Question 1

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:

Accepted Answer

Adequate peripheral circulation would result in a warm extremity with a capillary refill of less than three seconds, indicating good blood flow and oxygenation. Option A is incorrect as a capillary refill greater than three seconds is abnormal and indicates poor circulation. Option C is incorrect as decreased sensation and a weakened pulse would indicate poor circulation. Option D is incorrect as a palpable dorsalis pedis pulse but a weak posterior tibial pulse also indicates poor circulation.

Question 2

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:

Accepted Answer

Children who have undergone cardiac surgery are at an increased risk for developing infective endocarditis, an infection of the inner lining of the heart. Therefore, they should receive prophylactic antibiotics for any dental, oral, or upper respiratory tract procedures in order to reduce the risk of infection. Routine immunizations are not contraindicated and children should be encouraged to engage in appropriate play activities once cleared by their healthcare provider. A fever following surgery may be a sign of infection and should be promptly reported to the healthcare provider.

Question 3

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:

Accepted Answer

Spironolactone (Aldactone) is a potassium-sparing diuretic that blocks the aldosterone receptors in the distal renal tubules, preventing the reabsorption of sodium and water while conserving potassium. This is important for patients with congestive heart failure, who are often at risk for hypokalemia due to the use of other diuretics, such as furosemide (Lasix). While furosemide is also a diuretic that produces rapid diuresis by blocking the reabsorption of sodium and water, it does not spare potassium. Spironolactone can also have additional benefits in patients with congestive heart failure, such as reducing fluid overload and improving cardiac function.

Question 4

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:

Accepted Answer

Cyclosporin A is an immunosuppressant medication used to prevent rejection of transplanted organs, such as the heart in this case. It does not treat hypertension, reduce serum cholesterol level, or treat infections.

Question 5

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?

Accepted Answer

The answer of A 10-month-old infant is seen in the...

Question 6

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?

Accepted Answer

The Antistreptolysin-O (ASO) titer is a blood test used to detect previous infection by 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 makes it a useful test for confirming a recent streptococcal infection, especially when trying to diagnose conditions like rheumatic fever that may follow such infections.

Question 7

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?

Accepted Answer

Organizing activities to allow for uninterrupted sleep helps conserve the infant's energy, which is crucial in managing congestive heart failure.

Question 8

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

Accepted Answer

Tachycardia (an abnormally fast heart rate) is a common symptom of congestive heart failure in children. Weight loss is not typically a symptom of CHF in children, and in fact, they may experience weight gain due to fluid retention. Increased blood pressure may also occur, but it is not a primary symptom of CHF. Bradycardia (an abnormally slow heart rate) is not a typical symptom of CHF in children.

Question 9

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:

Accepted Answer

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

Question 10

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:

Accepted Answer

A child with a mild heart defect can maintain normal activity and should not be restricted unless otherwise advised by the healthcare provider. It is important to monitor for signs of congestive heart failure and report any concerning symptoms to the healthcare provider. Antipyretics can be given if the child has a fever, but should be used according to healthcare provider's orders.

Question 11

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:

Accepted Answer

The stent is inserted to keep the ductus arteriosus open, which allows oxygenated and unoxygenated blood to mix and maintain adequate oxygenation of the body before surgery or intervention can be done to correct the congenital heart defect.

Question 12

Following an automobile accident, an eight-year-old child is admitted to the emergency department with injuries that lead to hemorrhaging. The nurse would recognize the early signs of hypovolemic shock would include:

Accepted Answer

The answer of Following an automobile accident, an eight-year-old child...

Question 13

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:

Accepted Answer

Infants with congenital heart defects often have difficulty feeding and may tire easily. A) Breastfeeding is encouraged if possible because it is easily digestible and provides optimal nutrition. B) Completing each feeding within 30 minutes helps prevent the infant from expending too much energy on feeding, which is crucial for those with heart defects. E) Burping the infant frequently can help prevent the intake of excess air, which might cause discomfort and further complicate feeding issues. Positioning the infant flat (C) is incorrect because it can increase the risk of aspiration; a semi-upright position is generally recommended. Diluting formula with extra water (D) is incorrect and dangerous, as it can lead to electrolyte imbalances and inadequate nutrition.

Question 14

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

Accepted Answer

For a child with pulmonary-artery hypertension, the best option would be a low-impact activity that does not cause heavy exertion or strain on the heart and lungs. Golf would be a suitable choice as it is a moderate-intensity activity that involves walking and some upper body movement without causing excessive fatigue. Basketball, cross-country running, and soccer involve high-intensity physical activity and may not be well-tolerated by a child with pulmonary-artery hypertension.

Question 15

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

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, the heart-lung machine, or the surgeon's identity (options A, B, C) are less appropriate due to the child's developmental stage and understanding.

Question 16

An infant with tetralogy of Fallot (TOF) is having a hypercyanotic episode ("tet" spell). Which nursing interventions should the nurse implement?

Accepted Answer

Administering oxygen helps increase the oxygen saturation in the blood. Placing the child in a knee-chest position increases systemic vascular resistance, which helps to decrease the right-to-left shunting, thereby improving oxygenation. Administering morphine and propranolol as ordered can help by reducing the child's distress and decreasing heart rate, respectively, which can help manage the hypercyanotic episode.

Question 17

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

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

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?

Accepted Answer

Coarctation of the aorta is a narrowing of the aorta which can cause higher blood pressure in the upper extremities and weaker pulses in the lower extremities. Transposition of the great vessels, patent ductus arteriosus, and atrial septal defect would not necessarily cause this pattern of pulse and blood pressure readings.

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?

Accepted Answer

VSD causes increased pulmonary blood flow leading to pulmonary congestion, which can impede gas exchange. This results in impaired gas exchange, making option D the most appropriate nursing diagnosis. Hypothermia is not a common manifestation of VSD, eliminating option A. Congenital heart defects do not directly cause pain, eliminating option B. While cyanosis may be present, it is not the primary issue related to VSD, making option C an incorrect choice.

Question 20

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?

Accepted Answer

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

Quiz 48: The Child With Alterations in Cardiovascular Function