Question 1

What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)?
A) Assess the parents' anxiety level and readiness to learn
B) Gather literature for the parents
C) Secure a quiet place for teaching
D) Discuss the plan with the nursing team

Accepted Answer

Any effort to organize the right environment,plan,or literature is of no use if the parents are not ready to learn or have high anxiety.Decreasing their level of anxiety is often needed before new information can be processed.A baseline assessment of prior knowledge should be taken into consideration before developing any teaching plan.Locating a quiet place for meeting with parents is appropriate; however,an assessment should be done before any teaching is done.Discussing a teaching plan with the nursing team is appropriate after an assessment of the parents' knowledge and readiness.

Question 2

What is one of the most frequent causes of hypovolemic shock in children?
A) Myocardial infarction
B) Blood loss
C) Anaphylaxis
D) Congenital heart disease

Accepted Answer

Blood loss and extracellular fluid loss are two of the most frequent causes of hypovolemic shock in children.Myocardial infarction is rare in a child; if it occurred,the resulting shock would be cardiogenic,not hypovolemic.Anaphylaxis results in distributive shock from extreme allergy or hypersensitivity to a foreign substance.Congenital heart disease tends to contribute to hypervolemia,not hypovolemia.

Question 3

What is the most common causative agent of bacterial endocarditis?
A) Staphylococcus albus
B) Streptococcus hemolyticus
C) Staphylococcus albicans
D) Streptococcus viridans

Accepted Answer

Staphylococcus viridans is the most common causative agent in bacterial (infective)endocarditis.Staphylococcus albus,Streptococcus hemolyticus,and Staphylococcus albicans are not common causative agents.

Question 4

What 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 shock
B) Cardiogenic shock
C) Hypovolemic shock
D) Anaphylactic shock

Accepted Answer

Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance.Neurogenic shock results from loss of neuronal control,such as the interruption of neuronal transmission that occurs from a spinal cord injury.Cardiogenic shock is decreased cardiac output.Hypovolemic shock is a reduction in the size of the vascular compartment,decreasing blood pressure,and low central venous pressure.

Question 5

What is a major clinical manifestation of rheumatic fever?
A) Polyarthritis
B) Osler's nodes
C) Janeway spots
D) Splinter hemorrhages of distal third of nails

Accepted Answer

Polyarthritis is swollen,hot,red,and painful joints.The affected joints will change every 1 to 2 days.Primarily the large joints are affected.Osler's nodes,Janeway spots,and splinter hemorrhages are characteristic of infective endocarditis.

Question 6

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur.This finding is associated with which congenital heart defect?
A) Pulmonary stenosis
B) Patent ductus arteriosus
C) Ventricular septal defect
D) Coarctation of the aorta

Accepted Answer

The classic murmur associated with patent ductus arteriosus is a machinery-like one that can be heard throughout both systole and diastole.A systolic ejection murmur that may be accompanied by a palpable thrill is a manifestation of pulmonary stenosis.The characteristic murmur associated with ventricular septal defect is a loud,harsh,holosystolic murmur.A systolic murmur that is accompanied by an ejection click may be heard on auscultation when coarctation of the aorta is present.

Question 7

Which clinical changes occur as a result of septic shock?
A) Hypothermia
B) Increased cardiac output
C) Vasoconstriction
D) Angioneurotic edema

Accepted Answer

Increased cardiac output,which results in warm,flushed skin,is one of the manifestations of septic shock.Fever and chills are characteristic of septic shock.Vasodilation is more common in septic shock.Angioneurotic edema occurs as a manifestation in anaphylactic shock.

Question 8

What is an expected assessment finding in a child with coarctation of the aorta?
A) Orthostatic hypotension
B) Systolic hypertension in the lower extremities
C) Blood pressure higher on the left side of the body
D) Disparity in blood pressure between the upper and lower extremities

Accepted Answer

The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities.Orthostatic hypotension is not present with coarctation of the aorta.Systolic hypertension may be detected in the upper extremities.The left arm may not accurately reflect systolic hypertension because the left subclavian artery can be involved in the coarctation.

Question 9

In which situation is there the greatest risk that a newborn infant will have a congenital heart defect (CHD)?
A) Trisomy 21 detected on amniocentesis
B) Family history of myocardial infarction
C) Father has type 1 diabetes mellitus
D) Older sibling born with Turner's syndrome

Accepted Answer

The incidence of congenital heart disease is approximately 50% in children with trisomy 21 (Down syndrome).A family history of congenital heart disease,not acquired heart disease,increases the risk of giving birth to a child with CHD.Infants born to mothers who are insulin dependent have an increased risk of CHD.Infants identified as having certain genetic defects,such as Turner's syndrome,have a higher incidence of CHD.

Question 10

A nurse is teaching an adolescent about essential 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

Essential 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 11

What is a common,serious complication of rheumatic fever?
A) Seizures
B) Cardiac arrhythmias
C) Pulmonary hypertension
D) Cardiac valve damage

Accepted Answer

Cardiac valve damage is the most significant complication of rheumatic fever.Seizures,cardiac arrhythmias,and pulmonary hypertension are not common complications of rheumatic fever.

Question 12

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting.While an airway is being established,what medication should the nurse prepare for immediate administration?
A) Diphenhydramine
B) Dopamine
C) Epinephrine
D) Calcium chloride

Accepted Answer

After the first priority of establishing an airway,epinephrine is the drug of choice.Diphenhydramine is not a strong enough antihistamine for this severe a reaction.Dopamine and calcium chloride are not appropriate drugs for this type of reaction.

Question 13

A child with pulmonary atresia exhibits cyanosis with feeding.On reviewing this child's laboratory values,the nurse is not surprised to notice which abnormality?
A) Polycythemia
B) Infection
C) Dehydration
D) Anemia

Accepted Answer

Polycythemia is a compensatory response to chronic hypoxia.The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood.Infection is not a clinical consequence of cyanosis.Although dehydration can occur in cyanotic heart disease,it is not a compensatory mechanism for chronic hypoxia.It is not a clinical consequence of cyanosis.Anemia may develop as a result of increased blood viscosity.Anemia is not a clinical consequence of cyanosis.

Question 14

What is the primary nursing intervention necessary to prevent bacterial endocarditis?
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.

Accepted Answer

The objective of nursing care is to counsel the parents of high risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health.The child's dentist should be aware of the child's cardiac condition.Dental procedures should be done to maintain a high level of oral health.Prophylactic antibiotics are necessary.Observing for complications and encouraging restricted mobility in susceptible children should be done,but maintaining good oral health and using prophylactic antibiotics are most important.

Question 15

When caring for the child with Kawasaki disease,the nurse should understand that principle of care?
A) The 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.

Accepted Answer

High-dose intravenous gamma globulin and aspirin therapy are indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness.The fever of Kawasaki disease is unresponsive to antibiotics and antipyretics.Involvement of mucous membranes and conjunctiva,changes in the extremities,and cardiac involvement are seen.

Question 16

When discussing hyperlipidemia with a group of adolescents,the nurse should explain that high levels of what substance are thought to protect against cardiovascular disease?
A) Cholesterol
B) Triglycerides
C) Low-density lipoproteins (LDLs)
D) High-density lipoproteins (HDLs)

Accepted Answer

HDLs contain very low concentrations of triglycerides,relatively little cholesterol,and high levels of proteins.It is thought that HDLs protect against cardiovascular disease.Cholesterol,triglycerides,and LDLs do not protect against cardiovascular disease.

Question 17

What is the leading cause of death after heart transplantation?
A) Infection
B) Rejection
C) Cardiomyopathy
D) Congestive heart failure

Accepted Answer

The posttransplantation course is complex.The leading cause of death after cardiac transplantation is rejection.Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection.Cardiomyopathy is one of the indications for cardiac transplant.Congestive heart failure is not a leading cause of death.

Question 18

Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?
A) Weigh the infant every day on the same scale at the same time.
B) Notify the physician when weight gain exceeds more than 20 g/day.
C) Put the infant in a car seat to minimize movement.
D) Administer digoxin as ordered by the physician.

Accepted Answer

Excess fluid volume may not be overtly visible.Weight changes may indicate fluid retention.Weighing the infant on the same scale at the same time each day ensures consistency.An excessive weight gain for an infant is an increase of more than 50 g/day.With fluid volume excess,skin will be edematous.The infant's position should be changed frequently to prevent undesirable pooling of fluid in certain areas.Digoxin is used in the treatment of congestive heart failure to improve cardiac function.Diuretics will help the body get rid of excess fluid.

Question 19

Which postoperative intervention should be questioned for a child after a cardiac catheterization?
A) Continue intravenous (IV) fluids until the infant is tolerating oral fluids.
B) Check the dressing for bleeding.
C) Assess peripheral circulation on the affected extremity.
D) Keep the affected leg flexed and elevated.

Accepted Answer

The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure.IV fluid administration continues until the child is taking and retaining adequate amounts of oral fluids.The insertion site dressing should be observed frequently for bleeding.The nurse should also look under the child to check for pooled blood.Peripheral perfusion is monitored after catheterization.Distal pulses should be palpable,although they may be weaker than in the contralateral extremity.

Question 20

What term is used to describe the painful,tender,pea-sized nodules that may appear on the pads of the fingers or toes in cases of bacterial endocarditis?
A) Osler's nodes
B) Janeway lesions
C) Subcutaneous nodules
D) Aschoff's nodules

Accepted Answer

Osler's nodes are red,painful,intradermal nodes found on pads of the phalanges in bacterial endocarditis.Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis.Subcutaneous nodules are nontender swellings located over bony prominences,commonly found in rheumatic fever.Aschoff's nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.

Quiz 42: The Child With Cardiovascular Dysfunction

What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD) ?

What is one of the most frequent causes of hypovolemic shock in children?

What is the most common causative agent of bacterial endocarditis?

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

What is a major clinical manifestation of rheumatic fever?

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur.This finding is associated with which congenital heart defect?

Which clinical changes occur as a result of septic shock?

What is an expected assessment finding in a child with coarctation of the aorta?

In which situation is there the greatest risk that a newborn infant will have a congenital heart defect (CHD) ?

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

What is a common,serious complication of rheumatic fever?

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting.While an airway is being established,what medication should the nurse prepare for immediate administration?

A child with pulmonary atresia exhibits cyanosis with feeding.On reviewing this child's laboratory values,the nurse is not surprised to notice which abnormality?

What is the primary nursing intervention necessary to prevent bacterial endocarditis?

When caring for the child with Kawasaki disease,the nurse should understand that principle of care?

When discussing hyperlipidemia with a group of adolescents,the nurse should explain that high levels of what substance are thought to protect against cardiovascular disease?

What is the leading cause of death after heart transplantation?

Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?

Which postoperative intervention should be questioned for a child after a cardiac catheterization?

What term is used to describe the painful,tender,pea-sized nodules that may appear on the pads of the fingers or toes in cases of bacterial endocarditis?