Question 1

A nurse is concerned that a child with pulmonary hypertension (PA)is developing heart failure.Which manifestation would the nurse assess for first?
A)Cough
B)Dyspnea
C)Extremity edema
D)Tachycardia

Accepted Answer

As the pressure in the lungs increases in the child with PA,the right ventricle hypertrophies and will eventually fail.Manifestations of right-sided failure include peripheral edema.Lung manifestations are seen in left-sided heart failure.Tachycardia is nonspecific.Although both sides of the heart can eventually fail,the first signs and symptoms will be of right-sided failure.

Question 2

A child is being discharged after a pacemaker insertion.Which teaching point by the nurse takes priority?
A)Any prescribed activity restrictions
B)Need for a healthy balanced diet
C)Schedule for pacemaker testing
D)Signs of wound site infection

Accepted Answer

All options are important for the postoperative child who had a pacemaker insertion.However,the instruction that is specific to this operation is the schedule for follow-up pacemaker function testing,which will be lifelong.

Question 3

A 12-year-old child has been diagnosed with long QT syndrome.Which teaching by the nurse is most important?
A)No driving until rhythm disturbances are controlled for 6 months.
B)Parents and siblings of the child need to be tested for the disorder.
C)The child cannot participate in any contact sports for a year.
D)Watch the child for symptoms of heart failure or infection.

Accepted Answer

Parents and siblings need to be tested for long QT syndrome as soon as possible.It is True the child has driving restrictions until the rhythm is controlled for 6 months,but for a 12-year old,this is not priority information.Sports may be curtailed until the rhythm is controlled,but there is no specific restriction that lasts for 1 year.Heart failure and infection are not related.

Question 4

A 3-year-old child is 4 hours post-cardiac catheterization via the right femoral artery.Which assessment finding should the nurse report to the provider?
A)Crying,complaining of pain at site
B)Restless,tries to get up repeatedly
C)Right pedal pulse weaker than left
D)Wants to be held by a parent

Accepted Answer

Pedal pulses should be equal (or unchanged)after a cardiac catheterization.If a pedal pulse on the insertion side is weaker,arterial flow to the extremity may have been disrupted,and this should be reported.Pain is expected and is treated with acetaminophen.A 3-year-old would be expected to want to get up and not lie still and might want to be held.Sedation might be required to maintain bedrest with the affected leg kept straight.

Question 5

A child is prescribed warfarin (Coumadin).Which laboratory values does the nurse monitor? (Select all that apply.)
A)Electrolytes
B)Hematocrit (Hct)
C)International normalized ratio (INR)
D)Partial thromboplastin time (PTT)
E)Prothrombin time (PT)

Accepted Answer

Coumadin is monitored using the PT and INR.Electrolytes and hematocrit are important laboratory values but are not specific for this drug.The PTT is used to monitor heparin therapy.

Question 6

The pediatric intensive care nurse assesses for the main complications following cardiac transplantation.Which complications is the nurse assessing for after cardiac transplantation? (Select all that apply.)
A)Coronary artery disease
B)Infection
C)Post-transplant lymphoproliferative disorder
D)Rejection
E)Renal failure

Accepted Answer

Coronary artery disease,infection,post-transplant lymphoproliferative disorder,and rejection are the main complications after cardiac transplantation.Renal failure may occur,but is not one of the major complications.

Question 7

The pediatric nurse explains to the student that which valves are known as semilunar valves? (Select all that apply.)
A)Aortic
B)Bicuspid
C)Mitral
D)Pulmonary
E)Tricuspid

Accepted Answer

The aortic and pulmonary valves are known as semilunar valves because each of their cusps looks like a half-moon.The mitral and tricuspid valves are atrioventricular valves.A bicuspid valve simply has two cusps.

Question 8

A nursing faculty member is explaining the three different types of cardiomyopathy (CMP)to students.Which information does the faculty member include in this discussion? (Select all that apply.)
A)Dilated CMP is often caused by infection.
B)Dilated CMP is the least common form.
C)Hypertrophic CMP is usually familial.
D)Hypertrophic CMP involves poor filling.
E)Restrictive CMP is the most common type.

Accepted Answer

Dilated CMP is caused by toxic agents,often from infections,chemotherapy,immunological defects,or nutritional disorders.It is the most common form of CMP.Hypertrophic CMP is usually a familial disorder and involves a hyperdynamic ventricle that fills poorly because of thickening.Restrictive CMP is the least common type of CMP.

Question 9

The student studying pediatric cardiac disorders learns that which anomalies comprise the disorder tetralogy of Fallot? (Select all that apply.)
A)An overriding aorta
B)Atrial septal defect (ASD)
C)Hypertrophic right ventricle
D)Pulmonary stenosis or atresia
E)Ventricular septal defect (VSD)

Accepted Answer

The four defects seen in tetralogy of Fallot are VSD,an overriding aorta,pulmonary stenosis or atresia,and hypertrophic right ventricle.An ASD is not part of the condition.

Question 10

An infant has critical aortic stenosis.The physician orders several medications for the infant.Which prescribed medications would the nurse question for this infant? (Select all that apply.)
A)Bumetanide (Bumex)
B)Diltiazem (Cardizem)
C)Enoxaparin (Lovenox)
D)Epinephrine (Adrenalin)
E)Furosemide (Lasix)

Accepted Answer

In cases of critical aortic stenosis,medications include preload- and afterload-reducing agents,including bumetanine,diltiazem,and furosemide.Enoxaparin is a low-molecular-weight heparin.Epinephrine will raise heart rate and blood pressure and would cause this child's condition to worsen.

Question 11

A nurse is monitoring a child after an interventional catheterization for PDA.Before the procedure,blood pressure was 98/42 mm Hg.After the procedure,blood pressure was 98/74 mm Hg.One hour later,the blood pressure is 96/34 mm Hg.What action by the nurse is best?
A)Administer epinephrine (Adrenalin).
B)Contact the provider.
C)Document the findings.
D)Give a rapid fluid bolus.

Accepted Answer

After an interventional PDA repair,the child's pulse pressure should be normal (<40 mm Hg).Children with PDA usually have widened pulse pressure,which is normalized with correction.If the pulse pressure widens again the provider should be notified,as this may signal device embolization or dislodgement.

Question 12

The faculty is discussing cardiac output with a student.Which components comprise the cardiac output? (Select all that apply.)
A)Afterload
B)Contractility
C)Heart rate
D)Hemoglobin
E)Stroke volume

Accepted Answer

Cardiac output is the product of stroke volume and heart rate (CO = SV ´ HR).Afterload and contractility are components of stroke volume.Hemoglobin is not related to cardiac output but does impact tissue oxygenation.

Question 13

A pediatric nurse palpates a 2-year-old child's liver at 4 cm below the right costal margin.Which actions by the nurse are appropriate? (Select all that apply.)
A)Assess work of breathing.
B)Auscultate lung sounds.
C)Calculate child's intake and output.
D)Determine last bowel movement.
E)Listen for heart murmur.

Accepted Answer

An enlarged liver in a child can be indicative of heart failure or fluid overload from congenital heart defects.Assessing for respiratory distress,listening to heart and lung sounds,and calculating I&O will all give information related to cardiac function.Bowel movements are not related.

Question 14

The student is learning about atrioventricular canal defects (AVCs).Which information stated by the student reflects appropriate understanding of the disease process? (Select all that apply.)
A)Cyanosis is the cardinal manifestation.
B)It often occurs in children with Down syndrome.
C)Prostaglandin is administered preoperatively.
D)The tricuspid and mitral valves form one opening.
E)It will usually close on its own without surgery.

Accepted Answer

An AVC is formed during fetal endocardial development.The tricuspid and mitral valves come together and form one large opening,through which blood is mixed.Because the shunt is left to right,there is no cyanosis.This disorder is often seen in children with Down syndrome and must be repaired surgically for the child to live a normal life.Prostaglandin is used to maintain a patent ductus arteriosus,not for AVCs.

Question 15

A nurse is teaching a group of parents about bacterial endocarditis (BE)and follow-up care.Which parents should be instructed to obtain prophylactic antibiotics prior to dental cleaning? (Select all that apply.)
A)Child after complete repair via catheter for 1 year
B)Child after transplant,no residual defect,for 6 months
C)Child with congenital repair with residual defect,for life
D)Child with one prior episode of bacterial endocarditis
E)Child with prosthetic mitral valve for the first 6 months

Accepted Answer

Guidelines for who needs prophylaxis prior to invasive procedures were updated in 2007.They include children post-cardiac transplantation who do not have residual valve problems for 6 months post-transplant,any child with a residual defect after a surgical repair for the remainder of his or her life,and children who have already had one (or more)episode of BE.Prophylaxis after complete repairs is for 6 months.Prophylaxis after valve replacement is lifelong.

Question 16

An infant has been diagnosed with pulmonic stenosis.Which manifestations does the nurse document as normal findings for this condition? (Select all that apply.)
A)Cough
B)Dyspnea
C)Enlarged liver
D)Puffy eyelids
E)Retractions

Accepted Answer

Right-sided heart failure occurs with pulmonic stenosis.Manifestations include hepatomegaly (enlarged liver)and puffy eyelids.Cough and dyspnea are more likely due to left-sided heart failure.Retractions can occur with respiratory distress despite the cause.

Question 17

A child has a large ventricular septal defect (VSD)with left-to-right shunting.Which information about VSDs does the faculty member explain to the nursing student? (Select all that apply.)
A)The child will have obvious cyanosis.
B)A harsh,pansystolic murmur is heard.
C)This is the most common congenital heart defect.
D)Some VSDs can close spontaneously.
E)Transcatheter closure is common.

Accepted Answer

A VSD is the most common congenital heart defect and is one of the mildest forms.The murmur of a VSD is harsh,pansystolic,and heard best at the lower left sternal border.Some VSDs can close spontaneously;those that need invasive closure must be surgically repaired.Presently,transcatheter closure is not available.

Question 18

A child is suspected of having neurally mediated syncope.Which diagnostic test does the nurse prepare the child for?
A)Cerebral angiogram
B)Coronary angiogram
C)Echocardiogram
D)Tilt table test

Accepted Answer

The tilt table test is specific for neurally mediated syncope.

Quiz 26: Caring for the Child With a Cardiovascular Condition

A nurse is concerned that a child with pulmonary hypertension (PA) is developing heart failure.Which manifestation would the nurse assess for first?

A child is being discharged after a pacemaker insertion.Which teaching point by the nurse takes priority?

A 12-year-old child has been diagnosed with long QT syndrome.Which teaching by the nurse is most important?

A 3-year-old child is 4 hours post-cardiac catheterization via the right femoral artery.Which assessment finding should the nurse report to the provider?

A child is prescribed warfarin (Coumadin) .Which laboratory values does the nurse monitor? (Select all that apply.)

The pediatric intensive care nurse assesses for the main complications following cardiac transplantation.Which complications is the nurse assessing for after cardiac transplantation? (Select all that apply.)

The pediatric nurse explains to the student that which valves are known as semilunar valves? (Select all that apply.)

A nursing faculty member is explaining the three different types of cardiomyopathy (CMP) to students.Which information does the faculty member include in this discussion? (Select all that apply.)

The student studying pediatric cardiac disorders learns that which anomalies comprise the disorder tetralogy of Fallot? (Select all that apply.)

An infant has critical aortic stenosis.The physician orders several medications for the infant.Which prescribed medications would the nurse question for this infant? (Select all that apply.)

A nurse is monitoring a child after an interventional catheterization for PDA.Before the procedure,blood pressure was 98/42 mm Hg.After the procedure,blood pressure was 98/74 mm Hg.One hour later,the blood pressure is 96/34 mm Hg.What action by the nurse is best?

The faculty is discussing cardiac output with a student.Which components comprise the cardiac output? (Select all that apply.)

A pediatric nurse palpates a 2-year-old child's liver at 4 cm below the right costal margin.Which actions by the nurse are appropriate? (Select all that apply.)

The student is learning about atrioventricular canal defects (AVCs) .Which information stated by the student reflects appropriate understanding of the disease process? (Select all that apply.)

A nurse is teaching a group of parents about bacterial endocarditis (BE) and follow-up care.Which parents should be instructed to obtain prophylactic antibiotics prior to dental cleaning? (Select all that apply.)

An infant has been diagnosed with pulmonic stenosis.Which manifestations does the nurse document as normal findings for this condition? (Select all that apply.)

A child has a large ventricular septal defect (VSD) with left-to-right shunting.Which information about VSDs does the faculty member explain to the nursing student? (Select all that apply.)

A child is suspected of having neurally mediated syncope.Which diagnostic test does the nurse prepare the child for?