Chapter 27: The Child with Cardiovascular Dysfunction

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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.
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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.
ANS: D

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. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.
The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for?

A. Cardiac arrhythmia
B. Hypostatic pneumonia
C. Heart failure
D. Rapidly increasing blood pressure
ANS: A

Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.
Which explanation regarding cardiac catheterization is appropriate for a preschool child?

A. Postural drainage will be performed every 4 to 6 hours after the test.
B. It is necessary to be completely "asleep" during the test.
C. The test is short, usually taking less than 1 hour.
D. When the procedure is done, you will have to keep your leg straight for at least 4 hours.
ANS: D
The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.
The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:

A. notify physician.
B. apply new bandage with more pressure.
C. place the child in Trendelenburg position.
D. apply direct pressure above catheterization site.
ANS: D
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 a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.
The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?

A. "I should avoid tub baths but may shower."
B. "I have to stay on strict bed rest for 3 days."
C. "I should remove the pressure dressing the day after the procedure."
D. "I may attend school but should avoid exercise for several days."
ANS: B

The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.
Which 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. Heart failure
D. Systemic venous congestion
C. Heart failure
Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure?

A. Tachypnea
B. Tachycardia
C. Peripheral edema
D. Pale, cool extremities
C. Peripheral edema
The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)?

A. It decreases edema.
B. It decreases cardiac output.
C. It increases heart size.
D. It increases venous pressure.
ANS: A
Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size and venous pressure are decreased by digoxin.
A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse be administering?

A. Captopril (Capoten)
B. Furosemide (Lasix)
C. Spironolactone (Aldactone)
D. Chlorothiazide (Diuril)
A. Captopril (Capoten)
An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min.

A. 60
B. 70
C. 90
D. 100
B. 70
A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min. A. 60 B. 70 C. 90 to 110 D. 110 to 120C. 90 to 110The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity? A. Seizures B. Vomiting C. Bradypnea D. TachycardiaB. VomitingThe parents of a young child with heart failure tell the nurse that they are "nervous" about giving digoxin (Lanoxin). The nurse's response should be based on which statement? 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.D. Parents must learn specific, important guidelines for administration of digoxin.The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? A. "You may need to increase the caloric density of your infant's formula." B. "You should feed your baby every 2 hours." C. "You may need to increase the amount of formula your infant eats with each feeding." D. "You should place a nasal oxygen cannula on your infant during and after each feeding."A. "You may need to increase the caloric density of your infant's formula."As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). 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.B. potassium.The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk? A. Minimize seizures. B. Prevent dehydration. C. Promote cardiac output. D. Reduce energy expenditure.B. Prevent dehydration.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 which statement? A. Child needs opportunities to play with peers. B. Child needs to understand that peers' activities are too strenuous. C. Parents can meet all of the child's needs. D. Constant parental supervision is needed to avoid overexertion.A. Child needs opportunities to play with peers.Which should the nurse consider when preparing a school-age child and the family for heart surgery? A. Unfamiliar equipment should not be shown. B. Let child hear the sounds of an ECG monitor. C. Avoid mentioning postoperative discomfort and interventions. D. Explain that an endotracheal tube will not be needed if the surgery goes well.B. Let child hear the sounds of an ECG monitor.Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. Which action should the nurse take? A. Keep child warm with blankets. B. Apply a hypothermia blanket. C. Record temperature on nurses' notes. D. Report findings to physician.D. Report findings to physician.Which is an important nursing consideration when suctioning a young child who has had heart surgery? 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.C. Administer supplemental oxygen before and after suctioning.The nurse is caring for a child after heart surgery. Which should the nurse do if evidence is found of cardiac tamponade? A. Increase analgesia. B. Apply warming blankets. C. Immediately report this to physician. D. Encourage child to cough, turn, and breathe deeply.C. Immediately report this to physician.Which is an important nursing consideration when chest tubes will be removed from a child? A. Explain that it is not painful. B. Explain that only a Band-Aid will be needed. C. Administer analgesics before procedure. D. Expect bright red drainage for several hours after removal.C. Administer analgesics before procedure.When discussing hyperlipidemia with a group of adolescents, the nurse should explain that cardiovascular disease can be prevented by high levels of: A. cholesterol. B. triglycerides. C. low-density lipoproteins (LDLs). D. high-density lipoproteins (HDLs).D. high-density lipoproteins (HDLs).Which is the leading cause of death after heart transplantation? A. Infection B. Rejection C. Cardiomyopathy D. Heart failureB. RejectionNursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.) A. Allow ambulation as tolerated. B. Monitor vital signs every 2 hours. C. Assess the affected extremity for temperature and color. D. Check pulses above the catheterization site for equality and symmetry. E. Remove pressure dressing after 4 hours. F. Maintain a patent peripheral intravenous catheter until discharge.C. Assess the affected extremity for temperature and color. F. Maintain a patent peripheral intravenous catheter until discharge.Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.) A. Thirst and diminished urinary output B. Irritability and apprehension C. Cool extremities and decreased skin turgor D. Confusion and somnolence E. Normal blood pressure and narrowing pulse pressure F. Tachypnea and poor capillary refill timeC. Cool extremities and decreased skin turgor D. Confusion and somnolence F. Tachypnea and poor capillary refill timeThe nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.) A. Warm flushed extremities B. Weight loss C. Decreased urinary output D. Sweating (inappropriate) E. FatigueC. Decreased urinary output D. Sweating (inappropriate) E. FatigueA beta blocker; blocks a and B-adrenergic receptors, causing decreased heart rate, decreased blood pressure and vasodilation; used selectively in children; improves symptoms and left ventricular functionCarvedilolBlocks action of aldosterone to produce diuresis; allows retention of potassiumspironolactoneActs directly on distal tubules and possibly proximal tubules to decrease sodium, water, potassium, chloride, and bicarbonate absorption; decreases urinary diluting capacity; may need to supplement potassiumChlorothiazideCauses vasodilation that decreases pulmonary and systemic vascular resistance, decreased blood pressure, reduced after load, and decreased right and left atrial pressures.Angiotensin-converting enzyme (ACE) inhibitorBlocks reabsorption of sodium and water to produce diuresisfurosemideUsed because of its rapid onset and decreased risk for toxicity; increases the force of contraction (positive inotropic effect), decreases the heart rate (negative chronotropic effect), slows the conduction of impulses through the AV node (negative dromotropic effect), and indirectly enhances diuresisDigoxinACE inhibitors that are frequently used in pediatricslisinopril, catopril, enalaprilthe process of the formation of the heart's atrial septum results in a temporary flap called the a) truncus arteriosus b) foramen ovale c) sinus venosus d) ductus venosusb) foramen ovaleIn fetal circulation, the umbilical vein divides and sends blood directly to the inferior vena cava by way of the ductus venosus. This division occurs at the: a) heart b) lungs c) liver d) placentac) liverIn fetal circulation the majority of the oxygenated blood is pumped through the: a) foramen ovale b) lungs c) liver d) coronary sinusa) foramen ovaleWhen obtaining a history from the parents of an infant suspected of having altered cardiac function, the nurse would expect: a) specific concerns related to palpitations the infant is having b) feeding difficulty, sweating with activity, and poor weight gain c) specific concerns about the infant's shortness of breath d) concerns related to the infant's lack of cryingb) feeding difficulty, sweating with activity, and poor weight gainA clue in the mother's history that is important in the diagnosis of congenital heart disease is: a) rheumatoid arthritis b) rheumatic fever c) streptococcal infection d) rubellad) rubellacoarctation of the aorta should be suspected when: a) the blood pressure in the arms is different from the blood pressure in the legs b) the blood pressure in the right arm is different from the blood pressure in the left arm c) apical pulse is stronger than the radial pulse d) point of maximum impulse is shifted to the lefta) the blood pressure in the arms is different from the blood pressure in the legsof the following descriptions, the heart sound that would be considered normal in a young child is: a) splitting of S1 b) splitting of S2 c) splitting of S3 d) splitting of S4b) splitting of S2The standard pediatric ECG has: a) 6 leads b) 12 leads c) 15 leads d) 18 leadsc) 15 leadsThe diagnostic test that requires intravenous sedation and has been used increasingly in recent years to confirm the diagnosis of a congenital heart defect without a cardia catheterization is the: a) ECG b) echocardiogram c) transesophageal echocardiogram d) two-dimensional echocardiogramc) transesophageal echocardiogramIn children, the usual approach to the left ventricle of the heart in a cardiac catheterization is through the: a) left side of the heart b) right side of the heartb) right side of the heartWhen children develop heart failure from a congenital heart defect, the failure is usually: a) right sided only b) left sided only c) both right and left sidedc) both right and left sidedwhich one of the following heart rates would be considered tachycardia in an infant? a) a resting hr of 120 bpm b) a crying hr of 200 bpm c) a resting hr of 170 bpm d) a crying hr of 180 bpmc) a resting hr of 170 bpmThe presence of poor ventricular function and atrial arrhythmia increases the risk for: a) infection b) CVA c) fever d) air embolismc) feverair embolism may form in the venous system, traveling directly to the brain in the child with: a) a right to left shunt b) a left to right shunt c) dehydration and hypoxemia d) hypernatremia and hypokalemiaa) a right to left shuntwhich one of the following defects has the best prognosis? a) tetrology of fallot b) ventricular septal defect c) atrial septal defect d) hypoplastic left heart syndromec) atrial septal defectwhich of the following defects has the worst prognosis? a) tetrology of fallot b) atrial ventricular canal defect c) transposition of the great vessels d) hypoplastic left heart syndromed) hypoplastic left heart syndrometetrology of fallot consists of these defects: a) VSD b) ASD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aorta f) patent ductus arteriosusa) VSD c) right ventricular hypertrophy d) pulmonic stenosis e) overriding aortaa common finding on physical examination of the child with acute rheumatic heart disease is: a) a systolic murmur b) a pleural friction rub c) an ejection click d) a split S2a) a systolic murmurwhich of the following is not a major manifesto of rheumatic fever? a) carditis b) chorea c) erythema marginatum d) uveitis e) polyarthritise) polyarthritischildren who have been treated for rheumatic fever: a) do not need additional prophylaxis against BE b) are immune to rheumatic fever for the rest of their lives c) will have transitory manifestations of chorea for the rest of their lives d) may need antibiotic therapy for yearsd) may need antibiotic therapy for yearsthe peak age for the incidence of kawasaki disease is in the: a) infant age group b) toddler age group c) school age group d) adolescent age groupb) toddler age groupThe standard treatment for kawasaki disease is: a) aspirin and immune globulin b) aspirin and cryoprecipitate c) meperidine hydrochloride and immune globulin d) meperidine hydrochloride and cryoprecipitatea) aspirin and immune globulinBecause of the medication used for long term therapy, children with kawasaki disease are at increased risk for: a) chickenpox b) influenza c) reye syndrome d) myocardial infarctionc) reye syndrome1. A chest radiograph 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 do which of the following? 1. Show bones of chest but not the heart 2. Measure electrical potential generated from heart muscle 3. Provide permanent record of heart size and configuration 4. Provide computerized image of heart vessels and tissuesANS: 3 3. A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will be provide a baseline for future comparisons2. Which of the following is a complication that may occur after a cardiac catheterization? 1. Cardiac arrhythmia 2. Hypostatic pneumonia 3. Congestive heart failure 4. Rapidly increasing blood pressureANS: 1 1. Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient.3. José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: 1. Directed at his parents, because he is too young to understand. 2. Detailed in regard to the actual procedures so he will know what to expect. 3. Done several days before the procedure so that he will be prepared. 4. Adapted to his level of development so that he can understand.ANS: 4 4. Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations.4. Which of the following explanations regarding cardiac catheterization is appropriate for a preschool child? 1. Postural drainage will be performed every 4 to 6 hours after the test. 2. It is necessary to be completely "asleep" during the test. 3. The test is very short, usually taking less than 1 hour. 4. When the procedure is done, you will have to keep your leg straight for at least 4 hours.ANS: 4 4. The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position5. Nursing interventions for the child after a cardiac catheterization would include which of the following? 1. Allow ambulation as tolerated. 2. Monitor vital signs every 2 hours. 3. Assess the affected extremity for temperature and color. 4. Check pulses above the catheterization site for equality and symmetry.ANS: 3 3. The extremity that was used for access for the cardiac catheterization must be checked for temperature and color. Coolness and blanching may indicate arterial occlusion.6. After the child returns from cardiac catheterization, the nurse monitors the child's vital signs. The heart rate should be counted for how many seconds? 1. 10 2. 15 3. 30 4. 60ANS: 4 4. After cardiac catheterization, the heart rate should be counted for a full minute to detect evidence of dysrhythmias or bradycardia.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 which of the following? 1. Notify physician. 2. Apply new bandage with more pressure. 3. Place in Trendelenburg position. 4. Apply direct pressure above catheterization site.ANS: 4 4. 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.8. Which of the following should be included in the instructions to an active adolescent who is going home after a cardiac catheterization? 1. Avoid tub baths but may shower. 2. Maintain strict bed rest for 3 days. 3. Leave pressure dressing on for 7 days. 4. Stay home from school until Band-Aid is removed.ANS: 1 1. The catheterization site should be kept relatively dry with a adhesive bandage. Showers are recommended.9. Surgical closure of the ductus arteriosus would do which of the following? 1. Stop the loss of unoxygenated blood to the systemic circulation 2. Decrease the edema in legs and feet 3. Increase the oxygenation of blood 4. Prevent the return of oxygenated blood to the lungsANS: 4 4. The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary artery10. Which of the following defects results in increased pulmonary blood flow? 1. Pulmonic stenosis 2. Tricuspid atresia 3. Atrial septal defect 4. Transposition of the great arteriesANS: 3 3. 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.11. Which of the following structural defects constitute tetralogy of Fallot? 1. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy 2. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy 3. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy 4. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophyANS: 1 1. Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.12. Which of the following defects results in decreased pulmonary blood flow? 1. Atrial septal defect 2. Tetralogy of Fallot 3. Ventricular septal defect 4. Patent ductus arteriosusANS: 2 2. Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect13. Which of the following is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? 1. Pulmonary congestion 2. Congenital heart defect 3. Congestive heart failure 4. Systemic venous congestionANS: 3 3. 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.14. Which of the following is a clinical manifestation of the systemic venous congestion that can occur with congestive heart failure? 1. Tachypnea 2. Tachycardia 3. Peripheral edema 4. Pale, cool extremitiesANS: 3 3. Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion15. A beneficial effect of administering digoxin (Lanoxin) is that it: 1. Decreases edema. 2. Decreases cardiac output. 3. Increases heart size. 4. Increases venous pressure.ANS: 1 1. Digoxin has a rapid onset and is useful increasing cardiac output, decreasing venous pressure, and as a result, decreasing edema.16. Which of the following drugs is an angiotensin-converting enzyme (ACE) inhibitor? 1. Captopril (Capoten) 2. Furosemide (Lasix) 3. Spironolactone (Aldactone) 4. Chlorothiazide (Diuril)ANS: 1 1. Capoten is a drug which is an ACE inhibitor.17. An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following? 1. 60 2. 70 3. 90 4. 100ANS: 2 2. If a 1-minute apical pulse is less than 70 for an older child, the digoxin is withheld. 1. This is the cut-off for holding the digoxin dose in an adult.18. A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following? 1. 60 2. 70 3. 90 to 110 4. 110 to 120ANS: 3 3. If the 1-minute apical is below 90 to 110, the digoxin should not be given to a 6-month-old.19. Which of the following is a common sign of digoxin toxicity? 1. Seizures 2. Vomiting 3. Bradypnea 4. TachycardiaANS: 2 2. Vomiting is a common sign of digoxin toxicity20. 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 which of the following? 1. It is a very safe, frequently used drug. 2. It is difficult to either overmedicate or undermedicate with digoxin. 3. Parents lack the expertise necessary to administer digoxin. 4. Parents must learn specific, important guidelines for administration of digoxin.ANS: 4 4. 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 to monitor for side effects21. The infant with congestive heart failure has a need for: 1. Increased calories. 2. Increased fluids. 3. Decreased protein. 4. Decreased fat.ANS: 1 1. The metabolic rate of infants with congestive heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue.22. 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 for this child because they are high in which of the following? 1. Chlorides 2. Potassium 3. Sodium 4. VitaminsANS: 2 2. Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child's diet should be supplemented with this electrolyte23. Which of the following is a sign of hypokalemia? 1. Apnea 2. Oliguria 3. Twitching 4. Muscle weaknessANS: 4 4. Muscle weakness is a characteristic clinical manifestation of hypokalemia.24. An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be which of the following? 1. Assess for neurologic defects. 2. Place the child in the knee-chest position 3. Begin cardiopulmonary resuscitation. 4. Prepare family for imminent death.ANS: 2 2. The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated.25. The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which of the following is an important objective to decrease this risk? 1. Minimize seizures 2. Prevent dehydration 3. Promote cardiac output 4. Reduce energy expenditureANS: 2 2. In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes26. 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 which of the following? 1. Child needs opportunities to play with peers. 2. Child needs to understand that peers' activities are too strenuous. 3. Parents can meet all the child's needs. 4. Constant parental supervision is needed to avoid overexertion.ANS: 1 1. The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace.27. Which of the following should the nurse consider when preparing a school-age child and the family for heart surgery? 1. Unfamiliar equipment should not be shown. 2. Let child hear the sounds of an ECG monitor. 3. Avoid mentioning postoperative discomfort and interventions. 4. Explain that an endotracheal tube will not be needed if the surgery goes well.ANS: 2 2. The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized28. Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. The nurse should do which of the following? 1. Keep child warm with blankets. 2. Apply a hypothermia blanket. 3. Record temperature on nurses' notes. 4. Report findings to physician.ANS: 4 4. In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7° C or 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 indicated29. Which of the following is an important nursing consideration when suctioning a young child who has had heart surgery? 1. Perform suctioning at least every hour. 2. Suction for no longer than 30 seconds at a time. 3. Administer supplemental oxygen before and after suctioning. 4. Expect symptoms of respiratory distress when suctioning.ANS: 3 3. If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia30. The nurse is caring for a child after heart surgery. Which of the following should the nurse do if evidence is found of cardiac tamponade? 1. Increase analgesia. 2. Apply warming blankets. 3. Immediately report this to physician. 4. Encourage child to cough, turn, and breathe deeply.ANS: 3 3. 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 complication31. Which of the following is an important nursing consideration when chest tubes will be removed from a child? 1. Explain that it is not painful. 2. Explain that only a Band-Aid will be needed 3. Administer analgesics before procedure. 4. Expect bright red drainage for several hours after removal.ANS: 3 3. It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing IV line32. What is the most common causative agent of bacterial endocarditis? 1. Staphylococcus albus 2. Streptococcus hemolyticus 3. Staphylococcus albicans 4. Streptococcus viridansANS: 4 4. Staphylococcus viridans is the most common causative agent in bacterial (infective) endocarditis33. What painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? 1. Osler nodes 2. Janeway lesions 3. Subcutaneous nodules 4. Aschoff nodesANS: 1 1. Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis.34. The primary nursing intervention to prevent bacterial endocarditis is which of the following? 1. Institute measures to prevent dental procedures. 2. Counsel parents of high-risk children about prophylactic antibiotics. 3. Observe children for complications, such as embolism and heart failure. 4. Encourage restricted mobility in susceptible children.ANS: 2 2. The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child's dentist should be aware of the child's cardiac condition.35. Which of the following is a common, serious complication of rheumatic fever? 1. Seizures 2. Cardiac arrhythmias 3. Pulmonary hypertension 4. Cardiac valve damageANS: 4 4. Cardiac valve damage is the most significant complication of rheumatic fever.36. Which of the following is a major clinical manifestation of rheumatic fever? 1. Polyarthritis 2. Osler nodes 3. Janeway spots 4. Splinter hemorrhages of distal third of nailsANS: 1 1. Polyarthritis, which is swollen, hot, red, and painful joints. The affected joints will change every 1 to 2 days. Primarily the large joints are affected.37. Therapeutic management of the child with rheumatic fever includes: 1. Administration of penicillin. 2. Avoid salicylates (aspirin). 3. Strict bed rest for 4 to 6 weeks. 4. Administration of corticosteroids if chorea develops.ANS: 1 1. The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice38. Which of the following actions by the school nurse is important in the prevention of rheumatic fever? 1. Encourage routine cholesterol screenings. 2. Conduct routine blood pressure screenings. 3. Refer children with sore throats for throat cultures. 4. Recommend salicylates instead of acetaminophen for minor discomforts.ANS: 3 3. Nurses have a role in prevention; primarily in screening school-age children for sore throats caused by group A streptococci. This can be by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing.39. When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what are thought to protect against cardiovascular disease? 1. Cholesterol 2. Triglycerides 3. Low-density lipoproteins (LDLs) 4. High-density lipoproteins (HDLs)ANS: 4 4. HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high levels of proteins. It is thought that HDLs protect against cardiovascular disease.40. Which of the following is the leading cause of death after heart transplantation? 1. Infection 2. Rejection 3. Cardiomyopathy 4. Congestive heart failureANS: 2 2. The posttransplant course is complex. The leading cause of death after cardiac transplant is rejection.41. When caring for the child with Kawasaki disease, the nurse should know which of the following? 1. Child's fever is usually responsive to antibiotics within 48 hours. 2. Principal area of involvement is the joints. 3. Aspirin is contraindicated. 4. Therapeutic management includes administration of gamma globulin and aspirin.ANS: 4 4. High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness