Question 1

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.An important objective to decrease this risk is to achieve what result?

Accepted Answer

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

Question 2

An 8-month-old infant becomes hypercyanotic while blood is being drawn.What should be the nurse's first action?

Accepted Answer

The first action is to place the infant in the knee-chest position.Blow-by oxygen may be indicated.Neurologic 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; cardiopulmonary resuscitation is not necessary,and death is unlikely.

Question 3

What is an important nursing consideration 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 are to be avoided by using the appropriate technique.

Question 4

Which defect results in increased pulmonary blood flow?

Accepted Answer

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 5

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

Accepted Answer

The child and family should be exposed to the sights and sounds of the intensive care unit.All positive,nonfrightening aspects of the environment are emphasized.The child should be shown unfamiliar equipment,and its use should be demonstrated on a doll.Carefully prepare the child for the postoperative experience,including intravenous lines,incision,and endotracheal tube.

Question 6

Which complication should the nurse asses for when caring for a child post cardiac catheterization?

Accepted Answer

Because a catheter is introduced into the heart,a risk exists of catheter-induced arrhythmias occurring during the procedure.These are usually transient.Hypostatic pneumonia,congestive heart failure,and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

Question 7

The nurse is caring for a child after heart surgery.What intervention should the nurse implement immediately if evidence is found of cardiac tamponade?

Accepted Answer

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

Question 8

What beneficial effect is achieved by administering digoxin?

Accepted Answer

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

Question 9

José is 4 year old.Preoperative teaching for a 4-year-old child scheduled for a cardiac catheterization should be done with what primary consideration in mind?

Accepted Answer

Preoperative teaching should always be directed at 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 based on developmental level.This age-group does not understand in-depth descriptions.Preschoolers should be prepared close to the time of the cardiac catheterization.

Question 10

Seventy-two hours after cardiac surgery,a young child has a temperature of 37.7° C (101° F).The nurse should initially implement which intervention?

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 an elevated temperature continues after this period,it is most likely a sign of an 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 11

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 because they are high in what electrolyte?

Accepted Answer

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

Question 12

What intervention should be implemented prior to the removal of a child's chest tubes?

Accepted Answer

It is appropriate to prepare the child for the removal of chest tubes with analgesics.Short-acting medications can be used that are administered through an existing intravenous line.It is not a pain-free procedure.A sharp,momentary pain is felt,and this should not be misrepresented to the child.A petroleum gauze/airtight dressing is needed.Little or no drainage should be found on removal.

Question 13

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 most appropriate initial nursing action?

Accepted Answer

If bleeding occurs,direct continuous pressure is applied 2.5 cm (1 inch)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; it would increase the drainage from the lower extremities.

Question 14

What is best described as the inability of the heart 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.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 15

Which term is used to describe a clinical manifestation of the systemic venous congestion that can occur with congestive 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 16

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 knowing what information?

Accepted Answer

Digoxin has a narrow therapeutic range.The margin of safety between therapeutic,toxic,and lethal doses is very small.Specific guidelines are available for parents to learn how to administer the drug safely and monitor for side effects.Digoxin is a frequently used drug,but it has a narrow therapeutic range.Very small amounts of the liquid are given to infants,which makes it easy to overmedicate or undermedicate.Parents may lack the necessary expertise to administer the drug at first,but with discharge preparation they should be prepared to administer the drug safely.

Question 17

What 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 18

Parents of a 3-year-old child diagnosed 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 what knowledge?

Accepted Answer

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

Question 19

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

Accepted Answer

Capoten is an ACE inhibitor.Lasix is a loop diuretic.Aldactone blocks the action of aldosterone.Diuril works on the distal tubules.

Question 20

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 pulmonic stenosis but not aortic stenosis in tetralogy of Fallot.Right ventricular hypertrophy,not left ventricular hypertrophy,is present in tetralogy of Fallot.There is a ventricular septal defect,not an atrial septal defect,and overriding aorta,not aortic hypertrophy,is present.

Quiz 42: The Child With Cardiovascular Dysfunction

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.An important objective to decrease this risk is to achieve what result?