Question 1

The nurse is conducting a physical examination of a child with a ventricular septal defect. Which finding would the nurse expect to assess?

Accepted Answer

A ventricular septal defect (VSD) typically presents with a holosystolic (or pansystolic) harsh murmur heard along the left sternal border. This is due to the blood flow from the left ventricle to the right ventricle through the septal defect throughout systole.

Question 2

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next?

Accepted Answer

D

Question 3

The nurse is caring for an infant with suspected patent ductus arteriosus. Which of the following assessment findings would the nurse identify as helping to confirm this suspicion?

Accepted Answer

A harsh, continuous, machine-like murmur under the left clavicle is a classic sign of patent ductus arteriosus (PDA), which is a condition where the ductus arteriosus fails to close after birth, leading to abnormal blood flow between the aorta and the pulmonary artery.

Question 4

The nurse is conducting a physical examination of a child with a suspected cardiovascular disorder. Which of the following findings would the nurse most likely expect to assess if the child had transposition of the great vessels?

Accepted Answer

Transposition of the great vessels is a congenital heart defect where the two main arteries leaving the heart are reversed. This condition leads to poor oxygenation of blood, resulting in significant cyanosis (bluish coloration of the skin due to lack of oxygen) without necessarily causing a heart murmur.

Question 5

The nurse is assessing a child with suspected infective endocarditis. Which of the following assessment findings would the nurse interpret as a sign of extracardiac emboli?

Accepted Answer

Roth spots are retinal hemorrhages with white or pale centers and can be a sign of extracardiac emboli in infective endocarditis, indicating the spread of infection or embolic phenomena beyond the heart.

Question 6

When conducting a physical examination of a child with suspected Kawasaki disease, which of the following would the nurse expect to assess?

Accepted Answer

Kawasaki disease is characterized by symptoms including fever, rash, swelling of the hands and feet, redness of the eyes, lips, and throat, and a strawberry tongue, which is a red, swollen tongue with a bumpy surface. The other options are not typical features of Kawasaki disease.

Question 7

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which of the following as an assessment finding?

Accepted Answer

Jerky movements of the face and upper extremities, known as Sydenham's chorea, are a characteristic finding of acute rheumatic fever, indicating the involvement of the central nervous system.

Question 8

A nurse is reviewing the medical record of a child and finds that the child has a grade III murmur. After auscultating the child's heart sounds, the nurse would document this murmur as which of the following?

Accepted Answer

Grade III murmurs are characterized as loud murmurs that can be heard without the presence of a thrill, distinguishing them from grade IV murmurs which are loud and associated with a palpable thrill.

Question 9

The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which of the following statements by the mother indicates a need for further teaching?

Accepted Answer

The statement "I need to feed him every hour to make sure he eats enough" indicates a need for further teaching because feeding an infant every hour can lead to overfeeding and may not allow the infant's stomach to rest between feedings. Infants with heart failure often require more calories but should be fed in a way that does not overburden their system, typically through small, frequent feedings spaced appropriately apart.

Question 10

The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which of the following statements by the mother would warrant further investigation?

Accepted Answer

Positional comfort, such as an infant feeling more comfortable when held over the shoulder, can indicate respiratory distress or heart failure. This position may help to ease breathing, suggesting the need for further investigation into cardiovascular function.

Question 11

Auscultation of a child's heart reveals a loud murmur with a precordial thrill. The nurse documents this as which of the following?

Accepted Answer

A precordial thrill, which is a palpable vibration on the chest wall accompanying severe heart murmur, indicates a murmur of at least grade IV on the grading scale of heart murmurs. The scale ranges from I (very faint) to VI (very loud, with thrill palpable with just the edge of the hand).

Question 12

After assessing a child's blood pressure, the nurse determines the pulse pressure and finds that it is narrowed. Which of the following would the nurse identify as associated with this finding?

Accepted Answer

Aortic stenosis is associated with a narrowed pulse pressure because it leads to a decrease in systolic blood pressure without a significant change in diastolic pressure, resulting in a closer range between the two.

Question 13

A 9-year-old child has undergone a cardiac catheterization and is being prepared for discharge. The nurse is instructing the parents and child about postprocedure care. Which statement by the parents indicates that the teaching was successful?

Accepted Answer

The correct statement indicating successful teaching is that the child should avoid taking a bath for about 3 days but can shower. This is to prevent infection at the catheter insertion site while still maintaining hygiene.

Question 14

A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the physician will most likely order which medication?

Accepted Answer

Indomethacin is commonly used to close a patent ductus arteriosus in newborns by inhibiting prostaglandin synthesis, which is responsible for keeping the ductus arteriosus open.

Question 15

The nurse is preparing a teaching plan for the parents of a child who has been diagnosed with a congenital heart defect. Which of the following would the nurse be least likely to include?

Accepted Answer

Maintenance of strict bed rest is not typically recommended for children with congenital heart defects. Instead, activity is often encouraged as tolerated to promote development and well-being. The other options (daily weight assessment, prevention of infection, and recognizing signs of complications) are important components of care for a child with a congenital heart defect.

Question 16

A 7-year-old child with a family history of cardiovascular disease is being screened for hyperlipidemia. When reviewing the child's laboratory test results, which total cholesterol level would be of significant concern?

Accepted Answer

A total cholesterol level of 210 mg/dL is considered high for a child and would be of significant concern, especially with a family history of cardiovascular disease. The American Academy of Pediatrics recommends that children and adolescents with a total cholesterol level of 200 mg/dL or higher should receive further evaluation and management.

Question 17

A child with a suspected cardiovascular disorder is to undergo diagnostic testing and is scheduled for an echocardiogram. When explaining this test to the child, which of the following would the nurse most likely include?

Accepted Answer

An echocardiogram uses ultrasound (sound waves) to create images of the heart, which allows for the evaluation of the heart's structure and function. The description of using a "special wand that picks up sound" to check the heart aligns with how an echocardiogram is performed.

Question 18

The nurse is reviewing the medical record of a child with infective endocarditis. Which of the following would the nurse expect to find? Select all answers that apply.

Accepted Answer

Infective endocarditis often presents with microscopic hematuria due to emboli or immune complex deposition. A prolonged PR interval can occur due to heart block from infection affecting the conduction system. Petechiae, including on the palpebral conjunctiva, are common due to emboli or vasculitis. Leukopenia is not typical; leukocytosis is more common. Lung findings are variable and not specific to endocarditis.

Question 19

A child with heart failure is receiving supplemental oxygen. The nurse understands that in addition to improving oxygen saturation, this intervention also helps to do which of the following?

Accepted Answer

Supplemental oxygen can cause vasodilation, which can help reduce the workload on the heart by decreasing systemic vascular resistance.

Question 20

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was:

Accepted Answer

Digoxin is a medication used to treat heart conditions, and one of its side effects can be bradycardia, or a slow heart rate. For infants, a heart rate below 100 beats per minute is generally considered low and could indicate an adverse reaction to the medication. Therefore, if an infant's apical pulse rate was 80 beats per minute, it would be appropriate to hold the dose of digoxin and notify the physician.

Quiz 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder