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MULTIPLE CHOICE
1. A chest radiograph film is ordered for a child with suspected cardiac problems. The childs
parent asks the nurse, What will the radiograph show about the heart? The nurses response
should be based on knowledge that the x-ray film will show:
a. bones of chest but not the heart.
b. measurement of electrical potential generated from heart muscle.
c. permanent record of heart size and configuration.
d. computerized image of heart vessels and tissues.
ANS: C
A chest radiograph will provide information on the heart size and pulmonary blood-flow
patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as
the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated
from heart muscle. Echocardiography will produce a computerized image of the heart vessels
and tissues by using sound waves.
2. 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.
3. Jos 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 childs 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.
5. 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.
6. 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.
10. A nurse is teaching nursing students the physiology of congenital heart defects. Which defect
results in decreased pulmonary blood flow?
a. Atrial septal defect
b. Tetralogy of Fallot
c. Ventricular septal defect
d. Patent ductus arteriosus
ANS: B
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 defect. Atrial and ventricular septal defects and patent ductus arteriosus
result in increased pulmonary blood flow.
11. 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
ANS: C
The definition of 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 bodys metabolic
demands. 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.
PTS: 1 DIF: Cognitive Level: Understand REF: 830
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
12. 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
ANS: C
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.
13. 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.
16. 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 120
ANS: C
If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a
6-month-old. 60 beats/min is the cut-off for holding the digoxin dose in an adult. 70 beats/min
is the determining heart rate to hold a dose of digoxin for an older child. 110 to 120 beats/min
is an acceptable heart rate to administer digoxin to a 6-month-old.
17. The 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. Tachycardia
ANS: B
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. The heart rate will be
slower, not faster.
18. The parents of a young child with heart failure tell the nurse that they are nervous about
giving digoxin (Lanoxin). The nurses 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.
ANS: D
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 effects. Digoxin is a frequently used drug,
but it has a narrow therapeutic range. Small amounts of the liquid are given to infants, making
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.
19. 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 infants 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.
ANS: A
The metabolic rate of infants with 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. Infants with heart
failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest, and a 4-
hour schedule is too long. Fluids must be carefully monitored because of the heart failure.
Infants do not require supplemental oxygen with feedings.
20. 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.
ANS: B
Diuretics that work on the proximal and distal renal tubules contribute to increased losses of
potassium. The childs diet should be supplemented with this electrolyte. With this type of
diuretic, potassium must be monitored and supplemented as needed.
PTS: 1 DIF: Cognitive Level: Understand REF: 840
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
21. An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurses 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 family for imminent death.
ANS: B
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.
22. 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.
ANS: B
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.
23. 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 nurses 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 childs needs.
d. Constant parental supervision is needed to avoid overexertion.
ANS: A
The child needs opportunities for social development. Children usually limit their activities if
allowed to set their own pace. 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. The child will be able to regulate
activities.
24. 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.
ANS: B
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 emphasized. The child
should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare
the child for the postoperative experience, including intravenous (IV) lines, incision, and
endotracheal tube.
25. 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.
ANS: D
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. Hypothermia blanket is not indicated for this level of temperature. The
temperature should be recorded, but the physician must be notified for evaluation. 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 avoided by using
appropriate technique.
27. 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.
ANS: C
If evidence is noted of cardiac tamponade, which is 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 till after the evaluation by the
physician.
28. 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.
ANS: C
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 line. A sharp,
momentary pain is felt. This should not be misrepresented to the child. A petroleum gauze, air-
tight dressing will be needed, but it is not a pain-free procedure. Little or no drainage should
be found on removal.
30. Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in
bacterial endocarditis?
a. Osler nodes
b. Janeway lesions
c. Subcutaneous nodules
d. Aschoff nodes
ANS: A
Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial
endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial
endocarditis. Subcutaneous nodules are nontender swellings, located over bony prominences,
commonly found in rheumatic fever. Aschoff nodules are small nodules composed of cells and
leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.
33. The nurse is conducting a staff in-service on childhood-acquired heart diseases. Which is a
major clinical manifestation of rheumatic fever?
a. Polyarthritis
b. Osler nodes
c. Janeway spots
d. Splinter hemorrhages of distal third of nails
ANS: A
Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation of
rheumatic fever. The affected joints will change every 1 to 2 days. Primarily the large joints
are affected. Osler nodes, Janeway spots, and splinter hemorrhages are characteristic of
infective endocarditis.
34. The nurse is admitting a child with rheumatic fever. Which therapeutic management should
the nurse expect to implement?
a. Administering penicillin
b. Avoiding salicylates (aspirin)
c. Imposing strict bed rest for 4 to 6 weeks
d. Administering corticosteroids if chorea develops
ANS: A
The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is
the drug of choice. Salicylates can be used to control the inflammatory process, especially in
the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile
stage, but it does not need to be strict. The chorea is transient and will resolve without
treatment.
35. Which action by the school nurse is important in the prevention of rheumatic fever?
a. Encourage routine cholesterol screenings.
b. Conduct routine blood pressure screenings.
c. Refer children with sore throats for throat cultures.
d. Recommend salicylates instead of acetaminophen for minor discomforts.
ANS: C
Nurses have a role in preventionprimarily in screening school-age children for sore throats
caused by group A -hemolytic streptococci. They can achieve this by actively participating in
throat culture screening or by referring children with possible streptococcal sore throats for
testing. Cholesterol and blood pressure screenings do not facilitate the recognition and
treatment of group A -hemolytic streptococci. Salicylates should be avoided routinely
because of the risk of Reye syndrome after viral illnesses.
36. 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).
ANS: D
HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high
levels of proteins. It is thought that HDLs protect against cardiovascular disease. Cholesterol,
triglycerides, and LDLs are not protective against cardiovascular disease.
38. When caring for the child with Kawasaki disease, the nurse should know which information?
a. A childs fever is usually responsive to antibiotics within 48 hours.
b. The principal area of involvement is the joints.
c. Aspirin is contraindicated.
d. Therapeutic management includes administration of gamma globulin and aspirin.
ANS: D
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. The fever of
Kawasaki disease is unresponsive to antibiotics and antipyretics. Mucous membranes,
conjunctiva, changes in the extremities, and cardiac involvement are seen. Aspirin is part of
the therapy.
39. The nurse is teaching nursing students about shock that occurs in children. One of the most
frequent causes of hypovolemic shock in children is:
a. sepsis.
b. blood loss.
c. anaphylaxis.
d. congenital heart disease.
ANS: B
Blood loss is the most frequent cause of hypovolemic shock in children. Sepsis causes septic
shock, which is overwhelming sepsis and circulating bacterial toxins. Anaphylactic shock
results from extreme allergy or hypersensitivity to a foreign substance. Congenital heart
disease contributes to hypervolemia, not hypovolemia.
41. Which clinical manifestation should the nurse expect to see as shock progresses in a child and
becomes decompensated shock?
a. Thirst
b. Irritability
c. Apprehension
d. Confusion and somnolence
ANS: D
Confusion and somnolence are beginning signs of decompensated shock. Thirst, irritability,
and apprehension are signs of compensated shock.
43. A child is brought to the emergency department experiencing an anaphylactic reaction to a bee
sting. While an airway is being established, the nurse should prepare which medication for
immediate administration?
a. Diphenhydramine (Benadryl)
b. Dobutamine (Dobutarex)
c. Epinephrine (Adrenalin)
d. Calcium chloride (calcium chloride)
ANS: C
After the first priority of establishing an airway, administration of epinephrine is the drug of
choice. Diphenhydramine, an antihistamine, is usually not used for severe reactions.
Dobutamine and calcium chloride are not appropriate drugs for this type of reaction.
45. A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can
hold the child during the procedure. The nurse should answer with which response?
a. You will be able to hold your child during the procedure.
b. Your child can be active during the procedure, but cant sit in your lap.
c. Your child must lie quietly; sometimes a mild sedative is administered before the
procedure.
d. The procedure is invasive so your child will be restrained during the
echocardiogram.
ANS: C
Although an echocardiogram is noninvasive, painless, and associated with no known side
effects, it can be stressful for children. The child must lie quietly in the standard
echocardiographic positions; crying, nursing, or sitting up often leads to diagnostic errors or
omissions. Therefore, infants and young children may need a mild sedative; older children
benefit from psychological preparation for the test. The distraction of a video or movie is
often helpful.
46. The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan
which intervention to decrease cardiac demands?
a. Organize nursing activities to allow for uninterrupted sleep.
b. Allow the infant to sleep through feedings during the night.
c. Wait for the infant to cry to show definite signs of hunger.
d. Discourage parents from rocking the infant
ANS: A
The infant requires rest and conservation of energy for feeding. Every effort is made to
organize nursing activities to allow for uninterrupted periods of sleep. Whenever possible,
parents are encouraged to stay with their infant to provide the holding, rocking, and cuddling
that help children sleep more soundly. To minimize disturbing the infant, changing bed linens
and complete bathing are done only when necessary. Feeding is planned to accommodate the
infants sleep and wake patterns. The child is fed at the first sign of hunger, such as when
sucking on fists, rather than waiting until he or she cries for a bottle because the stress of
crying exhausts the limited energy supply. Because infants with CHD tire easily and may
sleep through feedings, smaller feedings every 3 hours may be helpful.
b. d.
ANS: A
The figure that depicts a narrowing of the aortic arch is coarctation of the aorta. It typically
occurs past the ductal area but can occur in other areas along the aortic arch. The figure that
depicts an opening between the atria is atrial septal defect. The figure that depicts an opening
between the ventricles is ventricular septal defect. The figure that depicts an opening from the
atrium to the pulmonary artery is patent ductus arteriosus.
MULTIPLE RESPONSE
1. Nursing 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.
ANS: C, F
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. The child
should have a patent peripheral intravenous line (PIV) to ensure adequate hydration. The child
should remain on bed rest with the leg extended for a minimum of 4 hours. Initially vital signs
are taken every 15 minutes, with emphasis on a heart rate counted for 1 minute. Pulses above
the catheterization site should not be affected by the catheterization. Pulses distal to the site
should be monitored. The pressure dressings should not be removed for 24 hours.
2. 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 time
ANS: C, D, F
Cool extremities, decreased skin turgor, confusion, somnolence, tachypnea, and poor capillary
refill time are beginning signs of decompensated shock. Thirst, diminished urinary output,
irritability, apprehension, normal blood pressure, and narrowing pulse pressure are signs of
compensated shock.
3. The 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. Fatigue
ANS: C, D, E
The signs and symptoms of heart failure include decreased urinary output, sweating, and
fatigue. Other signs include pale, cool extremities, not warm and flushed, and weight gain, not
weight loss.
SHORT ANSWER
1. Which is the acceptable mg/dl level, or below this level, low density lipoprotein (LDL)
cholesterol for a child from a family with heart disease? (Record your answer in a whole
number.)
ANS:
110
The low-density lipoproteins (LDLs) contain low concentrations of triglycerides, high levels
of cholesterol, and moderate levels of protein. LDL is the major carrier of cholesterol to the
cells. Cells use cholesterol for synthesis of membranes and steroid production. Elevated
circulating LDL is a strong risk factor in cardiovascular disease. For children from families
with a history of heart disease, the LDL should be <110.
ESSAY
1. An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during
a routine blood draw. Which interventions should the nurse implement? Place in order from
the highest-priority intervention to the lowest-priority intervention. Provide answer using
lowercase letters separated by commas (e.g., a, b, c, d).
a. Administer 100% oxygen by blow-by.
b. Place infant in knee-chest position.
c. Remain calm.
d. Give morphine subcutaneously or by an existing intravenous line.
ANS:
b, a, d, c
Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in
infants with tetralogy of Fallot, may occur in any child whose heart defect includes
obstruction to pulmonary blood flow and communication between the ventricles. The infant
becomes acutely cyanotic and hyperpneic because sudden infundibular spasm decreases
pulmonary blood flow and increases right-to-left shunting. Because profound hypoxemia
causes cerebral hypoxia, hypercyanotic spells require prompt assessment and treatment to
prevent brain damage or possibly death. The infant should first be placed in the knee-chest
position to reduce blood returning to the heart. Next 100% oxygen is given to alleviate the
hypoxemia. Morphine is next administered to reduce infundibular spasms. Last, the nurse
should remain calm.