Deck 25: The Child With Cardiovascular Dysfunction

Question 1

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

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

Answer 1

Parents must learn specific, important guidelines for administration of digoxin.

Question 2

An 8-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 of the following?

A)60
B)70
C)90
D)100

Answer 2

70

Question 3

Which of the following defects results in decreased pulmonary blood flow?

A)Atrial septal defect
B)Tetralogy of Fallot
C)Ventricular septal defect
D)Patent ductus arteriosus

Answer 3

Tetralogy of Fallot

Question 4

Which of the following is a clinical manifestation of the systemic venous congestion that can occur with congestive heart failure?

A)Tachypnea
B)Tachycardia
C)Peripheral edema
D)Pale, cool extremities

Question 5

A beneficial effect of administering digoxin (Lanoxin) is that it:

A)Decreases edema.
B)Decreases cardiac output.
C)Increases heart size.
D)Increases venous pressure.

Question 6

Which of the following 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, atrial septal defect, overriding aorta, left ventricular hypertrophy
D)Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

Question 7

A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following?

A)60
B)70
C)90 to 110
D)110 to 120

Question 8

Surgical closure of the ductus arteriosus would do which of the following?

A)Stop the loss of unoxygenated blood to the systemic circulation
B)Decrease the edema in legs and feet
C)Increase the oxygenation of blood
D)Prevent the return of oxygenated blood to the lungs

Question 9

Which of the following is a complication that may occur after a cardiac catheterization?

A)Cardiac arrhythmia
B)Hypostatic pneumonia
C)Congestive heart failure
D)Rapidly increasing blood pressure

Question 10

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

A)10
B)15
C)30
D)60

Question 11

Which of the following drugs is an angiotensin-converting enzyme (ACE) inhibitor?

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

Question 12

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

A)Show bones of chest but not the heart
B)Measure electrical potential generated from heart muscle
C)Provide permanent record of heart size and configuration
D)Provide computerized image of heart vessels and tissues

Question 13

Which of the following is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

A)Pulmonary congestion
B)Congenital heart defect
C)Congestive heart failure
D)Systemic venous congestion

Question 14

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:

A)Directed at his parents, because he is too young to understand.
B)Detailed in regard to the actual procedures so he will know what to expect.
C)Done several days before the procedure so that he will be prepared.
D)Adapted to his level of development so that he can understand.

Question 15

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. The most appropriate initial nursing action is which of the following?

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

Question 16

Which of the following is a common sign of digoxin toxicity?

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

Question 17

Which of the following should be included in the instructions to an active adolescent who is going home after a cardiac catheterization?

A)Avoid tub baths but may shower.
B)Maintain strict bed rest for 3 days.
C)Leave pressure dressing on for 7 days.
D)Stay home from school until Band-aid is removed.

Question 18

Nursing interventions for the child after a cardiac catheterization would include which of the following?

A)Allow ambulation as tolerated.
B)Monitor vital signs every 2 hours.
C)Assess the affected extremity for temperature and color.
D)Check pulses above the catheterization site for equality and symmetry.

Question 19

Which of the following defects results in increased pulmonary blood flow?

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

Question 20

Which of the following explanations regarding cardiac catheterization is appropriate for a preschool child?

A)Postural drainage will be performed every 4 to 6 hours after the test.
B)It is necessary to be completely "asleep" during the test.
C)The test is very short, usually taking less than 1 hour.
D)When the procedure is done, you will have to keep your leg straight for at least 4 hours.

Question 21

Which of the following is a major clinical manifestation of rheumatic fever?

A)Polyarthritis
B)Osler nodes
C)Janeway spots
D)Splinter hemorrhages of distal third of nails

Question 22

Which of the following is an important nursing consideration 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)Administer supplemental oxygen before and after suctioning.
D)Expect symptoms of respiratory distress when suctioning.

Question 23

Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. The nurse should do which of the following?

A)Keep child warm with blankets.
B)Apply a hypothermia blanket.
C)Record temperature on nurses' notes.
D)Report findings to physician.

Question 24

Which of the following is an important nursing consideration when chest tubes will be removed from a child?

A)Explain that it is not painful.
B)Explain that only a Band-aid will be needed
C)Administer analgesics before procedure.
D)Expect bright red drainage for several hours after removal.

Question 25

When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what are thought to protect against cardiovascular disease?

A)Cholesterol
B)Triglycerides
C)Low-density lipoproteins (LDLs)
D)High-density lipoproteins (HDLs)

Question 26

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. The nurse's reply should be based on which of the following?

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

Question 27

Which of the following is a sign of hypokalemia?

A)Apnea
B)Oliguria
C)Twitching
D)Muscle weakness

Question 28

Which of the following is a common, serious complication of rheumatic fever?

A)Seizures
B)Cardiac arrhythmias
C)Pulmonary hypertension
D)Cardiac valve damage

Question 29

The nurse is caring for a child after heart surgery. Which of the following should the nurse do if evidence is found of cardiac tamponade?

A)Increase analgesia.
B)Apply warming blankets.
C)Immediately report this to physician.
D)Encourage child to cough, turn, and breathe deeply.

Question 30

Which of the following should the nurse consider when preparing a school-age child and the family for heart surgery?

A)Unfamiliar equipment should not be shown.
B)Let child hear the sounds of an ECG monitor.
C)Avoid mentioning postoperative discomfort and interventions.
D)Explain that an endotracheal tube will not be needed if the surgery goes well.

Question 31

The primary nursing intervention to prevent bacterial endocarditis is which of the following?

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

Question 32

As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended for this child because they are high in which of the following?

A)Chlorides
B)Potassium
C)Sodium
D)Vitamins

Question 33

What is the most common causative agent of bacterial endocarditis?

A)Staphylococcus albus
B)Streptococcus hemolyticus
C)Staphylococcus albicans
D)Streptococcus viridans

Question 34

Which of the following actions by the school nurse is important in the prevention of rheumatic fever?

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 35

The infant with congestive heart failure has a need for:

A)Increased calories.
B)Increased fluids.
C)Decreased protein.
D)Decreased fat.

Question 36

Which of the following is the leading cause of death after heart transplantation?

A)Infection
B)Rejection
C)Cardiomyopathy
D)Congestive heart failure

Question 37

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

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

Question 38

What painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?

A)Osler nodes
B)Janeway lesions
C)Subcutaneous nodules
D)Aschoff nodes

Question 39

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be which of the following?

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

Question 40

Therapeutic management of the child with rheumatic fever includes:

A)Administration of penicillin.
B)Avoid salicylates (aspirin).
C)Strict bed rest for 4 to 6 weeks.
D)Administration of corticosteroids if chorea develops.

Question 41

Which of the following types of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?

A)Neurogenic shock
B)Cardiogenic shock
C)Hypovolemic shock
D)Anaphylactic shock

Question 42

Clinical manifestations of toxic shock syndrome include which of the following?

A)Severe hypertension
B)Subnormal temperature
C)Erythematous macular rash
D)Papular rash over extremities

Question 43

The nurse suspects shock in a child who is 1-day after surgery. The initial nursing action should be which of the following?

A)Obtain blood gases.
B)Administer oxygen.
C)Place on cardiac monitor.
D)Place in Trendelenburg position.

Question 44

Which of the following clinical manifestations would the nurse expect to see as shock progresses in a child and becomes uncompensated shock?

A)Thirst
B)Irritability
C)Apprehension
D)Confusion and somnolence

Question 45

When caring for the child with Kawasaki disease, the nurse should know which of the following?

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

Question 46

One of the most frequent causes of hypovolemic shock in children is which of the following?

A)Sepsis
B)Blood loss
C)Anaphylaxis
D)Congenital heart disease

Question 47

Which of the following occurs in septic shock?

A)Hypothermia
B)Increased cardiac output
C)Vasoconstriction
D)Angioneurotic edema

Question 48

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, the nurse should prepare which of the following medications for immediate administration?

A)Diphenhydramine (Benadryl)
B)Dopamine
C)Epinephrine
D)Calcium chloride