Question 1

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.

Accepted Answer

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

Question 2

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.

-First priority
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.

Accepted Answer

The answer of An infant with an unrepaired tetralogy of...

Question 3

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

Accepted Answer

The infant requires rest and conservation of energy for feeding.Every effort is made to organize nursing activities to allow for uninterrupted periods of sleep.Whenever possible,parents are encouraged to stay with their infant to provide the holding,rocking,and cuddling that help children sleep more soundly.To minimize disturbing the infant,changing bed linens and complete bathing are done only when necessary.Feeding is planned to accommodate the infant's sleep and wake patterns.The child is fed at the first sign of hunger,such as when sucking on fists,rather than waiting until he or she cries for a bottle because the stress of crying exhausts the limited energy supply.Because infants with CHD tire easily and may sleep through feedings,smaller feedings every 3 hours may be helpful.

Question 4

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

Accepted Answer

Tetralogy of Fallot results in decreased blood flow to the lungs.The pulmonic stenosis increases the pressure in the right ventricle,causing the blood to go from right to left across the interventricular septal defect.Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

Question 5

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.

Accepted Answer

The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery,causing a right-to-left shunt.If this is surgically closed,no additional oxygenated blood (from the aorta)will return to the lungs through the pulmonary artery.The aorta carries oxygenated blood to the systemic circulation.Because of the higher pressure in the aorta,blood is shunted into the pulmonary artery and the pulmonary circulation.Edema in the legs and feet is usually a sign of heart failure.This repair would not directly affect the edema.Increasing the oxygenation of blood would not interfere with the return of oxygenated blood to the lungs.

Question 6

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate,is sweating,and is not feeding well?
A)Recheck the infant's blood pressure.
B)Alert the physician.
C)Withhold oral feeding.
D)Increase the oxygen rate.

Accepted Answer

These are signs of early congestive heart failure,and the physician should be notified.Although rechecking blood pressure may be indicated,it is not the priority action.Withholding the infant's feeding is an incomplete response to the problem.Increasing oxygen may alleviate symptoms; however,medications such as digoxin and furosemide are necessary to improve heart function and fluid retention.Notifying the physician is the priority nursing action.

Question 7

For what reason might a newborn infant with a cardiac defect,such as coarctation of the aorta,that results in a right-to-left shunt receive prostaglandin E??
A)To decrease inflammation
B)To control pain
C)To decrease respirations
D)To improve oxygenation

Accepted Answer

Prostaglandin E? is given to infants with a right-to-left shunt to keep the ductus arteriosus patent.This will improve oxygenation and increase pulmonary blood flow.

Question 8

A child has a total cholesterol level of 180 mg/dL.What dietary recommendations should the nurse make to the child and the child's parents (Select all that apply)?
A)Replace whole milk with 2% or 1% milk
B)Increase servings of red meat
C)Increase servings of fish
D)Avoid excessive intake of fruit juices
E)Limit servings of whole grain

Accepted Answer

A low-fat diet includes using nonfat or low-fat dairy products,limiting red meat intake,and increasing intake of fish,vegetables,whole grains,and legumes.Children should avoid excessive intake of fruit juices and other sweetened drinks,sugars,and saturated fats.

Question 9

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."

Accepted Answer

Although an echocardiogram is noninvasive,painless,and associated with no known side effects,it can be stressful for children.The child must lie quietly in the standard echocardiographic positions; crying,nursing,being held,or sitting up often leads to diagnostic errors or omissions.Therefore,infants and young children may need a mild sedative; older children benefit from psychologic preparation for the test.The distraction of a video or movie is often helpful.

Question 10

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.

-Second priority
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.

Accepted Answer

The answer of An infant with an unrepaired tetralogy of...

Question 11

A nurse is teaching an adolescent about primary hypertension.The nurse knows that which of the following is correct?
A)Primary hypertension should be treated with diuretics as soon as it is detected.
B)Congenital heart defects are the most common cause of primary hypertension.
C)Primary hypertension may be treated with weight reduction.
D)Primary hypertension is not affected by exercise.

Accepted Answer

Primary hypertension in children may be treated with weight reduction and exercise programs.If ineffective,pharmacologic intervention may be needed.Primary hypertension is considered an inherited disorder.

Question 12

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery.The nurse instructs the parents to notify the physician if what conditions occur (Select all that apply)?
A)Respiratory rate of 36 at rest
B)Appetite slowly increasing
C)Temperature above 37.7° C (100° F)
D)New, frequent coughing
E)Turning blue or bluer than normal

Accepted Answer

The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C (100° F); new,frequent coughing; and any episodes of the infant turning blue or bluer than normal.A respiratory rate of 36 at rest for an infant is within normal expectations,and it is expected that the appetite will increase slowly.

Question 13

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

Accepted Answer

The signs and symptoms of heart failure include decreased urinary output,sweating,and fatigue.Other signs include pale,cool extremities,not warm and flushed,and weight gain,not weight loss.

Question 14

An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension.On further testing,it is discovered the child has a cardiac abnormality.The initial treatment of secondary hypertension initially involves:
A)Weight control and diet.
B)Treating the underlying disease.
C)Administration of digoxin.
D)Administration of b-adrenergic receptor blockers.

Accepted Answer

Identification of the underlying disease should be the first step in treating secondary hypertension.Weight control and diet are nonpharmacologic treatments for primary hypertension.Digoxin is indicated in the treatment of congestive heart failure.b-Adrenergic receptor blockers are indicated in the treatment of primary hypertension.

Question 15

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

Accepted Answer

The goal of medical management is the eradication of the hemolytic streptococci.Penicillin is the drug of choice.Salicylates can be used to control the inflammatory process,especially in the joints,and reduce the fever and discomfort.Bed rest is recommended for the acute febrile stage,but it does not need to be strict.The chorea is transient and will resolve without treatment.

Question 16

Which clinical manifestations would 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

Accepted Answer

Cool extremities,decreased skin turgor,confusion,somnolence,tachypnea,and poor capillary refill time are beginning signs of decompensated shock.

Question 17

Nursing interventions for the child after a cardiac catheterization include which of the following (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.

Accepted Answer

The extremity that was used for access for the cardiac catheterization must be checked for temperature and color.Coolness and blanching may indicate arterial occlusion.The child should have a patent peripheral intravenous line to ensure adequate hydration.Allowing ambulation,monitoring vital signs every 2 hours,checking pulses,and removing the pressure dressing after 4 hours are interventions that do not apply to a child after a cardiac catheterization.

Question 18

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."

Accepted Answer

The child does not need to be on strict bed rest for 3 days.Showers are recommended; children should avoid a tub bath.The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean.Strenuous activity must be avoided for several days,but the child can return to school.

Question 19

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."

Accepted Answer

The metabolic rate of infants with heart failure is greater because of poor cardiac function and increased heart and respiratory rates.Their caloric needs are greater than those of the average infants,yet their ability to take in the calories is diminished by their fatigue.Infants with heart failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest,and a 4-hour schedule is too long.Fluids must be carefully monitored because of the heart failure.Infants do not require supplemental oxygen with feedings.

Question 20

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

Accepted Answer

The answer of Which is the acceptable mg/dl level,or below...

Quiz 42: Cardiovascular Dysfunction

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

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. -First priority

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

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

Surgical closure of the ductus arteriosus would:

What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate,is sweating,and is not feeding well?

For what reason might a newborn infant with a cardiac defect,such as coarctation of the aorta,that results in a right-to-left shunt receive prostaglandin E??

A child has a total cholesterol level of 180 mg/dL.What dietary recommendations should the nurse make to the child and the child's parents (Select all that apply) ?

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?

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. -Second priority

A nurse is teaching an adolescent about primary hypertension.The nurse knows that which of the following is correct?

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery.The nurse instructs the parents to notify the physician if what conditions occur (Select all that apply) ?

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) ?

An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension.On further testing,it is discovered the child has a cardiac abnormality.The initial treatment of secondary hypertension initially involves:

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

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

Nursing interventions for the child after a cardiac catheterization include which of the following (Select all that apply) ?

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

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?

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