Question 1

An 8-month-old infant has a hypercyanotic spell while blood is being drawn.What is the nurse's initial action?

Accepted Answer

The first action is to place the infant in the knee-chest position.Blow-by oxygen may be indicated.Neurological defects are unlikely.The child should be assessed for airway,breathing,and circulation.Often calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

Question 2

What should the nurse do when suctioning a young child who has had heart surgery?

Accepted Answer

If 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,not on a routine basis.The child should be suctioned for no more than 5 seconds at one time.Symptoms of respiratory distress can be avoided by using the appropriate technique.

Question 3

Which drug is an angiotensin-converting enzyme (ACE)inhibitor?

Accepted Answer

Captopril is an ACE inhibitor.Furosemide is a loop diuretic.Spironolactone blocks the action of aldosterone.Chlorothiazide works on the distal tubules.

Question 4

When preparing a school-age child and the family for heart surgery,what should the nurse consider?

Accepted Answer

The child and family should be exposed to the sights and sounds of the critical care unit.The nurse should emphasize all positive,non-frightening aspects of the environment.The child should be shown unfamiliar equipment,and its use should be demonstrated on a doll.The nurse should carefully prepare the child for the postoperative experience,including intravenous (IV)lines,the incision,and the endotracheal tube.

Question 5

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

Accepted Answer

A chest x-ray provides information on the heart size and pulmonary blood flow patterns,providing a baseline for future comparisons.The heart,sternum,and ribs will be visible.Electrocardiography measures the electrical potential generated from heart muscle.Echocardiography produces a computerized image of the heart vessels and tissues by using sound waves.

Question 6

What is a beneficial effect of administering digoxin (Lanoxin)?

Accepted Answer

Digoxin has a rapid onset and is useful in increasing cardiac output,decreasing venous pressure,and,as a result,decreasing edema.Cardiac output is increased by digoxin,while heart size and venous pressure are decreased.

Question 7

Seventy-two hours after cardiac surgery,a young child has a temperature of 37.7°C.What should the nurse do?

Accepted Answer

In the first 24 to 48 hours after surgery,the body temperature may increase to 37.7°C (100°F)as part of the inflammatory response to tissue trauma.If the temperature is higher or continues after this period,it is most likely a sign of infection,and immediate investigation is indicated.Blankets should be removed from the child to keep the temperature from increasing.A hypothermia blanket is not indicated for this level of temperature.The temperature should be recorded,but the physician must be notified for evaluation.

Question 8

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.What knowledge should inform the nurse's reply?

Accepted Answer

The child needs opportunities for social development.Children usually limit their activities if allowed to set their own pace.Parents must be encouraged to seek appropriate social activities for the child,especially before kindergarten.The child needs to engage in activities that foster independence.

Question 9

As part of the treatment for heart failure,the child takes the diuretic furosemide.When teaching home care,the nurse encourages the family to give the child foods such as bananas,oranges,and leafy vegetables.What are these foods high in?

Accepted Answer

Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium,so the child's diet should be supplemented with potassium.

Question 10

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

Accepted Answer

Peripheral edema,especially periorbital edema,is a clinical manifestation of systemic venous congestion.Tachypnea is a manifestation of pulmonary congestion.Tachycardia and pale,cool extremities are clinical manifestations of impaired myocardial function.

Question 11

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

Accepted Answer

The definition of heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body.Pulmonary congestion is an excessive accumulation of fluid in the lungs.A congenital heart defect is a malformation of the heart present at birth.Systemic venous congestion is an excessive accumulation of fluid in the systemic vasculature.

Question 12

The parents of a young child with heart failure tell the nurse that they are "nervous" about giving digoxin.What knowledge should the nurse include in her response?

Accepted Answer

Digoxin is frequently used,but has a narrow therapeutic range.The difference between therapeutic,toxic,and lethal doses is very minor.Very small amounts of the liquid are given to infants,which makes it easy to under- or overmedicate.Parents may lack the necessary expertise to administer the drug at first,but with discharge instructions they should be prepared to administer the drug safely and monitor for adverse effects.

Question 13

Which is a common sign of digoxin toxicity?

Accepted Answer

Vomiting is a common sign of digoxin toxicity.Seizures are not associated with digoxin toxicity.The child will have a slower heart rate,not respiratory rate.

Question 14

The nurse is caring for a child after heart surgery.What should be done if there is evidence of cardiac tamponade?

Accepted Answer

If evidence is noted of cardiac tamponade,caused by blood or fluid in the pericardial space constricting the heart,the physician must be notified immediately of this life-threatening complication.Increasing analgesia may be done before the physician drains the fluid,but the physician must be notified first.Warming blankets are not indicated at this time.Encouraging the child to cough,turn,and breathe deeply should be deferred until after the physician's evaluation.

Question 15

A 4-year-old child is scheduled for a cardiac catheterization.Which statement reflects the correct way for the nurse to provide preoperative teaching?

Accepted Answer

Preoperative teaching should always be adapted to the child's stage of development.The caregivers also benefit from the same explanations.The parents may ask additional questions,which should be answered,but the child needs to receive the information in a way he can understand.This age group does not understand in-depth descriptions.Preschoolers should be prepared close to the time of the cardiac catheterization.

Question 16

Which 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.There is pulmonary stenosis but not atrial stenosis,and right ventricular hypertrophy,not left ventricular hypertrophy in tetralogy of Fallot,and an atrial septal defect,not aortic hypertrophy,is present.

Question 17

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.What is the priority nursing action?

Accepted Answer

If bleeding occurs,the nurse should apply direct,continuous pressure 2.5 cm above the percutaneous skin site to localize pressure over the vessel puncture.Notifying the physician and applying a new bandage with more pressure can be done after pressure is applied.The nurse can have someone else notify the physician while the pressure is being maintained.The Trendelenburg position would not be helpful,as it would increase the drainage from the lower extremities.

Question 18

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

Accepted Answer

In children with persistent hypoxia,polycythemia develops.Dehydration must be prevented in hypoxemic children because it increases the risk of strokes.Minimizing seizures,promoting cardiac output,and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

Question 19

Which defect results in increased pulmonary blood flow?

Accepted Answer

The atrial septal defect results in increased pulmonary blood flow.Blood flows from the left atrium (higher pressure)into the right atrium (lower pressure)and then to the lungs via the pulmonary artery.Pulmonic stenosis is an obstruction to blood flowing from the ventricles.Tricuspid atresia results in decreased pulmonary blood flow.Transposition of the great arteries results in mixed blood flow.

Question 20

Which complication may occur after a cardiac catheterization?

Accepted Answer

Because a catheter is introduced into the heart,there is a risk that catheter-induced transient dysrhythmias could occur during the procedure.Hypostatic pneumonia,heart failure,and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

Quiz 47: Cardiovascular Dysfunction