Question 1

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?

Accepted Answer

These are the insidious symptoms of bacterial endocarditis.Because the child is in a high-risk group for this disorder (VSD repair),immediate evaluation and treatment are indicated to prevent cardiac damage.With appropriate antibiotic therapy,bacterial endocarditis is successfully treated in approximately 80% of the cases.The child's complaints should not be dismissed.The low-grade fever is not a symptom that the child can fabricate.

Question 2

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

Accepted Answer

The child and family should be exposed to the sights and sounds of the intensive care unit (ICU).All positive,nonfrightening aspects of the environment are emphasized.The family and child should make the decision about a tour of the unit if it is an option.The child should be shown unfamiliar equipment and its use demonstrated on a doll.Carefully prepare the child for the postoperative experience,including intravenous lines,incision,endotracheal tube,expected discomfort,and management strategies.

Question 3

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

Accepted Answer

Polyarthritis,which is swollen,hot,red,and painful joints,is a major clinical manifestation.The affected joints will change every 1 or 2 days.The large joints are primarily affected.Fever is considered a minor manifestation of RF.Osler nodes and Janeway spots are characteristic of bacterial endocarditis.

Question 4

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

Accepted Answer

The diagnosis of hypertension is made after the BP is elevated on three separate occasions.Take the BP in a quiet area with the appropriate size cuff and the child sitting.Although left arm and left leg BP readings may be compared,it is not the procedure to diagnose hypertension.The appropriate size cuff is indicated.The most common cause of inaccurate readings is the use of a cuff that is too small.

Question 5

What structural defects constitute tetralogy of Fallot?

Accepted Answer

Tetralogy of Fallot has these four characteristics: pulmonary stenosis,ventricular septal defect,overriding aorta,and right ventricular hypertrophy.

Question 6

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

Accepted Answer

ACE inhibitors act by interfering with the production of angiotensin II,which is a potent vasoconstrictor.Diuretics lower blood pressure by increasing fluid output.Vasodilators act on the vascular smooth muscle.By causing arterial dilation,blood pressure is lowered.Beta-blockers interfere with beta stimulation and depress renin output.

Question 7

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

Accepted Answer

High-dose intravenous gamma globulin and salicylate therapy are indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness.Aspirin is part of the therapy.Mucous membranes,conjunctiva,changes in the extremities,and cardiac involvement are seen.The fever of Kawasaki disease is unresponsive to antibiotics.It is responsive to anti-inflammatory doses of aspirin and antipyretics.

Question 8

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

Accepted Answer

A fall in the serum potassium level enhances the effects of digoxin,increasing the risk of digoxin toxicity.Increased serum potassium levels diminish digoxin's effect.Therefore,serum potassium levels (normal range,3.5-5.5 mmol/L)must be carefully monitored.

Question 9

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

Accepted Answer

Patient irritability is a hallmark of Kawasaki disease and is the most challenging problem.A quiet environment is necessary to promote rest.The diagnosis is often difficult to make,and the course of the disease can be unpredictable.Intravenous gamma globulin and salicylates are the therapy of choice,not antibiotics.The child often is reluctant to eat.Soft foods and fluids should be offered to prevent dehydration.

Question 10

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?

Accepted Answer

The child needs opportunities for social development.Children are able to regulate and limit their activities based on their energy level.Parents must be encouraged to seek appropriate social activities for the child,especially before kindergarten.The child needs to have activities that foster independence.

Question 11

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

Accepted Answer

Persistent hypoxemia that occurs with tetralogy of Fallot stimulates erythropoiesis,which results in polycythemia,an increased number of red blood cells.

Question 12

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

Accepted Answer

Nurses have a role in prevention,primarily in screening school-age children for sore throats caused by group A streptococci.They can actively participate in throat culture screening or refer children with possible streptococcal sore throats for testing.Routine cholesterol screenings and blood pressure screenings do not facilitate the recognition and treatment of group A hemolytic streptococci.Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

Question 13

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?

Accepted Answer

Discharge instructions for a parent of a child who recently had a cardiac catheterization should include changing the bandage every day for the next 2 days.The child should avoid strenuous exercise but can go back to school.The child should avoid a tub bath,but an older child could take a shower the first day after the catheterization.The site should not have swelling or redness; if there is,it should be reported to the health care practitioner.

Question 14

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?

Accepted Answer

In the first 24 to 48 hours after surgery,the body temperature may increase to 37.8° C (100° F)as part of the inflammatory response to tissue trauma.If the temperature is higher or fever continues after this period,it is most likely a sign of an infection,and immediate investigation is indicated.A hypothermia blanket is not indicated for this level of temperature.Blankets should be removed from the child to keep the temperature from increasing.The temperature should be recorded,but the practitioner must be notified for evaluation.

Question 15

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?

Accepted Answer

The practitioner is notified immediately.Increases of chest tube drainage to more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate postoperative hemorrhage.Increased chest tube drainage with apprehensiveness and tachycardia may indicate cardiac tamponade-blood or fluid in the pericardial space constricting the heart-which is a life-threatening complication.Warming blankets are not indicated at this time.Additional pain medication can be given before the practitioner drains the fluid,but the notification is the first action.Encouraging the child to cough,turn,and deep breathe should be deferred until after evaluation by the practitioner.

Question 16

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

Accepted Answer

The posttransplant course is complex.The leading cause of death after cardiac transplant is rejection.Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection.Cardiomyopathy is one of the indications for cardiac transplant.Heart failure is not a leading cause of death.

Question 17

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

Accepted Answer

When suctioning is indicated,supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia.Suctioning should be done only as indicated and very carefully to avoid vagal stimulation.The child should be suctioned for no more than 5 seconds at a time.Symptoms of respiratory distress are avoided by using appropriate technique.

Question 18

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

Accepted Answer

The objective of nursing care is to counsel the parents of high-risk children about the need for both prophylactic antibiotics for dental procedures and maintaining excellent oral health.The child's dentist should be aware of the child's cardiac condition.Dental procedures should be done to maintain a high level of oral health.Restricted mobility in susceptible children is not indicated.Parents are taught to observe for unexplained fever,weight loss,or change in behavior.

Question 19

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

Accepted Answer

Obesity is an indication for cholesterol screening in children.A BMI in the 95th percentile or higher is considered obese.Children who are hypertensive meet the criteria for screening,but blood pressure in the 50th percentile is within the normal range.A parent or grandparent with a cholesterol level of 240 mg/dl or higher places the child at risk.Early cardiovascular disease in a first- or second-degree relative is a risk factor.Age 75 years is not considered early.

Question 20

What child has a cyanotic congenital heart defect?

Accepted Answer

Tetralogy of Fallot is a cyanotic congenital heart defect.Patent ductus arteriosus,atrial septal defect,and ventricular septal defect are acyanotic congenital heart defects.

Quiz 29: The Child With Cardiovascular Dysfunction