Question 1

A diagnosis of rheumatic fever is being ruled out for a child. The parents cannot remember the child having a recent streptococcal infection. Which lab test would confirm a recent streptococcal infection?
A)Erythrocyte sedimentation rate
B)Throat culture
C)C-reactive protein
D)Antistreptolysin-O (ASO) titer

Accepted Answer

The Antistreptolysin-O (ASO) titer is a blood test used to detect previous infection with Group A Streptococcus, the bacteria responsible for diseases such as strep throat and rheumatic fever. It measures antibodies against streptolysin O, a toxin produced by these bacteria. This test is useful in diagnosing rheumatic fever, especially when a recent streptococcal infection is suspected but not confirmed by history or other laboratory tests.

Question 2

The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities and higher blood pressure readings in the arms than in the legs. This could be indicative of what heart defect?
A)Transposition of the great vessels
B)Patent ductus arteriosus
C)Coarctation of the aorta
D)Atrial septal defect

Accepted Answer

These symptoms are typical of coarctation of the aorta, which is a narrowing of the aorta that restricts blood flow to the lower extremities. This results in stronger pulses and higher blood pressure readings in the upper extremities. The other options do not typically present with these symptoms.

Question 3

A toddler has been started on digoxin (Lanoxin) for cardiac failure. The nurse will teach the parents to monitor the child for signs of digoxin (Lanoxin) toxicity including:
A)Bradycardia.
B)Tinnitus.
C)Ataxia.
D)Lowered blood pressure.

Accepted Answer

Bradycardia is a common sign of digoxin toxicity, especially in children. Digoxin affects the heart directly, and one of its effects when in toxic levels is to slow the heart rate excessively.

Question 4

An infant has been diagnosed with a mild heart defect. Surgery to correct the defect will not be performed for at least two years. The nurse teaches the parents that a child with a mild heart defect should:
A)Have a low-grade fever until the defect is repaired.
B)Maintain normal activity.
C)Not develop congestive heart failure.
D)Not be given antipyretics.

Accepted Answer

A child with a mild heart defect can engage in regular activities as long as the physician has given permission. There is no need to restrict activity or avoid sports. Congestive heart failure and fever are not necessarily associated with mild heart defects, and avoiding antipyretics is not necessary unless there is a specific reason to do so.

Question 5

The nurse is explaining fetal circulation to a woman pregnant with a fetus with a congenital heart defect. The nurse explains that there are three fetal structures and explains that blood flow from the umbilical vein flows through the three fetal structures in the following order: Standard Text: Click and drag the options below to move them up or down. 
A)Ductus arteriosus 
B)Ductus venosus 
C)Foramen ovale

Accepted Answer

Blood flow from the umbilical vein first flows through the ductus venosus, then through the foramen ovale, and finally through the ductus arteriosus before entering the systemic circulation. This is important to understand in the case of a congenital heart defect, as the abnormality may affect one of these structures and impact fetal circulation.

Question 6

A two-month-old infant with a congenital heart defect has been admitted to the pediatric intensive care unit with congestive heart failure. Nursing care for this child should include which intervention?
A)Monitor respirations during active periods.
B)Give larger feedings less often to conserve energy.
C)Organize activities to allow for uninterrupted sleep.
D)Force fluids appropriate for age.

Accepted Answer

The answer of A two-month-old infant with a congenital heart...

Question 7

The nurse is checking peripheral perfusion to a child's extremity following a cardiac catheterization. If there is adequate peripheral circulation, the nurse would find that the extremity:
A)Has a capillary refill of greater than three seconds.
B)Is warm, with a capillary refill of less than three seconds.
C)Has decreased sensation with a weakened dorsalis pedis pulse.
D)Has a palpable dorsalis pedis pulse but a weak posterior tibial pulse.

Accepted Answer

Adequate peripheral circulation would be indicated by a warm extremity with a capillary refill of less than three seconds. The other choices describe signs of poor peripheral circulation.

Question 8

A four-year-old child is being emotionally prepared for open heart surgery. The nurse will want to provide the child with which information?
A)Who will be performing the surgery
B)What the surgical procedure will entail
C)The purpose of the heart-lung machine
D)What the ICU will look and sound like when the child wakes up

Accepted Answer

For a four-year-old child, understanding what their immediate environment will look and sound like when they wake up from surgery is crucial for emotional preparation. This helps reduce fear and anxiety by making the unfamiliar setting of the ICU more predictable. Detailed explanations about the surgery, its purpose, or the heart-lung machine are likely beyond the comprehension level of a child this age and may not be as effective in providing emotional comfort.

Question 9

Following an injury that led to hypovolemic shock, a child is being treated in the emergency department. Which treatment measures would be given the highest priority for this child with hypovolemic shock?
A)Assess the cause of bleeding.
B)Establish an open airway and administer oxygen.
C)Administer analgesics for control of pain.
D)Provide replacement of volume.

Accepted Answer

The answer of Following an injury that led to hypovolemic...

Question 10

A child diagnosed with congestive heart failure is started on digoxin (Lanoxin) and spironolactone (Aldactone). The mother questions why the child was placed on spironolactone (Aldactone) instead of furosemide (Lasix), which her elderly grandmother uses. The nurse explains that spironolactone (Aldactone) is a diuretic that:
A)Produces rapid diuresis.
B)Blocks reabsorption of sodium and water in renal tubules.
C)Spares potassium.
D)Promotes vascular relaxation.

Accepted Answer

Spironolactone (Aldactone) is a potassium-sparing diuretic, meaning it promotes diuresis without causing excessive loss of potassium. This can be important in the treatment of congestive heart failure, where electrolyte imbalances can worsen the condition. Furosemide (Lasix), on the other hand, is a loop diuretic that promotes rapid diuresis but can also cause significant potassium loss. Therefore, spironolactone may be a better option for this particular patient.

Question 11

A child has had a heart transplant. In preparation for discharge, the nurse provides teaching about home medications. The nurse recognizes that postoperative teaching has been successful when the parents state that the child is on cyclosporin A to:
A)Treat hypertension.
B)Reduce serum cholesterol level.
C)Prevent rejection.
D)Treat infections.

Accepted Answer

Cyclosporin A is an immunosuppressive agent used to prevent rejection after organ transplantation. It works by suppressing the immune system's response to the transplanted organ. It is not used to treat hypertension, reduce serum cholesterol levels, or treat infections.

Question 12

The nurse is teaching the parents of a group of cardiac patients. The nurse includes in the information that any child who has undergone cardiac surgery:
A)Should not receive routine immunizations.
B)Should be restricted from most play activities.
C)Can be expected to have a fever for several weeks following the surgery.
D)Should receive prophylactic antibiotics for any dental, oral, or upper respiratory tract procedures.

Accepted Answer

Children who have undergone cardiac surgery are at increased risk for developing bacterial infections, so they should receive prophylactic antibiotics for any dental, oral or upper respiratory tract procedures. Routine immunizations are still necessary, and play activities should be encouraged within the limitations set by the healthcare team. A fever for several weeks following surgery is not typical and should be reported to the healthcare team.

Question 13

A term infant is found to have a congenital heart defect. During a cardiac catheterization, a stent is inserted to maintain the ductus arteriosus. The parents ask the nurse to explain the purpose of this procedure. The nurse's response would include the information that the stent:
A)Will keep the ductus arteriosus open and oxygenated and unoxygenated blood mixed.
B)Is used to close the ductus arteriosus to prevent mixing of arterial and venous blood.
C)Will redirect the blood so that blood bypasses the right ventricle.
D)Connects the ventricle to the atrium.

Accepted Answer

The stent is being used to keep the ductus arteriosus open, allowing oxygenated and unoxygenated blood to mix. This is necessary in certain congenital heart defects, as the mixing of blood can improve oxygenation throughout the body.

Question 14

A 10-month-old infant is seen in the emergency department for a heart rate of 226 beats per minute. Supraventricular tachycardia is diagnosed. The emergency department nurse will prepare to assist with which possible treatments? Standard Text: Select all that apply.
A)Administration of intravenous adenosine (Adenocard)
B)Administration of intravenous amiodarone (Cardarone)
C)Preparation for cardioversion
D)Application of ice to the face
E)Having the child perform a Valsalva maneuver

Accepted Answer

Adenosine is a first-line treatment for supraventricular tachycardia (SVT) due to its ability to temporarily block the AV node and reset the heart rhythm. Amiodarone is used for various types of tachyarrhythmias, including SVT, when other treatments are ineffective or contraindicated. Cardioversion is a procedure that can be used in emergency situations to restore a normal heart rhythm when medication is not effective. Applying ice to the face can stimulate the vagus nerve, which can help slow down the heart rate in SVT. The Valsalva maneuver is generally not recommended for infants due to their inability to perform it.

Question 15

An infant with a congenital heart defect is being discharged home until the infant reaches an appropriate weight for the corrective surgery. The nurse would teach the parents infant feeding techniques including: Standard Text: Select all that apply.
A)Breastfeed if possible.
B)Complete each feeding within 30 minutes.
C)Position the infant flat to promote swallowing.
D)Dilute the formula with extra water to ensure adequate fluid intake.
E)Burp the infant frequently.

Accepted Answer

Breastfeeding is encouraged for its nutritional benefits and bonding. Completing feedings within 30 minutes prevents the infant from expending too much energy, which is crucial for those with heart defects. Frequent burping helps prevent air from accumulating in the stomach, which can cause discomfort and interfere with effective feeding. Positioning the infant flat is incorrect because it can increase the risk of aspiration; infants should be fed in a more upright position. Diluting formula is also incorrect as it can lead to inadequate nutritional intake and potentially dangerous electrolyte imbalances.

Question 16

A child has been admitted to the hospital unit in congestive heart failure (CHF). Symptoms related to this admission diagnosis would include:
A)Tachycardia.
B)Weight loss.
C)Increased blood pressure.
D)Bradycardia.

Accepted Answer

Congestive heart failure can cause the heart to beat faster in order to compensate for the decreased cardiac output. This results in tachycardia. Weight loss is not typically a symptom of CHF, as patients with this condition often experience fluid retention and weight gain. Increased blood pressure may be present in some cases, but it is not a defining symptom of CHF. Bradycardia is also not typically seen in CHF, as the heart is often trying to compensate for decreased cardiac output by increasing the heart rate.

Question 17

The nurse has admitted a child with a cyanotic heart defect. Which initial lab result will the nurse anticipate?
A)A low platelet count
B)A high white blood cell count
C)A high hemoglobin
D)A low hematocrit

Accepted Answer

Cyanotic heart defects cause decreased oxygenation, leading to compensatory polycythemia as the body attempts to increase oxygen delivery to tissues, resulting in high hemoglobin levels.

Question 18

Which athletic activity could the nurse recommend for a school-age child with pulmonary-artery hypertension?
A)Golf
B)Basketball
C)Cross-country running
D)Soccer

Accepted Answer

Golf is a low-intensity, non-contact sport that can be enjoyed at a slower pace. It is less likely to cause excessive strain on the cardiovascular system and could be a suitable option for a child with pulmonary-artery hypertension. Basketball, cross-country running, and soccer are all high-intensity sports that involve running and jumping, which may be too strenuous for a child with this condition.

Question 19

The nurse has admitted a child with a ventricular septal defect (VSD) to the unit. Which nursing diagnosis is appropriate for this child?
A)Hypothermia related to decreased metabolic state
B)Acute pain related to the effects of a congenital heart defect
C)Ineffective tissue perfusion (peripheral) related to cyanosis secondary to congenital heart defect
D)Impaired gas exchange related to pulmonary congestion secondary to the increased pulmonary blood flow

Accepted Answer

Impaired gas exchange related to pulmonary congestion secondary to the increased pulmonary blood flow is the most appropriate nursing diagnosis for a child with a ventricular septal defect since this defect leads to an increased amount of blood flowing through the lungs, causing pulmonary congestion and impaired gas exchange.

Question 20

An infant with tetralogy of Fallot (TOF) is having a hypercyanotic episode ("tet" spell). Which nursing interventions should the nurse implement? Standard Text: Select all that apply.
A)Administer oxygen.
B)Place the child in knee-chest position.
C)Administer morphine and propranolol intravenously as ordered.
D)Draw blood for a serum hemoglobin.
E)Administer Benadryl as ordered.

Accepted Answer

During a hypercyanotic episode, the infant may become cyanotic, agitated, and have a decreased level of consciousness. The knee-chest position can increase systemic vascular resistance and decrease right-to-left shunting, helping to alleviate cyanosis. Administering oxygen can help to increase oxygenation and relieve hypoxemia. Administering morphine can help to reduce systemic vascular resistance and anxiety, while propranolol can help to reduce heart rate and contractility. Drawing blood for a serum hemoglobin or administering Benadryl are not typically indicated in the management of a hypercyanotic episode in an infant with TOF.

Quiz 26: Alterations in Cardiovascular Function

A diagnosis of rheumatic fever is being ruled out for a child. The parents cannot remember the child having a recent streptococcal infection. Which lab test would confirm a recent streptococcal infection?

The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities and higher blood pressure readings in the arms than in the legs. This could be indicative of what heart defect?

A toddler has been started on digoxin (Lanoxin) for cardiac failure. The nurse will teach the parents to monitor the child for signs of digoxin (Lanoxin) toxicity including:

An infant has been diagnosed with a mild heart defect. Surgery to correct the defect will not be performed for at least two years. The nurse teaches the parents that a child with a mild heart defect should:

A two-month-old infant with a congenital heart defect has been admitted to the pediatric intensive care unit with congestive heart failure. Nursing care for this child should include which intervention?

The nurse is checking peripheral perfusion to a child's extremity following a cardiac catheterization. If there is adequate peripheral circulation, the nurse would find that the extremity:

A four-year-old child is being emotionally prepared for open heart surgery. The nurse will want to provide the child with which information?

Following an injury that led to hypovolemic shock, a child is being treated in the emergency department. Which treatment measures would be given the highest priority for this child with hypovolemic shock?

A child has had a heart transplant. In preparation for discharge, the nurse provides teaching about home medications. The nurse recognizes that postoperative teaching has been successful when the parents state that the child is on cyclosporin A to:

The nurse is teaching the parents of a group of cardiac patients. The nurse includes in the information that any child who has undergone cardiac surgery:

A term infant is found to have a congenital heart defect. During a cardiac catheterization, a stent is inserted to maintain the ductus arteriosus. The parents ask the nurse to explain the purpose of this procedure. The nurse's response would include the information that the stent:

A 10-month-old infant is seen in the emergency department for a heart rate of 226 beats per minute. Supraventricular tachycardia is diagnosed. The emergency department nurse will prepare to assist with which possible treatments? Standard Text: Select all that apply.

An infant with a congenital heart defect is being discharged home until the infant reaches an appropriate weight for the corrective surgery. The nurse would teach the parents infant feeding techniques including: Standard Text: Select all that apply.

A child has been admitted to the hospital unit in congestive heart failure (CHF) . Symptoms related to this admission diagnosis would include:

The nurse has admitted a child with a cyanotic heart defect. Which initial lab result will the nurse anticipate?

Which athletic activity could the nurse recommend for a school-age child with pulmonary-artery hypertension?

The nurse has admitted a child with a ventricular septal defect (VSD) to the unit. Which nursing diagnosis is appropriate for this child?

An infant with tetralogy of Fallot (TOF) is having a hypercyanotic episode ("tet" spell) . Which nursing interventions should the nurse implement? Standard Text: Select all that apply.