Question 1

A child has been admitted for suspected bacterial endocarditis.What action takes priority?
A)Administering antibiotics
B)Education on valve replacement
C)Giving an antipyretic
D)Obtaining blood cultures

Accepted Answer

The priority action is to obtain blood cultures,either drawn by the nurse or laboratory.Antibiotics are not started until these are collected.If the child is febrile,an antipyretic is appropriate,but it is not the priority.Education on valve replacement is not warranted until later in the course of the disease if it is needed.

Question 2

A child has been admitted with Kawasaki disease and is started on aspirin and warfarin (Coumadin).For which nursing diagnosis does the nurse plan interventions as the priority?
A)Acute pain related to mouth redness and cracked lips
B)Altered body image related to peeling skin rash
C)Altered nutrition: less than body requirements
D)Risk for bleeding related to medication effects

Accepted Answer

Actual nursing diagnoses take priority over "risk for" diagnoses when the actual diagnoses exist.There is no information in the stem to show that the child has impaired mucous membranes leading to pain,an altered body image related to rash,or altered nutrition,although all of these are possible for this child.Risk for injury is the priority because the child is taking two medications that alter coagulation,and for patient safety,this is a critical diagnosis.

Question 3

The nurse is teaching the parents of a child who had a surgical correction of a congenital heart defect about subacute bacterial endocarditis (SBE).Which recommendation regarding antibiotic administration prior to dental cleanings is the most appropriate?
A)All children with congenital heart defects need SBE prophylaxis.
B)Chronic SBE prophylaxis is recommended for most similar children.
C)Risks for SBE are very high but easily prevented with antibiotics.
D)The provider must weigh the risk-to-benefit ratio for SBE prophylaxis.

Accepted Answer

In 2007 the American Heart Association made major changes to the guidelines for prophylaxis needed for patients who have known cardiac disease.The provider needs to weigh the risk-to-benefit ratio,as prophylaxis will only prevent a few cases of SBE and the risk of antibiotic resistance is high.When used,SBE prophylaxis is usually a one-time dose.The actual risk of SBE from dental procedures is less than that from toothbrushing.

Question 4

The mother of a toddler reports to the nurse that the child becomes cyanotic when he cries.Which question by the nurse is most important to ask the mother?
A)"Does he squat while he cries?"
B)"How long does the cyanosis last?"
C)"Is he growing normally?"
D)"What was his birth weight?"

Accepted Answer

The mother is describing a "tet" spell,which is a hallmark sign of tetralogy of Fallot.A child with this condition becomes cyanotic when playing or crying and draws his or her legs up or squats.By doing this,the child lowers his or her pulmonary vascular resistance and relieves the cyanosis.The other questions are important,but will not give information specific to this condition.

Question 5

A child has been diagnosed with an atrioventricular canal defect (AVC).While awaiting surgical correction,which teaching takes priority?
A)Care of tubes and drains postoperatively
B)Feeding the child frequent,small amounts
C)Monitoring weight gain and urine output
D)Returning for all scheduled appointments

Accepted Answer

Children with uncorrected AVC have shortness of breath,leading to feeding problems.The parents should be taught to feed the child small amounts frequently to limit dyspnea that may accompany feeding.The child will not go home with drains and tubes postoperatively.Monitoring weight gain and urine output is important for all children with cardiac defects.Returning for appointments is important for all children.

Question 6

A child is being released from the hospital after surgical correction of an atrioventricular canal defect (AVC).What referral by the nurse is most appropriate?
A)Down syndrome support group
B)Hospice services team
C)Lions eye bank
D)Transplant team

Accepted Answer

Up to 75% of cases of AVC occur in children with Down syndrome,so this is the most appropriate referral if this is the case for this child.There is no information in the stem of the question to indicate that the child is terminally ill;the Lions eye bank is unrelated to this condition,and the child is probably not a candidate for a heart transplant because these defects can be repaired surgically.

Question 7

A nurse is admitting a child scheduled for a Fontan repair.Which condition does the nurse understand the child to have?
A)Aortic stenosis
B)Patent ductus arteriosus
C)Pulmonary regurgitation
D)Tricuspid atresia

Accepted Answer

A child scheduled for a Fontan repair has tricuspid atresia.

Question 8

A 10-year-old child is being discharged after surgical repair of a total anomalous pulmonary venous return defect (TAPVR).Which referral made by the nurse is most appropriate for this child?
A)Hospice team
B)Occupational therapy
C)School nurse
D)Visiting nurse

Accepted Answer

After a TAPVR repair,most children go on to live full and normal lives.Because this child will return to school,communication with the school nurse is appropriate.Hospice,visiting nurses,and occupational therapy are not warranted.

Question 9

A nurse is assessing a school-age child admitted with new heart murmur,arthritis-type symptoms,erythema marginatum,and fever.When taking the child's history,which question is most likely to provide important information?
A)"Did your child have any vaccinations recently?"
B)"Has your child been exposed to contagious illnesses?"
C)"Has your child had a sore throat in the last 2 to 3 weeks?"
D)"Is there a family history of autoimmune disorders?"

Accepted Answer

This child is displaying manifestations of rheumatic fever,which typically arises after an episode of acute pharyngitis.The nurse should ask about recent sore throats.The other questions are not as likely to provide vital information.

Question 10

At a well-child visit,the nurse notes a 4-year-old child to be in the 95th percentile for weight.Which screening measure is most important for the nurse include in this visit?
A)Body mass index (BMI)
B)Cholesterol panel
C)Congenital heart disease
D)None;child is too young

Accepted Answer

After the age of 2 years,children who meet certain criteria should be screened for hypercholesterolemia-hyperlipidemia.Criteria include a child who is at the 85% percentile or greater for weight.A BMI can be calculated from the height and weight,but does not screen for other diseases.Congenital heart disease is not related to a heavy weight.

Question 11

A nurse is assessing patients for the presence of patent ductus arteriosus (PDA).Which patient should the nurse assess first?
A)1-year old,history of frequent colds
B)4-year old,blood pressure of 102/36 mm Hg
C)Infant with history of poor feeding
D)Toddler with murmur at right sternal border

Accepted Answer

This child has a wide pulse pressure,which is a sign of PDA.The nurse would assess this child first.Frequent colds and poor feeding can be seen in PDA,but they are vague symptoms and could be related to a number of other conditions.The murmur of a PDA is heard best at the left subclavicular margin.

Question 12

A child has truncus arteriosus with hypotension and poor perfusion.Which medication does the nurse prepare to administer?
A)Amiodarone (Cordarone)
B)Clopidogrel (Plavix)
C)Dopamine (Intropin)
D)Isoproterenol (Isuprel)

Accepted Answer

Drugs used in this condition include preload- and afterload-reducing agents and positive inotropes.Dopamine is a positive inotrope.The other drugs would not be appropriate.

Question 13

A 42-lb (19-kg)child is admitted for initial management of cardiomyopathy (CMP).The physician leaves orders for carvedilol (Coreg),15 mg orally twice a day.What action by the nurse is most appropriate?
A)Ask the provider to clarify the dose.
B)Consult pharmacy about the drug choice.
C)Give the medication as ordered.
D)Withhold any antacids in this patient.

Accepted Answer

Coreg is a beta blocker and is used in the treatment of CMP.The safe dose for this drug is 0.07 mg/kg,with a maximal dose of 0.5 mg/kg.The dose of 15 mg is far above the safe dose range.The nurse should consult the provider about the dose.Consulting pharmacy about the appropriateness of this drug is unnecessary.There is no contraindication to antacids.

Question 14

A student nurse records a systolic blood pressure of 106 mm Hg for a 4-year-old child.Which response by the registered nurse is best?
A)Ask the student if this is a normal finding.
B)Have the student repeat the blood pressure.
C)Refer the family to a health-care provider.
D)Tell the student to document the results.

Accepted Answer

This blood pressure is in the 95th percentile for age.For screening purposes,a blood pressure greater than 20 mm Hg above normal for the child's age is considered a red flag for hypertension,and the child should be referred to a health-care provider. The other options are all appropriate but are not as important as referring the child for further workup.

Question 15

The parents of a child with transposition of the great vessels ask the nurse why the child looks blue.Which response by the nurse is the most appropriate?
A)"Her body gets blood that doesn't have much oxygen."
B)"Her lungs are underdeveloped and underperfused."
C)"She is not able to regulate her temperature and is cold."
D)"This is very unusual for this condition,so I'll ask the doctor."

Accepted Answer

In this condition,the aorta arises from the right side of the body,so systemic circulation consists of oxygen-poor blood.The other answers are not appropriate.

Question 16

A child has coarctation of the aorta (CoA).The parents report that the child is hesitant to participate in activities due to aching in his legs.Which information does the nurse provide?
A)"Aching or pain is due to lower blood pressure in the legs."
B)"Encourage activity so that collateral circulation develops."
C)"Maybe he is getting to much blood pressure medication."
D)"Your child needs to rest and limit participation in activities."

Accepted Answer

In CoA,the blood pressure to the lower extremities is less than 10 mm Hg lower than the BP in the upper extremities.Normally,the lower extremity BP should be the same or higher.The lack of perfusion with oxygenated blood leads to pain or aching in the legs.The nurse provides accurate information about the condition.Developing collateral circulation is not a treatment methodology as you would see in peripheral arterial occlusions.The blood pressure is not lower due to medication;it is a manifestation of the condition.The child should participate as he is able and comfortable in order to maximize growth and development.

Question 17

The parents of a child born with severe hypoplastic left heart syndrome ask the nurse about treatment options.Which option is inconsistent with the nurse's knowledge about this condition?
A)"Palliative or end-of-life care is one possibility."
B)"She can be listed for a cardiac transplant."
C)"Surgical correction involves several procedures."
D)"We can give a series of dopamine (Intropin)infusions."

Accepted Answer

Although dopamine is a positive inotrope,serial infusions are not used for this condition.The other statements relay possible treatment decision points for this child.

Question 18

The nurse is assigned to four patients on the pediatric progressive care unit.After receiving shift report,which patient should the nurse see first?
A)Blood pressure of 88/56 mm Hg in 4-year-old child with heart failure
B)Child crying inconsolably after his parents went home
C)Pain 5/10 in a child 2 days after cardiac surgery
D)Temperature 104.6°F (40.3°C)3 days after dental visit

Accepted Answer

This child likely has infective endocarditis or bacterial endocarditis.Any high fever after an invasive procedure or dental cleaning needs to be investigated for this possibility.The blood pressure of 88/56 mm Hg is at about the 50% percentile for a 4-year-old and would be considered adequate.Pain is an expected finding after surgery and needs to be treated,but not as the priority.The crying child could be comforted by a nursing assistant,child-life specialist,social worker,or even a volunteer until the nurse can see the child.

Question 19

A 5-year-old child is being discharged after valve replacement surgery.Which discharge information specific to this child does the nurse provide?
A)"Be sure to keep all follow-up appointments."
B)"Encourage your child to eat a healthy diet."
C)"Monitor the chest incision for redness or heat."
D)"This valve will need replacement in about 5 years."

Accepted Answer

All options are appropriate for any child with a heart condition or after surgery.The option most specific to this child's condition is informing the parents that as the child grows,the valve will need to be replaced about once every 5 years.

Question 20

A student nurse asks the faculty why a child with patent ductus arteriosus (PDA)is taking a nonsteroidal anti-inflammatory drug (NSAID).Which response by the faculty is the most appropriate?
A)Decreases venous stasis,lowering risks of clotting
B)Inhibits prostaglandin,which helps close the PDA
C)Provides long-lasting pain and inflammation control
D)Reduces swelling around the PDA,making surgery easier

Accepted Answer

Prostaglandin helps keep the PDA open,so an NSAID that inhibits prostaglandin synthesis will help close the opening.This is especially beneficial for premature infants.It is not used for venous stasis,pain relief,or swelling.

Quiz 26: Caring for the Child With a Cardiovascular Condition

A child has been admitted for suspected bacterial endocarditis.What action takes priority?

A child has been admitted with Kawasaki disease and is started on aspirin and warfarin (Coumadin) .For which nursing diagnosis does the nurse plan interventions as the priority?

The nurse is teaching the parents of a child who had a surgical correction of a congenital heart defect about subacute bacterial endocarditis (SBE) .Which recommendation regarding antibiotic administration prior to dental cleanings is the most appropriate?

The mother of a toddler reports to the nurse that the child becomes cyanotic when he cries.Which question by the nurse is most important to ask the mother?

A child has been diagnosed with an atrioventricular canal defect (AVC) .While awaiting surgical correction,which teaching takes priority?

A child is being released from the hospital after surgical correction of an atrioventricular canal defect (AVC) .What referral by the nurse is most appropriate?

A nurse is admitting a child scheduled for a Fontan repair.Which condition does the nurse understand the child to have?

A 10-year-old child is being discharged after surgical repair of a total anomalous pulmonary venous return defect (TAPVR) .Which referral made by the nurse is most appropriate for this child?

A nurse is assessing a school-age child admitted with new heart murmur,arthritis-type symptoms,erythema marginatum,and fever.When taking the child's history,which question is most likely to provide important information?

At a well-child visit,the nurse notes a 4-year-old child to be in the 95th percentile for weight.Which screening measure is most important for the nurse include in this visit?

A nurse is assessing patients for the presence of patent ductus arteriosus (PDA) .Which patient should the nurse assess first?

A child has truncus arteriosus with hypotension and poor perfusion.Which medication does the nurse prepare to administer?

A 42-lb (19-kg) child is admitted for initial management of cardiomyopathy (CMP) .The physician leaves orders for carvedilol (Coreg) ,15 mg orally twice a day.What action by the nurse is most appropriate?

A student nurse records a systolic blood pressure of 106 mm Hg for a 4-year-old child.Which response by the registered nurse is best?

The parents of a child with transposition of the great vessels ask the nurse why the child looks blue.Which response by the nurse is the most appropriate?

A child has coarctation of the aorta (CoA) .The parents report that the child is hesitant to participate in activities due to aching in his legs.Which information does the nurse provide?

The parents of a child born with severe hypoplastic left heart syndrome ask the nurse about treatment options.Which option is inconsistent with the nurse's knowledge about this condition?

The nurse is assigned to four patients on the pediatric progressive care unit.After receiving shift report,which patient should the nurse see first?

A 5-year-old child is being discharged after valve replacement surgery.Which discharge information specific to this child does the nurse provide?

A student nurse asks the faculty why a child with patent ductus arteriosus (PDA) is taking a nonsteroidal anti-inflammatory drug (NSAID) .Which response by the faculty is the most appropriate?