Question 1

A complication that may occur after a cardiac catheterization is:
A)Cardiac arrhythmia.
B)Hypostatic pneumonia.
C)Congestive heart failure.
D)Rapidly increasing blood pressure.

Accepted Answer

Because a catheter is introduced into the heart,a risk exists of catheter-induced arrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia,congestive heart failure,and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

Question 2

Seventy-two hours after cardiac surgery,a young child has a temperature of 37.7° C (101° F). The nurse should:
A)Keep the child warm with blankets.
B)Apply a hypothermia blanket.
C)Record the temperature on nurses' notes.
D)Report findings to physician.

Accepted Answer

In the first 24 to 48 hours after surgery the body temperature may increase to 37.7° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or continues after this period,it is most likely a sign of an infection and immediate investigation is indicated. Blankets should be removed from the child to keep the temperature from increasing. A hypothermia blanket is not indicated for this level of temperature. The temperature should be recorded,but the physician must be notified for evaluation.

Question 3

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?
A)Pulmonary congestion
B)Congenital heart defect
C)Congestive heart failure
D)Systemic venous congestion

Accepted Answer

The definition of congestive heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body. Pulmonary congestion is an excessive accumulation of fluid in the lungs. Congenital heart defect is a malformation of the heart present at birth. Systemic venous congestion is an excessive accumulation of fluid in the systemic vasculature.

Question 4

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on knowing that:
A)The child needs opportunities to play with peers.
B)The child needs to understand that peers' activities are too strenuous.
C)Parents can meet all the child's needs.
D)Constant parental supervision is needed to avoid overexertion.

Accepted Answer

The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace and regulate their activities. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child,especially before kindergarten. The child needs to have activities that foster independence.

Question 5

Which defect results in increased pulmonary blood flow?
A)Pulmonic stenosis
B)Tricuspid atresia
C)Atrial septal defect
D)Transposition of the great arteries

Accepted Answer

The atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. Pulmonic stenosis is an obstruction to blood flowing from the ventricles. Tricuspid atresia results in decreased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

Question 6

The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on knowing that:
A)It is a safe,frequently used drug.
B)It is difficult to either overmedicate or undermedicate with digoxin.
C)Parents lack the expertise necessary to administer digoxin.
D)Parents must learn specific,important guidelines for administration of digoxin.

Accepted Answer

Digoxin has a narrow therapeutic range. The margin of safety between therapeutic,toxic,and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and monitor for side effects. Digoxin is a frequently used drug,but it has a narrow therapeutic range. Very small amounts of the liquid are given to infants,which makes it easy to overmedicate or undermedicate. Parents may lack the necessary expertise to administer the drug at first,but with discharge preparation they should be prepared to administer the drug safely.

Question 7

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:
A)Notify the physician.
B)Apply a new bandage with more pressure.
C)Place in the Trendelenburg position.
D)Apply direct pressure above the catheterization site.

Accepted Answer

If bleeding occurs,direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying the physician and applying a new bandage with more pressure can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. The Trendelenburg position would not be helpful;it would increase the drainage from the lower extremities.

Question 8

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:
A)Directed at his parents because he is too young to understand.
B)Detailed in regard to the actual procedures so he will know what to expect.
C)Done several days before the procedure so that he will be prepared.
D)Adapted to his level of development so that he can understand.

Accepted Answer

Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions,which should be answered,but the child needs to receive the information based on developmental level. This age group does not understand in-depth descriptions. Preschoolers should be prepared close to the time of the cardiac catheterization.

Question 9

A chest x-ray film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse,"What will the radiograph show about the heart?" The nurse's response should be based on knowledge that the x-ray film will:
A)Show bones of the chest but not the heart.
B)Measure electrical potential generated from heart muscle.
C)Provide a permanent record of heart size and configuration.
D)Provide a computerized image of heart vessels and tissues.

Accepted Answer

A chest x-ray film provides information on the heart size and pulmonary blood-flow patterns. It provides a baseline for future comparisons. The heart,sternum,and ribs will be visible. Electrocardiography measures the electrical potential generated from heart muscle. Echocardiography produces a computerized image of the heart vessels and tissues by using sound waves.

Question 10

Which structural defects constitute tetralogy of Fallot?
A)Pulmonic stenosis,ventricular septal defect,overriding aorta,right ventricular hypertrophy
B)Aortic stenosis,ventricular septal defect,overriding aorta,right ventricular hypertrophy
C)Aortic stenosis,atrial septal defect,overriding aorta,left ventricular hypertrophy
D)Pulmonic stenosis,ventricular septal defect,aortic hypertrophy,left ventricular hypertrophy

Accepted Answer

Tetralogy of Fallot has these four characteristics: pulmonary stenosis,ventricular septal defect,overriding aorta,and right ventricular hypertrophy. There is pulmonary stenosis but not atrial stenosis in tetralogy of Fallot. Right ventricular hypertrophy,not left ventricular hypertrophy,is present in tetralogy of Fallot,and an atrial septal defect,not aortic hypertrophy,is present.

Question 11

A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is:
A)Tachypnea.
B)Tachycardia.
C)Peripheral edema.
D)Pale,cool extremities.

Accepted Answer

Peripheral edema,especially periorbital edema,is a clinical manifestation of systemic venous congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale,cool extremities are clinical manifestations of impaired myocardial function.

Question 12

An important nursing consideration when suctioning a young child who has had heart surgery is to:
A)Perform suctioning at least every hour.
B)Suction for no longer than 30 seconds at a time.
C)Administer supplemental oxygen before and after suctioning.
D)Expect symptoms of respiratory distress when suctioning.

Accepted Answer

If suctioning is indicated,supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated,not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are to be avoided by using the appropriate technique.

Question 13

As part of the treatment for congestive heart failure,the child takes the diuretic furosemide. As part of teaching home care,the nurse encourages the family to give the child foods such as bananas,oranges,and leafy vegetables. These foods are recommended because they are high in:
A)Chlorides.
B)Potassium.
C)Sodium.
D)Vitamins.

Accepted Answer

Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with potassium.

Question 14

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to:
A)Assess for neurologic defects.
B)Place the child in the knee-chest position.
C)Begin cardiopulmonary resuscitation.
D)Prepare the family for imminent death.

Accepted Answer

The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. The child should be assessed for airway,breathing,and circulation. Often calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

Question 15

A beneficial effect of administering digoxin (Lanoxin) is that it:
A)Decreases edema.
B)Decreases cardiac output.
C)Increases heart size.
D)Increases venous pressure.

Accepted Answer

Digoxin has a rapid onset and is useful in increasing cardiac output,decreasing venous pressure,and as a result decreasing edema. Cardiac output is increased by digoxin. Heart size is decreased by digoxin. Digoxin decreases venous pressure.

Question 16

A common sign of digoxin toxicity is:
A)Seizures.
B)Vomiting.
C)Bradypnea.
D)Tachycardia.

Accepted Answer

Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower heart rate,not respiratory rate.

Question 17

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents (strokes) exists. An important objective to decrease this risk is to:
A)Minimize seizures.
B)Prevent dehydration.
C)Promote cardiac output.
D)Reduce energy expenditure.

Accepted Answer

In children with persistent hypoxia polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures,promoting cardiac output,and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

Question 18

When preparing a school-age child and the family for heart surgery,the nurse should consider:
A)Not showing unfamiliar equipment.
B)Letting child hear the sounds of an electrocardiograph monitor.
C)Avoiding mentioning postoperative discomfort and interventions.
D)Explaining that an endotracheal tube will not be needed if the surgery goes well.

Accepted Answer

The child and family should be exposed to the sights and sounds of the intensive care unit. All positive,nonfrightening aspects of the environment are emphasized. The child should be shown unfamiliar equipment,and its use should be demonstrated on a doll. Carefully prepare the child for the postoperative experience,including intravenous (IV) lines,incision,and endotracheal tube.

Question 19

The nurse is caring for a child after heart surgery. What should he or she do if evidence is found of cardiac tamponade?
A)Increase analgesia.
B)Apply warming blankets.
C)Immediately report this to the physician.
D)Encourage the child to cough,turn,and breathe deeply.

Accepted Answer

If evidence is noted of cardiac tamponade,blood or fluid in the pericardial space constricting the heart,the physician is notified immediately of this life-threatening complication. Increasing analgesia may be done before the physician drains the fluid,but the physician must be notified. Warming blankets are not indicated at this time. Encouraging the child to cough,turn,and breathe deeply should be deferred until after the evaluation by the physician.

Question 20

Which drug is an angiotensin-converting enzyme (ACE) inhibitor?
A)Captopril (Capoten)
B)Furosemide (Lasix)
C)Spironolactone (Aldactone)
D)Chlorothiazide (Diuril)

Accepted Answer

Capoten is a drug in an ACE inhibitor. Lasix is a loop diuretic. Aldactone blocks the action of aldosterone. Diuril works on the distal tubules.

Quiz 48: Cardiovascular Dysfunction

A complication that may occur after a cardiac catheterization is:

Seventy-two hours after cardiac surgery,a young child has a temperature of 37.7° C (101° F) . The nurse should:

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on knowing that:

Which defect results in increased pulmonary blood flow?

The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on knowing that:

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:

A chest x-ray film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse,"What will the radiograph show about the heart?" The nurse's response should be based on knowledge that the x-ray film will:

Which structural defects constitute tetralogy of Fallot?

A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is:

An important nursing consideration when suctioning a young child who has had heart surgery is to:

As part of the treatment for congestive heart failure,the child takes the diuretic furosemide. As part of teaching home care,the nurse encourages the family to give the child foods such as bananas,oranges,and leafy vegetables. These foods are recommended because they are high in:

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to:

A beneficial effect of administering digoxin (Lanoxin) is that it:

A common sign of digoxin toxicity is:

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents (strokes) exists. An important objective to decrease this risk is to:

When preparing a school-age child and the family for heart surgery,the nurse should consider:

The nurse is caring for a child after heart surgery. What should he or she do if evidence is found of cardiac tamponade?

Which drug is an angiotensin-converting enzyme (ACE) inhibitor?