Deck 25: The Child with Cardiovascular Dysfunction

Question 1

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.

Answer 1

adapted to his level of development so that he can understand.

Question 2

Surgical closure of the ductus arteriosus would:

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.

Answer 2

prevent the return of oxygenated blood to the lungs.

Question 3

The nurse is preparing an adolescent for discharge after a cardiac catheterization.Which statement by the adolescent would indicate a need for further teaching?

A)"I should avoid tub baths but may shower."
B)"I have to stay on strict bed rest for 3 days."
C)"I should remove the pressure dressing the day after the procedure."
D)"I may attend school but should avoid exercise for several days."

Answer 3

"I have to stay on strict bed rest for 3 days."

Question 4

The nurse is conducting a staff in-service on congenital heart defects.Which structural defect constitutes tetralogy of Fallot?

A)Pulmonic 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)Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

Question 5

Which explanation 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 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 6

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 show:

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

Question 7

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

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

Question 8

The nurse is preparing to administer a dose of digoxin (Lanoxin)to a child in heart failure (HF).Which is a beneficial effect of administering digoxin (Lanoxin)?

A)It decreases edema.
B)It decreases cardiac output.
C)It increases heart size.
D)It increases venous pressure.

Question 9

The nurse is teaching parents about signs of digoxin (Lanoxin)toxicity.Which is a common sign of digoxin toxicity?

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

Question 10

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

A)notify physician.
B)apply new bandage with more pressure.
C)place the child in Trendelenburg position.
D)apply direct pressure above catheterization site.

Question 11

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 _____ beats/min.

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

Question 12

A nurse is teaching nursing students the physiology of congenital heart defects.Which defect results in decreased pulmonary blood flow?

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

Question 13

Which 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)Heart failure
D)Systemic venous congestion

Question 14

Which defect results in increased pulmonary blood flow?

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

Question 15

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 _____ beats/min.

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

Question 16

As part of the treatment for heart failure,the child takes the diuretic furosemide (Lasix).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 because they are high in:

A)chlorides.
B)potassium.
C)sodium.
D)vitamins.

Question 17

The nurse is talking to a parent of an infant with heart failure about feeding the infant.Which statement about feeding the child is correct?

A)"You may need to increase the caloric density of your infant's formula."
B)"You should feed your baby every 2 hours."
C)"You may need to increase the amount of formula your infant eats with each feeding."
D)"You should place a nasal oxygen cannula on your infant during and after each feeding."

Question 18

The nurse is assessing a child after a cardiac catheterization.Which complication should the nurse be assessing for?

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

Question 19

A nurse is preparing to administer an angiotensin-converting enzyme (ACE)inhibitor.Which drug should the nurse be administering?

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

Question 20

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

A)It is a 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.

Question 21

The nurse is teaching nursing students about shock that occurs in children.One of the most frequent causes of hypovolemic shock in children is:

A)sepsis.
B)blood loss.
C)anaphylaxis.
D)congenital heart disease.

Question 22

When discussing hyperlipidemia with a group of adolescents,the nurse should explain that cardiovascular disease can be prevented by high levels of:

A)cholesterol.
B)triglycerides.
C)low-density lipoproteins (LDLs).
D)high-density lipoproteins (HDLs).

Question 23

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

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

Question 24

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 is an important objective to decrease this risk?

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

Question 25

Which action 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 26

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

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

Question 27

An 8-month-old infant has a hypercyanotic spell while blood is being drawn.The nurse's first action should be to:

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 28

Which 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 29

The primary nursing intervention to prevent bacterial endocarditis is to:

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 30

Which 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 31

Which 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 32

The nurse is conducting a staff in-service on childhood-acquired heart diseases.Which 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 33

Which is a common,serious complication of rheumatic fever?

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

Question 34

The nurse is caring for a child after heart surgery.Which 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 35

Which is the most common causative agent of bacterial endocarditis?

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

Question 36

The nurse is admitting a child with rheumatic fever.Which therapeutic management should the nurse expect to implement?

A)Administering penicillin
B)Avoiding salicylates (aspirin)
C)Imposing strict bed rest for 4 to 6 weeks
D)Administering corticosteroids if chorea develops

Question 37

Which 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 38

Which is the leading cause of death after heart transplantation?

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

Question 39

Seventy-two hours after cardiac surgery,a young child has a temperature of 101° F.Which action should the nurse take?

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

Question 40

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 statement?

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

Question 41

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock?

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

Question 42

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 medication for immediate administration?

A)Diphenhydramine (Benadryl)
B)Dobutamine (Dobutarex)
C)Epinephrine (Adrenalin)
D)Calcium chloride (calcium chloride)

Question 43

Nursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.)

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.
E)Remove pressure dressing after 4 hours.
F)Maintain a patent peripheral intravenous catheter until discharge.

Question 44

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting.Once the airway is established,the nurse should do which action? Place in correct sequence.Provide answer using lowercase letters separated by commas (e.g., a,b,c).
a. Administer epinephrine.
b. Keep child warm and calm.
c. Obtain vascular access.

Question 45

The nurse is caring for an infant with congestive heart disease (CHD).The nurse should plan which intervention to decrease cardiac demands?

A)Organize nursing activities to allow for uninterrupted sleep.
B)Allow the infant to sleep through feedings during the night.
C)Wait for the infant to cry to show definite signs of hunger.
D)Discourage parents from rocking the infant

Question 46

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.)

A)Thirst and diminished urinary output
B)Irritability and apprehension
C)Cool extremities and decreased skin turgor
D)Confusion and somnolence
E)Normal blood pressure and narrowing pulse pressure
F) Tachypnea and poor capillary refill time

Question 47

An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during a routine blood draw.Which interventions should the nurse implement? Place in order from the highest-priority intervention to the lowest-priority intervention.Provide answer using lowercase letters separated by commas (e.g., a,b,c,d).
a. Administer 100% oxygen by blow-by.
b. Place infant in knee-chest position.
c. Remain calm.
d. Give morphine subcutaneously or by an existing intravenous line.

Question 48

Clinical manifestations of toxic shock syndrome include:

A)severe hypertension.
B)subnormal temperature.
C)erythematous macular rash.
D)papular rash over extremities.

Question 49

The nurse is admitting a child with coarctation of the aorta.Which figure depicts this congenital heart defect?

A)
B)
C)
D)

Question 50

Which is the acceptable mg/dl level,or below this level,low density lipoprotein (LDL)cholesterol for a child from a family with heart disease? (Record your answer in a whole number.)

Question 51

Which occurs in septic shock?

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

Question 52

A preschool child is scheduled for an echocardiogram.Parents ask the nurse whether they can hold the child during the procedure.The nurse should answer with which response?

A)"You will be able to hold your child during the procedure."
B)"Your child can be active during the procedure, but can't sit in your lap."
C)"Your child must lie quietly; sometimes a mild sedative is administered before the procedure."
D)"The procedure is invasive so your child will be restrained during the echocardiogram."

Question 53

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot.Which signs and symptoms should the nurse include? (Select all that apply.)

A)Warm flushed extremities
B)Weight loss
C)Decreased urinary output
D)Sweating (inappropriate)
E)Fatigue