an ACE inhibitor. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.)

A) Stay well hydrated.
B) Increase intake of potassium.
C) Avoid rapid position changes.
D) Take the medication with meals.
E) Side effects may include a cough.

Question 47

A 1-year-old has been admitted for complete repair of a tetralogy of Fallot. What assessment finding should the nurse expect to be documented?

A) Weight gain
B) Pale skin color
C) Increasing cyanosis
D) Decrease in hemoglobin and hematocrit

Question 48

The nurse is teaching parents about administering digoxin (Lanoxin). What instructions should the nurse tell the parents?

A) If the child vomits, give another dose.
B) Give the medication at regular intervals.
C) If a dose is missed, give a give an extra dose.
D) Give the medication mixed with the child's formula.

Question 49

Bacterial infective endocarditis (IE) should be treated with which protocol?

A) Oral antibiotics for 6 months
B) Oral antibiotics (penicillin) for 10 full days
C) IV antibiotics, diuretics, and digoxin
D) IV antibiotics (penicillin type) for 2 to 8 weeks

Question 50

The test that provides the most reliable evidence of recent streptococcal infection is which?

A) Throat culture
B) Mantoux test
C) Antistreptolysin O test
D) Elevation of liver enzymes

Question 51

An adolescent is being placed on a beta-blocker. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.)

A) Medication may cause fatigue.
B) Side effects may include impotence.
C) Side effects may include bradycardia.
D) Take the medication 1 hour before meals.
E) Side effects may include peripheral edema.

Question 52

The nurse is teaching an adolescent with hypertension foods recommended on the DASH diet. What foods should the nurse include in the teaching session? (Select all that apply.)

A) Green beans
B) Energy drinks
C) Low-fat yogurt
D) Chocolate milk
E) Whole grain bread

Question 53

Heart failure (HF) is a problem after the child has had a congenital heart defect repaired. The nurse knows a sign of HF is what?

A) Wheezing
B) Increased blood pressure
C) Increased urine output
D) Decreased heart rate

Question 54

An infant is diagnosed with transposition of the great vessels. Prostaglandin E1 is given intravenously. The parents ask how long the child will remain on the prostaglandin E1. What is the appropriate response by the nurse?

A) Prostaglandin E1 will be given intermittently until corrective surgery is performed.
B) Prostaglandin E1 will be given continuously until corrective surgery is performed.
C) Prostaglandin E1 will be given continuously throughout the preoperative and postoperative periods until the child is stable.
D) Prostaglandin E1 will be given intermittently throughout the preoperative and postoperative periods until the child is stable.

Question 55

A 12-year-old child with Down syndrome is admitted to the hospital for surgical correction of a heart defect. The boy's mental age is that of a 3-year-old child. The nurse should prepare the child and family for surgery by what method?

A) Extend preoperative teaching over several days.
B) Explain the surgery to the child and the parents in detail.
C) Exclude the child from preoperative teaching; teach only the parents.
D) Provide teaching to the parents, keeping the information to the child simple.

Question 56

The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose and draws up 4 ml of the drug. The most appropriate nursing action is which?

A) Mix the dose with juice to disguise its taste.
B) Do not give the dose; suspect a dosage error.
C) Check the heart rate; administer digoxin if the rate is greater than 100 beats/min.
D) Check the heart rate; administer digoxin if the rate is greater than 80 beats/min.

Question 57

The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication?

A) Pulmonary hypertension
B) Right-to-left shunt of blood
C) Pulmonary embolism
D) Left ventricular hypertrophy

Question 58

A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what?

A) Tetralogy of Fallot
B) Coarctation of the aorta
C) Pulmonary stenosis
D) Ventricular septal defect

Question 59

The nurse is teaching an adolescent with elevated triglycerides foods that should be decreased. What foods should the nurse include in the teaching? (Select all that apply.)

A) Avocados
B) Canola oil
C) White flour
D) White rice
E) Sugary cereals

Question 60

The nurse is caring for a child with Kawasaki disease in the acute phase. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Osler nodes
B) Cervical lymphadenopathy
C) Strawberry tongue
D) Chorea
E) Erythematous palms
F) Polyarthritis

Question 61

A health care provider prescribes hydroxyzine (Atarax), 0.6 mg/kg PO every 4 to 6 hours as needed for pruritus for a child with Kawasaki disease. The medication label states: "Hydroxyzine 10 mg/5 ml." The child weighs 20 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.
________________

Question 62

MATCHING
Match the cardiac terms with their definitions.

Has three leaflets

A)Mitral valve
B)Tricuspid valve
C)Atria
D)Ventricles

Question 63

MATCHING
Match the cardiac terms with their definitions.

The two upper chambers of the heart

A)Mitral valve
B)Tricuspid valve
C)Atria
D)Ventricles

Question 64

MATCHING
Match the cardiac terms with their definitions.

Has two leaflets

A)Mitral valve
B)Tricuspid valve
C)Atria
D)Ventricles

Question 65

A health care provider prescribes furosemide (Lasix), 10 mg intravenously (IV) now, for a child with heart failure. The medication label states: "Furosemide (Lasix) 20 mg/2 ml." The nurse prepares to administer the dose. How many milliliters will the nurse prepare to administer the dose? Fill in the blank. Record your answer in a whole number.
________________

Question 66

A health care provider prescribes acetaminophen (Tylenol) gtt, 10 mg/kg/dose PO every 4 to 6 hours as needed for fever for a child with rheumatic fever. The child weighs 8 kg. The medication label states: "Acetaminophen 80 mg/0.8 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.
________________

Question 67

Match the normal findings of an ECG with their definitions.

Represents atrial depolarization

A)P wave
B)QRS complex
C)T wave
D)Q-T interval
E)ST segment

Question 68

A health care provider prescribes captopril (Capoten), 2.5 mg PO every 12 h for a child with heart failure. The medication label states: "Captopril 5 mg/5 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.
________________

Question 69

Match the normal findings of an ECG with their definitions.

Represents ventricular repolarization

A)P wave
B)QRS complex
C)T wave
D)Q-T interval
E)ST segment

Question 70

Match the normal findings of an ECG with their definitions.

Represents ventricular depolarization

A)P wave
B)QRS complex
C)T wave
D)Q-T interval
E)ST segment

Question 71

What interventions should the nurse anticipate being administered to a child with supraventricular tachycardia (SVT)?

A) Bed rest
B) Applying ice to the face
C) Administration of atropine
D) Administration of adenosine (Adenocor)
E) Having the child perform a Valsalva maneuver

Question 72

Match the normal findings of an ECG with their definitions.

Represents the time that the ventricles are in the absolute refractory period

A)P wave
B)QRS complex
C)T wave
D)Q-T interval
E)ST segment

Question 73

MATCHING
Match the cardiac terms with their definitions.

The two bottom chambers of the heart

A)Mitral valve
B)Tricuspid valve
C)Atria
D)Ventricles

Question 74

Match the normal findings of an ECG with their definitions.

Represents ventricular depolarization and repolarization

A)P wave
B)QRS complex
C)T wave
D)Q-T interval
E)ST segment