Question 1

The nurse is caring for a newborn diagnosed with patent ductus arteriosus. Which finding will the nurse assess that is consistent with this diagnosis?&#10;A) Slow heart rate&#10;B) Expiratory grunt&#10;C) Wide pulse pressure&#10;D) Absent femoral pulses

Accepted Answer

On physical examination, the child with patent ductus arteriosus usually has a wide pulse pressure. The diastolic pressure is low because of the shunt or runoff of blood, which reduces resistance. Manifestations of patent ductus arteriosus do not include a slow heart rate, expiratory grunt, or absent femoral pulses.

Question 2

Which of the following nursing diagnoses would best apply to a child during the acute phase of rheumatic fever?&#10;A) Disturbed sleep pattern related to hyperexcitability&#10;B) Ineffective breathing pattern related to cardiomegaly&#10;C) Risk for self-directed violence related to development of cerebral anoxia&#10;D) Activity intolerance related to inability of heart to sustain extra workload

Accepted Answer

The course of rheumatic fever is about 6 to 8 weeks. Children are maintained on bed rest only during the acute phase of illness until the pulse rate returns to normal. Because pulse rate is a valuable sign of improvement, monitoring vital signs is essential during and following the acute phase. Obtain an apical pulse for a full minute for best results. Taking it while the child is asleep as well as when the child is awake helps to measure the effect of activity on the pulse rate; another way to judge inflammation is decreasing and the child's heart action is improving. Chorea occurs in some children with rheumatic fever; however, it is not known if this manifestation will disturb the child's sleep.
Children with rheumatic fever may develop congestive heart failure; however, cardiomegaly is not a long-term effect of the disease. The child is not at risk for self-directed violence because cerebral anoxia is not a manifestation of the disease.

Question 3

The nurse is planning a program for community family members that focuses on the 2020 National Health Goals to improve cardiovascular health. Which content should the nurse include in this program? (Select all that apply.)

A) Measures to reduce obesity
B) Importance of daily exercise
C) Starting reduced-fat diets upon birth
D) Engaging in stress-reduction activities
E) Following a diet that supports heart function

Measures to reduce obesity
Importance of daily exercise
Following a diet that supports heart function

Accepted Answer

Nurses can help the nation achieve the 2020 National Health Goals by educating parents and children about the importance of reducing obesity and planning exercise and nutrition programs for sound cardiovascular health. Parents should be cautioned not to start their children on reduced-fat diets until they are 2 years old to allow for myelination of nerve cells. Stress-reduction activities are not identified as actions to achieve the 2020 National Health Goals for cardiovascular health.

Question 4

A newborn is diagnosed with coarctation of the aorta. Which assessment should the nurse make when caring for this infant?&#10;A) Observing for excessive crying&#10;B) Auscultating for a cardiac murmur&#10;C) Assessing for the presence of femoral pulses&#10;D) Recording an upper extremity blood pressure

Accepted Answer

If the coarctation is slight, absence of palpable femoral pulses from the decreased blood pressure in the lower body may be the only symptom seen. To help detect this, the nurse should always include evaluation of femoral pulses in all initial newborn assessments and admission inspections to newborn nurseries. Excessive crying, cardiac murmur, and blood pressure changes are not manifestations of coarctation of the aorta.

Question 5

What should the nurse teach the parents of a child with tetralogy of Fallot to do if the child suddenly becomes cyanotic and dyspneic?&#10;A) Place in a knee-chest position.&#10;B) Lie prone and maintain the airway.&#10;C) Lie supine with the head turned to one side.&#10;D) Place in a semi-Fowler's position in an infant seat.

Accepted Answer

Parents need to try to keep hypercyanotic episodes to a minimum and learn what steps to take if one should occur. Placing the baby in a knee-chest position to trap blood in the lower extremities and keep the heart from being overwhelmed generally reduces symptoms. Lying prone, supine, or in the semi-Fowler's position will not help reduce cyanosis and dyspnea.

Question 6

Which health teaching concept should the nurse emphasize when instructing the parents of a child with polycythemia caused by a congenital heart disorder?&#10;A) Prepare for seizures.&#10;B) Prevent dehydration.&#10;C) Expect the skin to turn yellow.&#10;D) Encourage progressive activity.

Accepted Answer

Hydration must be monitored so dehydration does not occur in children with polycythemia so the polycythemia does not become so severe clotting or thrombophlebitis results. Seizures are not a threat with polycythemia. Jaundice is not associated with polycythemia. Encourage parents to observe the infant carefully when new activities are introduced so they can recognize the first signs of respiratory distress or the point at which the child is beginning to exceed exercise tolerance.

Question 7

The nurse instructs the parents of a child with a congenital heart disorder on the administration of digoxin at home. Which observation indicates that teaching has been effective?&#10;A) The father provides a dose of the medication after the baby spits it up.&#10;B) The father provides a dose of the medication at the conclusion of a feeding.&#10;C) The mother feels for a radial pulse before giving the baby the next scheduled dose.&#10;D) The mother provides a dose of the medication 1 hour before the next scheduled feeding.

Accepted Answer

Guidelines to ensure safe digoxin administration at home include providing a dose of the medication 1 hour before the next scheduled feeding. If a dose is vomited, do not repeat the dose. The medication should be given 2 hours after a feeding and not immediately after. The apical heart rate and not the radial pulse should be assessed before providing a dose of the medication.

Question 8

The parents of a child having a cardiac catheterization are waiting to see the child after the procedure. What should the nurse instruct the parents to expect when seeing the child for the first time?&#10;A) The child will be sleeping for at least 8 hours.&#10;B) A bulky pressure dressing will be present over the insertion site.&#10;C) The child will have bruising over the upper and lower extremities.&#10;D) The child will be on seizure precautions and have padded side rails.

Accepted Answer

When a child returns from a cardiac catheterization, a pressure dressing will be present over the catheter insertion site. This dressing is snug and will be checked to ensure that no bleeding is occurring. The child may or may not be sleepy after the procedure. The child will not have bruising over the upper and lower extremities. Seizure precautions are not necessary after a cardiac catheterization.

Question 9

The nurse is planning care for an 8-month-old infant with a ventricular septal defect. Which nursing diagnosis should the nurse use to help guide the care for this patient?&#10;A) Impaired gas exchange related to a right-to-left shunt&#10;B) Impaired skin integrity related to poor peripheral circulation&#10;C) Ineffective airway clearance related to altered pulmonary status&#10;D) Ineffective tissue perfusion related to inefficiency of the heart as a pump

Accepted Answer

Ventricular septal defect is the most common type of congenital cardiac disorder. With this disorder, an opening is present in the septum between the two ventricles. Blood shunts from left to right across the septum impairing the efficiency of the heart because blood that should be forced into the aorta and out to the body from contraction of the left ventricle shunts back into the pulmonary circulation, resulting in right ventricular hypertrophy and increased pressure in the pulmonary artery. This disorder does not impair gas exchange, cause impaired skin integrity, or cause ineffective airway clearance.

Question 10

An infant is prescribed digoxin. What should the nurse explain to the parents regarding the action of this medication?&#10;A) Increases the heart rate&#10;B) Slows and strengthens the heartbeat&#10;C) Thickens the walls of the myocardium&#10;D) Prevents subacute bacterial endocarditis

Accepted Answer

Digoxin, a cardiac glycoside made from digitalis, acts directly on the heart to increase the contractility of the myocardium and the force of contraction to slow the heart rate. Digoxin does not increase the heart rate, thicken the walls of the myocardium, or prevent subacute bacterial endocarditis.

Question 11

The nurse is assessing the heart rate of a child with a congenital heart defect. What should the nurse document when a pulse of one strong beat and one weak beat is assessed?&#10;A) Dicrotic pulse&#10;B) Thready pulse&#10;C) Pulsus alternans&#10;D) Water hammer pulse

Accepted Answer

The answer of The nurse is assessing the heart rate...

Question 12

Which action should the nurse implement for an infant who develops heart failure?&#10;A) Restricting daily milk intake&#10;B) Keeping in a supine position&#10;C) Planning ways to reduce salt intake&#10;D) Placing in a semi-Fowler's position

Accepted Answer

The answer of Which action should the nurse implement for...

Question 13

The nurse is caring for a child with chest tubes inserted after heart surgery that are attached to an underwater-seal drainage system. For which reason should the nurse prepare to clamp the chest tubes?

A) The child is coughing.
B) A clot obstructs the tubing.
C) A tube becomes disconnected.
D) Red-stained drainage appears in a tube.

Accepted Answer

The answer of The nurse is caring for a child...

Question 14

The cardiac monitor of a child recovering from heart surgery alarms, and the nurse finds the child without a heartbeat. What should the nurse do first?&#10;A) Apply oxygen.&#10;B) Establish an airway.&#10;C) Begin rescue breathing.&#10;D) Begin cardiac compressions.

Accepted Answer

The answer of The cardiac monitor of a child recovering...

Question 15

A toddler is diagnosed with a functional heart murmur. What should the nurse explain to the child's parents about this murmur?&#10;A) This type of murmur is innocent.&#10;B) Mild activity restrictions are indicated.&#10;C) More frequent health appraisals are indicated.&#10;D) Corrective surgery may be required later in life.

Accepted Answer

The answer of A toddler is diagnosed with a functional...

Deck 41: Nursing Care of a Family When a Child Has a Cardiovascular Disorder