Chapter 41- Nursing Care of the Child With an Alteration in Perfusion-Cardiovascular Disorder

What information would be included in the care plan of an infant in heart failure?

Maintain child in the supine position.

Administer digoxin even if the infant is vomiting.

Encourage larger, less frequent feedings.

Begin formulas with increased calories.

Begin formulas with increased calories. Explanation: Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often times are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering.

On assessment immediately following cardiac surgery, which condition would the nurse expect to find in an infant?

Hyperexcitability

Hypothermia

Hypertension

Hypovolemia

Hypothermia Explanation: Cardiac surgery is often performed under hypothermia to decrease the child’s oxygen needs during surgery.

After a cardiac catheterization, the nurse monitors the child’s fluid balance closely based on the understanding that:

the contrast material used has a diuretic effect.

blood loss during the procedure can be significant.

the insertion of the catheter into the heart stimulates a diuretic response.

the prolonged preprocedure fasting state places the child at risk for dehydration.

The contrast material used has a diuretic effect. Explanation: The contrast material has a diuretic effect so the nurse assesses the child closely for signs and symptoms of dehydration and hypovolemia. Although blood loss can occur, this is not the reason for monitoring the child’s fluid balance. Catheter insertion into the heart does not initiate a diuretic response. Typically, food and fluid is withheld for 4 to 6 hours before the procedure.

The nurse is implementing the plan of care for a child with acute rheumatic fever. What treatments would the nurse expect to administer if ordered? Select all that apply.

Digoxin

Intravenous immunoglobulin

Penicillin

Nonsteroidal anti-inflammatory drugs

Corticosteroids

• Nonsteroidal anti-inflammatory drugs • Penicillin • Corticosteroids Explanation: A full 10-day course of penicillin or equivalent is used. Corticosteroids are used as part of the treatment for acute rheumatic fever. Nonsteroidal anti-inflammatory drugs are used as part of the treatment for acute rheumatic fever. Digoxin is used to treat heart failure, atrial fibrillation, atrial flutter, and supraventricular tachycardia. Intravenous immunoglobulin is used to treat Kawasaki disease.

A group of nurses is reviewing the cardiovascular system and its function. Which statement by one of the nurses demonstrates an understanding of a child’s cardiovascular system?

"Between the ages of 5 and 6, the child’s left ventricle grows to about two times the size of the right."

"The child’s heart doesn’t mature and function like an adult’s until between 8 and 10 years of age."

"At birth, the infant’s right and left ventricle are about the same size."

"The heart rate of the child decreases whenever the child experiences a fever."

"At birth, the infant’s right and left ventricle are about the same size." Explanation: At birth, both the right and left ventricles are about the same size, but by a few months of age, the left ventricle is about two times the size of the right. If the infant has a fever, respiratory distress, or any increased need for oxygen, the pulse rate goes up to increase the cardiac output. Although the size is smaller, by the time the child is 5 years old, the heart has matured, developed, and functions just as the adult’s heart.

When educating the family of an ill infant with an atrioventricular canal defect/septal defect, what information would be included in the education if the doctor is planning on performing palliative care until the infant is healthier?

VSD patching surgery should be performed immediately.

The medication indomethacin is used to try to close the hole.

Most infants do not need surgical repair for this if palliative procedures are performed.

Palliative pulmonary artery banding should help the infant grow.

Palliative pulmonary artery banding should help the infant grow. Explanation: Palliative pulmonary artery banding should help the infant grow enough so that the large VSD can be repaired. The pulmonary artery banding will help, but the defect will still need to be fixed. Most infants will need surgery for a large, symptomatic VSD. The medication indomethacin is used for a PDA.

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of which of the following as the major mechanism involved?

Mixing of well-oxygenated and poorly oxygenated blood

Narrowing of the major vessel

Obstruction of blood flow to the lungs

Increased pulmonary blood flow

Obstruction of blood flow to the lungs Explanation: Tricuspid atresia is a congenital heart defect in which the valve between the right atrium and right ventricle fails to develop, resulting in no opening to allow blood to flow from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs. It is classified as a disorder of decreased pulmonary blood flow due to obstruction of blood flow to the lungs. Defects with connections involving the left and right sides, such as atrial or ventricular septal defects, will shunt blood from the higher-pressure left side to the lower-pressure right side and subsequently more blood will go to the lungs. A narrowed major vessel leads to an obstructive defect, interfering with the ability of the blood to flow freely through the vessel. Mixed defects such as transposition of the great vessels involve the mixing of well-oxygenated with poorly oxygenated blood, leading to a systemic blood flow that contains a lower oxygen content.

A nursing instructor is preparing for a class about the structural and functional differences in the cardiovascular system of infants and children as compared to adults. What would the instructor include in the class discussion?

The heart’s apex is higher in the chest in children younger than the age of 7 years.

The heart is about four times the birth size between the ages of 6 and 12 years.

Left ventricular function predominates immediately after birth.

Blood pressure is initially high at birth but gradually decreases to adult levels.

The heart’s apex is higher in the chest in children younger than the age of 7 years. Explanation: In infants and children younger than age 7 years, the heart lies more horizontally, resulting in the apex lying higher in the chest. Right ventricular function predominates at birth, and over the first few months of life, left ventricular function becomes dominant. A normal infant’s blood pressure is about 80/40 mm Hg and increases over time to adult levels. Between the ages of 1 and 6 years, the heart is four times the birth size; between 6 and 12 years of age, the heart is 10 times its birth size.

In caring for the child with rheumatic fever which medication would the nurse likely administer?

Aspirin Explanation: Salicylates are administered in the form of aspirin to reduce fever and to relieve joint inflammation and pain in the child with rheumatic fever. Although salicylates as a general rule are not given to children, they continue to be the treatment of choice for rheumatic fever. Tylenol is not effective for the inflammation. Insulin would be given for diabetes and dilantin for seizure disorders.

A child is being placed on a cardiopulmonary bypass machine. The nurse understands the heart will pump again on its own when which of the following occurs?

The child starts getting warm again

When digoxin is administered

When chest compressions are performed

When cardioplegia is administered

The child starts getting warm again. Explanation: The child is placed in a hypothermic state when placed on a cardiopulmonary bypass. When the child is warmed, the heart starts pumping again.

A group of students are reviewing information about acute rheumatic fever. The students demonstrate a need for additional review when they identify what as a major Jones criterion?

Arthralgia

Subcutaneous nodules

Carditis

Erythema marginatum

Arthralgia Explanation: Arthralgia is considered a minor criterion. Carditis is a major criterion. Erythema marginatum is considered a major criterion. Subcutaneous nodules are considered a major criterion.

A nurse is caring for a newborn with congenital heart disease (CHD). Which of the following would the nurse interpret as indicating distress?

Subbcostal retraction at the time of feeding Explanation: Subcostal retraction during feeding is indicative of distress associated with feeding in newborn infants with CHD. Feeding can be a stress to newborns with CHD who are seriously compromised. Additional features indicating distress in infants with CHD include increased respiratory rate, perspiration along the hairline during feeding and feeding time longer than 30 minutes.

The nurse is assessing a child with suspected rheumatic fever. What assessment findings are consistent with the disease process? Select all that apply.

Nonpalpable subcutaneous nodules

Tender swollen joints

Diastolic murmur

Macular rash on trunk

Involuntary limb movement

• Involuntary limb movement • Macular rash on trunk • Tender swollen joints Explanation: Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.

An 8-month-old has a ventricular septal defect. Which nursing diagnosis would best apply?

Impaired gas exchange related to a right-to-left shunt

Impaired skin integrity related to poor peripheral circulation

Ineffective airway clearance related to altered pulmonary status

Ineffective tissue perfusion related to inefficiency of the heart as a pump

Ineffective tissue perfusion related to inefficiency of the heart as a pump Explanation: A ventriculoseptal defect permits blood to flow across a septum, creating an ineffective pump.

The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy the process of digitalization is done for which of the following reasons?

To build the blood levels to a therapeutic level Explanation: The use of large doses of digoxin at the beginning of therapy, administered to build up the blood levels of the drug to a therapeutic level, is known as digitalization. A maintenance dose is given, usually daily, after digitalization. Digoxin is used to improve the cardiac efficiency by slowing the heart rate and strengthening the cardiac contractility. Digoxin is not indicated for relief of pain.

A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which statement should the nurse make to the girl’s mother in response to these findings?

Not say anything, as the girl has an insignificant heart murmur and there is no reason to alarm the mother or her.

"Your daughter has an innocent heart murmur, which is nothing to worry about."

"Your daughter has an organic heart murmur, which indicates that she has some degree of heart disease. The doctor will provide a referral to a good cardiologist."

"Your daughter has a functional heart murmur; I recommend that you limit her physical activity so that her heart rate is not elevated for long periods of time."

"Your daughter has an innocent heart murmur, which is nothing to worry about." Explanation: The symptoms described indicate an innocent heart murmur. Although innocent murmurs are of no consequence, parents need to be told when their child has one because this finding will undoubtedly be discovered again at a future health assessment or during a febrile illness, anxiety, or pregnancy. Activities need not be restricted when a child has an innocent murmur and the child requires no more frequent health appraisals than other children. If a murmur is present as the result of heart disease or a congenital disorder, it is an organic heart murmur.

The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. Which of the following would be included in the intervention strategies?

The nurse would review the child’s 24-hour diet recall. Explanation: With a child in the 90th percentile for blood pressure, diet and physical activity should be the main focus. Blood pressures should be measured, but daily is not necessary. Children are not routinely put on beta blockers and the child should be allowed to participate in sports if monitored.

A nurse is giving discharge instructions to the parents of a newborn with a congenital heart disorder. Which of the following should the nurse instruct the parents to do in the event that the child becomes cyanotic?

Administer prescribed amoxicillin

Administer low-dose aspirin

Perform hands-on CPR

Place him in a knee-chest position

Place him in a knee-chest position Explanation: Before parents leave the hospital with a newborn who has a congenital heart disorder, be certain they have the name and number of the health professional to call if they have a question about their infant’s health. Review with them the steps to take if their child should become cyanotic, such as placing the child in a knee-chest position. "Hands on" CPR is not recommended for children as it is for adults. Remind parents that children with many types of congenital heart disorders or rheumatic fever need prophylactic low-dose aspirin therapy to avoid blood clotting; although becoming a controversial practice, they may be prescribed antibiotic therapy such as oral amoxicillin before oral surgery.

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. Which of the following would be the priority nursing intervention?

Administer epinephrine.

Elevate the head of the bed.

Observe vitals every two hours.

Notify the doctor immediately.

Notify the doctor immediately. Explanation: The nurse would notify the doctor immediately. Cardiac tamponade is a medical emergency and should be addressed. The child can die if intervention is postponed. It would not be appropriate to perform any interventions until confirming that this is the actual diagnosis.

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?

Digoxin Explanation: Digoxin is indicated for atrial fibrillation. It increases the contractility of the heart muscle by decreasing conduction and increasing force. Alprostadil is indicated for temporary maintenance of ductus arteriosus patency in infants with ductal-dependent congenital heart defects. Furosemide is used for the management of edema associated with heart failure. Indomethacin is used to close a patent ductus arteriosus

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:

narrow pulse.

bounding pulse.

hepatomegaly.

femoral pulse weaker than brachial pulse.

Femoral pulse weaker than brachial pulse Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure

A school nurse finds a 10-year-old’s blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect?

The child will need the blood pressure checked two more times. Explanation: The child will need the blood pressure checked two more times. It is routine to check the blood pressure on three separate occasions to get the most accurate analysis of the blood pressure. The child usually does not need surgery or need to go to the emergency room. This is not a normal result in a blood pressure finding

The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which of the following reactions?

Stomach upset

Wheezing

Nausea with diarrhea

Abdominal distress

Wheezing Explanation: The nurse must report any hypersensitivity reactions such as wheezing and pruritus, as these could be a sign of anaphylaxis. Stomach upset is common with oral antibiotics and is not something that needs to be reported immediately. Nausea with diarrhea is common with oral antibiotics and does not need to be reported immediately. Abdominal distress is common with oral antibiotics and does not need to be reported immediately.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

Serum potassium level Explanation: Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug. Serum sodium levels may be obtained in children with heart failure to ensure that an increased sodium level is not causing edema. The erythrocyte sedimentation rate identifies inflammation and is unrelated to the use of diuretics and digoxin. Oxygen saturation levels may be done to evaluate for hypoxemia, but these results would be unrelated to the use of digoxin and diuretics.

A parent brings an infant in for poor feeding. Which of the following assessment data would most likely indicate a coarctation of the aorta?

Pulses weaker in lower extremities compared to upper extremities Explanation: An infant with coarctation of the aorta has decreased systemic circulation causing this problem. The cyanosis would be associated with tetralogy of Fallot.

When caring for a child that has just had a cardiac catheterization, what is a sign of hypotension?

Decreased heart rate and dizziness

Syncope and tachypnea

Cold, clammy skin and increased heart rate

Diaphoresis and tachycardia

Cold clammy skin and increased heart rate Explanation: Cold, clammy skin, increased heart rate, and dizziness are signs of hypotension that may be a complication after a cardiac catheterization. Decreased heart rate, syncope, and tachypnea would also be very concerning, but not necessarily a sign of hypotension.

A nurse is providing education to a family about cardiac catheterization. What information would be included in the education?

The catheter will be placed in the femoral artery.

The procedure will be performed even if the child has a fever.

The child will be able to move their leg again immediately after the procedure.

The catheter will be placed in the brachial artery.

The catheter will be placed in the femoral artery. Explanation: The femoral artery is the correct placement of the cardiac catheter. The child will need to lie still for several hours after the procedure. The procedure is usually postponed if the child has a fever.

A parent is asking for more information about their infant’s patent ductus arteriosus (PDA). What would be included in the education?

An IV for fluids will be started immediately.

Your child may need multiple surgeries to correct this defect.

This is caused by an opening that usually closes by 1 week of age.

This type of defect is caused by having a genetic predisposition for it.

This is caused by an opening that usually closes by 1 week of age. Explanation: A PDA is caused by an opening that usually closes by 1 week of age called the ductus arteriosus. The defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

An infant girl is prescribed digoxin. You would teach her parents that the action of this drug is to

Slow and strengthen her heartbeat. Explanation: Digoxin is a cardiac glycoside that slows and strengthens the heartbeat.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. Which of the following would most likely explain this assessment finding?

The liver increases in right-sided heart failure. Explanation: The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly.

Parents are told their infant has a hypoplastic left heart. What is the type of education that would be included for this family?

This is a problem where the left side of the heart did not develop properly.

This is a problem where the right side of the heart did not develop properly.

The infant will have immediate surgery to completely correct the heart defect.

There are no surgeries that can help the child live with this heart defect.

This is a problem where the left side of the heart did not develop properly. Explanation: This is a problem where the left side of the heart did not develop properly. There is a three-step palliative surgery that can be implemented or the child will need a heart transplant.

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching?

"Strenuous activity should be limited for the next 3 days."

"We need to watch for changes in skin color or difficulty breathing."

"We need to avoid a tub bath for the next 3 days."

"The feeling of the heart skipping a beat is common."

"The feeling of the heart skipping a beat is common." Explanation: Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. This statement is appropriate because tub baths should be avoided for about 3 days. This statement is appropriate because strenuous activity is limited for about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported.

At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important?

Assuring the child that the procedure is now over

Allowing the child to talk about the procedure

Allowing the child to adapt to the light in the room gradually

Taking pedal pulses for the first 4 hours

Taking pedal pulses for the first 4 hours Explanation: Insertion of a catheter into the femoral vein can cause vessel spasm, interfering with blood circulation in the leg. Assessing pedal pulses ensures circulation is adequate.

The nurse is caring for a child diagnosed with rheumatic fever. When addressing the child’s pain, the nurse should perform which interventions? Select all that apply.

Teach the child how to use a patient-controlled analgesia system.

Carefully handle the child’s knees, ankles, elbows and wrists when moving the child.

Administer intravenous morphine as prescribed.

Prioritize non-pharmacologic interventions over pharmacologic interventions.

Administer salicylates after meals or with milk.

• Carefully handle the child’s knees, ankles, elbows and wrists when moving the child. • Administer salicylates after meals or with milk Explanation: Pain control and relief are the highest priorities for the child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever and relieve joint inflammation and pain

A mother asks why her infant with a cyanotic heart defect turns blue. What is the best response by the nurse?

This is a sign of heart failure.

This is due to a decreased amount of oxygen to the peripheral tissue.

This is considered a medical emergency and needs immediate surgery.

This is due to the lack of oxygen to the brain.

This is due to a decreased amount of oxygen to the peripheral tissue. Explanation: Cyanosis associated with certain congenital heart defects is due to the body naturally compensating and decreasing the amount of oxygen to the peripheral tissue. This keeps the oxygen with the vital organs to sustain life. The lack of oxygen is not in the brain; it is in the systemic flow of the body. Cyanosis is a common finding with these types of heart defects and in general, does not usually need immediate surgery or is a sign of heart failure

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?

Low blood pressure and decreased heart rate

Decreased heart rate and impalpable pulse

Irritability and dry mucous membranes

Peeling hands and feet and fever

Peeling hands and feet and fever Explanation: One of the signs of Kawasaki disease is the peeling hands and feet. The other symptoms are not necessarily characteristic of Kawasaki disease.

A child is having surgery for a congenital heart defect. The parent asks about their 1-year-old’s growth and developmental delays and what they can expect after surgery. What is the best response by the nurse?

"After surgery, most children will catch up." Explanation: A child with a congenital heart defect who has growth and developmental delays will usually catch up after the defect is fixed. There is no way of predicting exactly what each child will do and it is not appropriate to tell a parent that these delays are permanent when that is unknown until the defect is corrected by surgery.

The nurse would teach the mother of a boy with tetralogy of Fallot that if the child suddenly becomes cyanotic and dyspneic, the mother should:

have him lie supine with the head turned to one side.

have him lie prone, being sure he can breathe easily.

place him in a semi-Fowler’s position in an infant seat.

place him in a knee-chest position.

place him in a knee-chest position. Correct Explanation: Placing a child in a knee-chest or squatting position traps blood in the legs, allowing the child to better oxygenate that remaining in the trunk.

A child is diagnosed with tetralogy of Fallot and during a temper tantrum turns blue. Which of the following would the nurse do first?

Assess for an irregular heart rate.

Assess for an increased respiratory rate.

Place child in the knee-to-chest position.

Explain to the child the need to calm down since it is affecting the heart.

Place child in the knee-to-chest position. Explanation: Place child in the knee-to-chest position. This position is the first priority of the child with tetralogy of Fallot. Cyanosis is caused by the heart defect and placing the child in this position will decrease the cyanosis.

You take an infant’s apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant?

100 beats per minute Explanation: Because digoxin slows the heart rate, it is important that it is not already beating at a slow rate before administration.

The nurse is explaining possible side effects of corticosteroids to the caregiver of a child diagnosed with rheumatic fever. The caregiver comments, "I don’t understand what hirsutism means." The nurse would be correct in explaining that hirsutism is which of the following?

Abnormal hair growth Explanation: The child whose pain is not con trolled with salicylates may be ad ministered corticosteroids. Side effects such as hirsutism (abnormal hair growth) and "moon face" may be noted. Facial grimaces and repetitive involuntary movements are symptoms of chorea.

The nurse is administering medications to the child with congestive heart failure. Large doses of which of the following medications are used initially in the treatment of CHF to attain a therapeutic level?

Digoxin (Lanoxin) Explanation: The use of large doses of digoxin, at the beginning of therapy, to build up the blood levels of the drug to a therapeutic level is known as digitalization.

A 6-year-old girl is diagnosed with pulmonary stenosis. The mother asks the nurse what the likely treatment for this condition will involve. The nurse should tell the mother which of the following?

Insertion of a catheter with an uninflated balloon tip into the affected valve, followed by inflation of the balloon to break up adhesions Explanation: Balloon angioplasty by way of cardiac catheterization is the procedure of choice for pulmonary stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed valve. As the balloon is inflated, it breaks valve adhesions and relieves the stenosis. The other answers refer to interventions related to patent ductus arteriosus, not pulmonary stenosis.

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed?

"We can stop the penicillin when her symptoms disappear." Explanation: For a child with rheumatic fever, drug therapy must be given for the full 10 to 14 days to ensure complete eradication of the infection. The drug must not be stopped when the signs and symptoms disappear. To prevent recurrent attacks, prophylactic antibiotic therapy is prescribed for at least 5 years or until the child is 18 years old. Additional prophylactic therapy should be instituted when dental or tonsillar surgery is planned.

The nurse is collecting data on a 5 year old child admitted with the diagnosis of congestive heart failure. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis?

Failure to gain weight Explanation: In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and clubbing of the fingers is seen in cystic fibrosis.

A nurse is reviewing blood work on a patient with a cyanotic heart defect. Which of the following results would most likely be seen in a patient experiencing polycythemia?

Increased RBC

Increased WBC

Decreased WBC

Decreased RBC

Increased RBC Explanation: Polycythemia can occur in patients with a cyanotic heart defect. The body tries to compensate for having low oxygen levels and produces more red blood cells (RBCs). This would cause an increased result on the lab tests. This problem does not affect the white blood cells (WBCs).

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever?

"The onset and progression of this disorder is rapid."

"Children who have this diagnosis may have had strep throat."

"Being up-to-date on immunizations is the best way to prevent this disorder."

"This disorder is caused by genetic factors."

"Children who have this diagnosis may have had strep throat." Explanation: Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle.

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?

Place the infant in the knee-chest position.

Prepare the infant for surgery.

Start an IV for fluids.

Raise the head of the bed.

Place the infant in the knee-chest position. Explanation: Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position.

A newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis?

Tetralogy of Fallot Explanation: Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis.

Infants with congenital heart disease should not be allowed to become dehydrated because this makes them prone to

cerebrovascular accident. Explanation: Children who have polycythemia from cardiovascular disease can develop thrombi if they become dehydrated.

The infant has been hospitalized and develops hypercyanosis. The physician has ordered the nurse to administer 0.1 mg of morphine sulfate per every kilogram of the infant’s body weight. The infant weighs 15.2 pounds. Calculate the infant’s morphine sulfate dose. Round your answer to the nearest tenth.

0.7 Explanation: The infant weighs 15.2 pounds (2.2 pounds = 1 kg.) 15.2 pounds x 1 kg/2.2 pounds = 6.818 kg The infant weighs 6.818 kg. For each kilogram of body weight, the infant should receive 0.1 mg of morphine sulfate. 6.818 kg x 0.1 mg/1 kg = 0.6818 mg Rounded to the tenth place = 0.7 mg The infant will receive 0.7 mg of morphine sulfate.

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the:

child will have to remain NPO for 6 to 8 hours after the procedure to prevent vomiting.

procedure is noninvasive and not frightening for children.

child will require a general anesthetic and needs to be prepared for this.

child will return with a bulky pressure dressing over the catheter insertion area.

child will return with a bulky pressure dressing over the catheter insertion area. Explanation: Cardiac catheterization is typically performed with the child awake but using conscious sedation. A dressing will be placed on the catheter insertion site.

A nurse is interviewing a mother who is about to deliver her baby. Which of the following responses would alert the nurse for a higher potential for a heart defect in the infant?

The mother has seizures, but did not take medication while pregnant.

The mother states she slept all the time while pregnant.

The mother states she took acetaminophen while pregnant.

The mother states she has lupus.

The mother states she has lupus. Explanation: Having lupus while pregnant could contribute to a congenital heart defect. Acetaminophen and sleeping do not have an effect on a child developing a heart defect. The seizure medication can have an impact on the child having a heart defect, but not necessarily a history of seizures in the mother.

The nurse is assessing an infant for peripheral edema. Based on the nurse’s knowledge, the nurse would expect edema to occur in which area first?

Lower extremities

Face

Presacral region

Upper extremities

Face Explanation: In infants, peripheral edema occurs first in the face, then the presacral region, and then the extremities. Edema of the lower extremities is characteristic of right ventricular heart failure in older children.

The nurse is caring for a 6-year-old with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?

Use a calm, comforting approach.

Provide supplemental oxygen.

Administer propranolol (0.1 mg/kg IV).

Place the child in a knee-to-chest position.

Place the child in a knee-to-chest position. Explanation: The priority nursing action is to place the infant or child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen would be provided as ordered. Once a child is placed in the knee-to-chest position, medications would be given as ordered.

A nurse is taking the history of a 4-year-old boy who will undergo a cardiac catheterization. Which statement by his mother may necessitate rescheduling of the procedure?

"He is not taking any medication."

"He is allergic to iodine and shellfish."

"He seems listless and slightly warm."

"He is very scared and nervous about the procedure."

"He seems listless and slightly warm." Explanation: Fever and other signs and symptoms of infection may necessitate rescheduling the procedure. Although information about allergies is important, not all contrast media contain iodine as a base. The nurse should address the child’s fears in a developmentally appropriate way, but fear of the procedure does not warrant rescheduling. Not using any medication would not be a reason for rescheduling the procedure.

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia?

Child C with a total cholesterol level of 190 mg/dL and LDL of 125 mg/dL.

Child B with a total cholesterol level of 175 mg/dL and LDL of 105 mg/dL.

Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL.

Child D with a total cholesterol level of 220 mg/dL and LDL of 138 mg/dL.

Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. Explanation: Total cholesterol levels below 170 mg/dL and LDL levels less than 100 mg/dL are considered within the acceptable range. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels greater than or equal to 200 mg/dL and LDL levels greater than or equal to 130 mg/dL are considered elevated and place this child at greatest risk.

A nurse is caring for a child who is experiencing heart failure. Which of the following assessment data was most likely seen when initially examined?

Tachycardia Explanation: If a child were experiencing heart failure, the most likely sign of this would be tachycardia, not bradycardia. The child may also experience hepatomegaly or oliguria, but not splenomegaly or polyuria.

A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can to reduce the risk of this type of condition occurring in her baby. Which of the following should the nurse mention to this patient?

"Make sure you are fully immunized." Explanation: The cause of congenital heart disease often cannot be documented, although it is associated with familial patterns of inheritance and possibly triggers such as rubella (German measles) and varicella (chickenpox) infection during pregnancy. Women need to enter pregnancy fully immunized to help prevent infection during pregnancy. Encouraging the child to eat a low-sodium diet and exercise as he grows up will help prevent acquired heart disease, not congenital heart disease

Which nursing diagnosis would best apply to a child with rheumatic fever?

Disturbed sleep pattern related to hyperexcitability

Risk for self-directed violence related to development of cerebral anoxia

Activity intolerance related to inability of heart to sustain extra workload

Ineffective breathing pattern related to cardiomegaly

Activity intolerance related to inability of heart to sustain extra workload Explanation: Children with rheumatic fever need to reduce activity to relieve stress during the course of the illness.

A nurse is caring for a child that just had open-heart surgery and the parents are asking why there are wires coming out of the chest of the infant. What is the best response by the nurse?

The wires are left in the heart one month after surgery for potential arrhythmias.

These wires are connected to the heart and will detect if your child’s heart gets out of rhythm.

The wires will administer ongoing electrical shocks to the heart to maintain rhythm.

The wires are measuring the fluid level in the heart.

These wires are connected to the heart and will detect if your child’s heart gets out of rhythm. Explanation: The wires may be connected to a pacemaker. Connection to the temporary pacemaker is usually until the child is out of danger for arrhythmia.

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection?

Apply EMLA cream to the catheter insertion site

Record pedal pulses

Keep the child NPO for 2 to 4 hours before the procedure

Avoid drawing a blood specimen from the right femoral vein before the procedure

Avoid drawing a blood specimen from the right femoral vein before the procedure Explanation: Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine.

When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?

Inability to sweat

Splenomegaly

Bradycardia

Tachycardia

Tachycardia Explanation: Tachycardia is one of the signs of heart failure. Bradycardia, inability to sweat, and splenomegaly are not necessarily signs of heart failure.

A nurse is administering digoxin to a 3-year-old. What would be a reason to hold the dose of digoxin?

Hypertension

Nausea and vomiting

Fever and tinnitus

Ataxia

Nausea and vomiting Explanation: Nausea and vomiting are signs of digoxin toxicity. The other symptoms listed here are not necessarily signs of a digoxin toxicity.

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse?

This image will clarify the structures within the heart.

It will show if blood is being shunted.

It will determine if the heart is enlarged.

It will determine disturbances in heart conduction.

It will determine if the heart is enlarged. Explanation: Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI.

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child’s mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. Which of the following should the nurse mention in explaining how this diagnostic test works?

High-frequency sound waves are directed toward the heart

A microphone is placed on the child’s chest to record heart sounds and translate them into electrical energy

A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video

X-rays are directed toward the heart

High-frequency sound waves are directed toward the heart Explanation: Echocardiography, or ultrasound cardiography, has become the primary diagnostic test for congenital heart disease. For this, high-frequency sound waves, directed toward the heart, are used to locate and study the movement and dimensions of cardiac structures, such as the size of chambers, thickness of walls, relationship of major vessels to chambers, and the thickness, motion, and pressure gradients of valves. You can remind parents echocardiography does not use x-rays so it can be repeated at frequent intervals without exposing their child to the possible risk of radiation. The other answers refer to other types of diagnostic tests, including X-ray studies, radioangiocardiography, and phonocardiography.

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education?

"The medication indomethacin is used to try to close the hole."

"Surgery is usually performed in the first two months of life for this."

"The medication prostaglandin E1 is used to try to close the hole."

"Most infants do not need surgical repair for this."

"Most infants do not need surgical repair for this." Explanation: Most infants do not need surgical repair for an ASD unless they are symptomatic. The hole will close spontaneously 87% of the time. The medication indomethacin is used to help close the opening of a PDA and the medication prostaglandin E1 is used to keep a patent ductus arteriosus (PDA) open. These medications are not used for ASDs.

A parent asks if the reason her infant has a congenital heart defect is because of something she did while she was pregnant. What is the best response by the nurse?

No, heart defects are mainly caused by genetic factors.

The studies show it is impossible to know what causes heart defects.

Yes, there is a chance you caused this defect.

There are several reasons a baby can have a heart defect, let’s talk about those causes.

There are several reasons a baby can have a heart defect, let’s talk about those causes. Explanation: Focus on the therapeutic communication in this situation, while still obtaining more information. This will help the nurse explore various options for the cause of the defect with the parent.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?

Oxygen saturation level

Serum potassium level

Serum sodium level

Erythrocyte sedimentation rate

Serum potassium level Explanation: Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug. Serum sodium levels may be obtained in children with heart failure to ensure that an increased sodium level is not causing edema. The erythrocyte sedimentation rate identifies inflammation and is unrelated to the use of diuretics and digoxin. Oxygen saturation levels may be done to evaluate for hypoxemia, but these results would be unrelated to the use of digoxin and diuretics.

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply.

Bradycardia

Tiring easily when eating

Shortness of breath when playing

Hypertension

Crackles on lung auscultation

• Shortness of breath when playing • Crackles on lung auscultation • Tiring easily when eating Explanation: Manifestations of heart failure include difficulty feeding or eating or becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension.

A nurse is caring for an infant who is experiencing heart failure. What would be the most appropriate care for this infant?

Administer oxygen.

Administer antidiuretic.

Restrict fluids.

Provide large, less frequent feedings.

Administer oxygen. Explanation: If a child is experiencing heart failure, the infant will need oxygen. One of the medications the infant would be on is a diuretic. An infant with heart failure will need smaller, more frequent feedings to conserve energy for feeding. Infants are not usually put on fluid restriction.

When reviewing the record of a child with tetralogy of Fallot, which of the following would you expect to discover?

Leukopenia

Anemia

Increased platelet level

Polycythemia

Polycythemia Explanation: Children who cannot oxygenate red cells well often produce excess red blood cells or develop polycythemia.

When caring for a child with Kawasaki Disease, the nurse would know that:

management includes administration of aspirin and IVIG.

steroid creams are used for the hand peeling.

joint pain is a permanent problem.

antibiotics should be administered exactly every 8 hours by IV.

Management includes administration of aspirin and IVIG. Explanation: Kawasaki disease is managed with IVIG and aspirin to prevent cardiac complications. Joint pain is not necessarily a permanent problem associated with Kawasaki disease. Antibiotics and steroid creams are not used for this disorder.

A client’s newborn is diagnosed with tetralogy of Fallot. When explaining this condition to the client, which defect would the nurse’s description include?

Atrial septal defect

Left ventricular hypertrophy

Stenosis of the aorta

Overriding of the aorta

Overriding of the aorta Explanation: One of the components in the Tetralogy of Fallot is overriding of the aorta. Tetralogy of Fallot is a congenital heart disease with 4 components. The defects in the Tetralogy of Fallot include ventricular septal defect, overriding of the aorta, pulmonary stenosis, and right ventricular hypertrophy. Atrial septal defect, stenosis of the aorta and left ventricular hypertrophy are not components of Tetralogy of Fallot.

A parent asks about the risk of a congenital heart defect being passed on to another child since they already have one child that has it, but no one else in the family has one. What is the best response by the nurse?

There is a less than 7% chance a sibling would inherit a heart defect. Explanation: The risk to subsequent siblings of a child with CHD is approximately 2% to 6% so genetics can play a role in the child having a cardiac defect

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?

This test can only determine the size of the heart.

This is a test that will check the electrical impulses in the heart.

This is a test that will check how blood is flowing through the heart.

This test is an invasive test that will measure the blockage in the heart.

This is a test that will check how blood is flowing through the heart. Explanation: Echocardiograms can determine the size of the heart and how the heart is pumping blood. An echocardiogram does not check the electrical impulses or the size of the heart. This is a non-invasive test.

A school nurse is caring for a child with a severe sore throat and fever. What is the nurse’s best recommendation to the parent?

Have the child drink fluids that contain electrolytes.

Give acetaminophen for the fever and pain, and have the child rest.

Have the child go to the emergency room.

Have the child be seen by the primary care provider.

Have the child be seen by the primary care provider. Explanation: Children with sore throats and fevers should be seen by their primary care provider to rule out strep throat. This is extremely important due to the fact they may contract an acquired heart disease called rheumatic fever. Taking acetaminophen, resting, and drinking fluids are all good recommendations, but the best recommendation is to see the provider. Going to the emergency room is not necessary at this time.

What would be the most important measure to implement for an infant who develops heart failure?

Planning ways to reduce salt intake

Placing her in a semi-Fowler’s position

Restricting milk intake daily

Keeping her supine and playing quiet games

Placing her in a semi-Fowler’s position Explanation: Placing an infant with heart failure in a semi-Fowler’s position reduces the pressure of abdominal contents against the chest and gives the heart the opportunity to function more effectively.

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting?

Feeding problems

Bradypnea

Bradycardia

Yellowish color

Feeding problems Explanation: The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. The heart beats faster in an attempt to increase blood flow. Failure to gain weight, weakness, and an enlarged liver and heart are other possible indicators of CHF but are not as common as tachycardia and may take longer to develop

The nurse is performing an ECG on a 12-year-old boy. On completion, she notices that boy’s P-R interval is lengthened. Which of the following does this finding indicate?

Difficulty with coordination between the SA and AV nodes (first-degree heart block) Explanation: On an ECG tracing, a longer-than-usual P wave suggests the atria are hypertrophied making it take longer than usual for the electrical conduction to spread over the atria. A lengthened P-R interval suggests there is a difficulty with coordination between the SA and AV nodes (first-degree heart block). A heightened R wave indicates ventricular hypertrophy is present. An R wave which is decreased in height suggests the ventricles are not contracting fully, as happens if they are surrounded by fluid (pericarditis). Elongation of the T wave occurs in hyperkalemia; depression of the T wave is associated with anoxia; depression of the ST segment is associated with abnormal calcium levels.

Coarctation of the aorta demonstrates few symptoms in newborns. Which of the following is an important assessment to make on all newborns to help reveal this condition?

Observing for excessive crying

Assessing for the presence of femoral pulses

Recording an upper extremity blood pressure

Auscultating for a cardiac murmur

Assessing for the presence of femoral pulses Explanation: Infants with a narrowing (coarctation) of the aorta have decreased pressure in the lower extremities or absence of femoral pulses.

An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize?

"You get some medicine that will make you sleepy."

"You need to lie very still during this test."

"You’ll have to wear the monitor for 24 hours."

"You need to report any symptoms you are having during the test."

"You need to report any symptoms you are having during the test." Explanation: It is important for the child to report any symptoms felt during the test to help quantify the child’s exercise tolerance. Exercise stress testing involves activity. Ambulatory electrocardiographic monitoring is performed over 24 hours. Sedation is not used for an exercise stress test. It is used for an arteriogram.

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks she has noticed that the child seems to have lack of coordination. In addition, she reports the child has had facial grimaces and repetitive involuntary movements. The signs the caregiver reports indicate the child has:

polyarthritis.

carditis.

chorea.

arthralgia.

Chorea Explanation: Chorea is a disorder characterized by emotional instability, purposeless movements, and muscular weakness. The onset of chorea is gradual, with increasing incoordination, facial grimaces, and repetitive involuntary movements.

A parent is told their infant has a heart defect with a left to right shunt. What is the best way for the nurse to explain this type of shunting to the parent?

This type of shunting causes a decrease of blood to the lungs.

This type of shunting causes an increase of blood to the lungs.

This type of shunting causes an increase of blood to the systemic circulation.

This type of shunting causes a decrease of blood to the brain.

This type of shunting causes an increase of blood to the lungs. Explanation: This type of shunting causes an increase of blood to the lungs. A right to left shunt causes an increase in blood to the systemic circulation that is mixed with deoxygenated blood.

The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding?

110/60 mm Hg

80/40 mm Hg

100/60 mm Hg

90/64 mm Hg

90/64 mm Hg Explanation: The toddler’s or preschooler’s blood pressure averages 80 to 100/64 mm Hg. The normal infant’s blood pressure is about 80/40 mm Hg. The school-age child’s blood pressure averages 94 to 112/56 mm Hg. An adolescent’s blood pressure averages 100 to 120/50 to 70 mm Hg.

The nurse is caring for a 10-year-old boy following a cardiac catheterization. Four hours after the procedure, the nurse notes some minor bleeding at the site. Which action would be most appropriate?

Change the dressing.

Contact the physician.

Apply pressure 1 inch above the site.

Ensure that the child’s leg is kept straight.

Apply pressure 1 inch above the site. Explanation: If bleeding occurs after a cardiac catheterization, apply pressure 1 inch above the site to create pressure over the vessel, thereby reducing the blood flow to the area. The nurse should first apply pressure and then notify the physician if this measure is ineffective or the bleeding increases. The child should maintain the leg in a straight position for about 4 to 8 hours. However, this would not address the bleeding assessed at the site. Changing the dressing would not be effective.

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Which of the following findings would the nurse expect to note?

Lower extremities

Face

Presacral region

Hands

Lower extremities Explanation: Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents the following expected finding:

Appropriate mastery of developmental milestones

Steady weight gain since birth

Softening of the nail beds

Intact rooting reflex

Softening of the nail beds Explanation: Softening of nail beds is the first sign of clubbing due to chronic hypoxia. Rounding of the fingernails is followed by shininess and thickness of nail ends.

The nurse is assessing the past medical history of an infant with a suspected cardiovascular disorder. Which response by the mother warrants further investigation?

"I had the flu during my last trimester."

"His Apgar score was an 8."

"I am on a low dose of steroids."

"I was really nauseous throughout my whole pregnancy."

"I am on a low dose of steroids" Explanation: Some medications, like corticosteroids, taken by pregnant women may be linked with the development of congenital heart defects. Reports of nausea during pregnancy and an Apgar score of eight would not trigger further questions. Febrile illness during the first trimester, not the third, may be linked to an increased risk of congenital heart defects.

The care provider has ordered the drug furosemide (Lasix) to treat a child diagnosed with congestive heart failure. The nurse knows that this drug will be used to:

Eliminate excess fluids Explanation: Diuretics, such as furosemide (Lasix), thiazide diuretics, or spironolactone (Aldac tone), and fluid restriction in the acute stages of CHF help to eliminate excess fluids in the child with congestive heart failure. Vasodilators are used to dilate the blood vessels. Digoxin is used to improve the cardiac efficiency by slowing the heart rate and strengthening the cardiac contractility.

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? Select all that apply.

4-month-old child with an apical heart rate of 102 beats per minute

5-year-old child who developed vomiting and diarrhea, and is difficult to arouse

2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning

12-year-old child whose digoxin level was 0.9 ng/ mL on a blood draw this morning

16-year-old child with a heart rate of 54 beats per minute

• The 16-year-old child has a heart rate of 54 beats per minute • The 5-year-old child has developed vomiting, diarrhea and is difficult to arouse • The 2-year-old child has a digoxin level of 2.4 ng/mL from a blood draw this morning Explanation: The nurse should not administer digoxin to children with the following issues: The adolescent with an apical pulse under 60 beats per minute, the child with a digoxin level above 2 ng/mL, and the child who exhibiting signs of digoxin toxicity

The nurse is conducting a physical examination of a 7-year-old girl prior to a cardiac catheterization. The nurse knows to pay particular attention to assessing the child’s pedal pulses. How can the nurse best facilitate their assessment after the procedure?

Mark the child’s pedal pulses with an indelible marker, then document.

Assess the location and quality of the child’s peripheral pulses.

Mark the location of the child’s peripheral pulses with an indelible marker.

Document the location and quality of the child’s pedal pulses.

Mark the child’s pedal pulses with an indelible marker, then document Explanation: The nurse should pay particular attention to assessing the child’s peripheral pulses, including pedal pulses. Using an indelible pen, the nurse should mark the location of the child’s pedal pulses as well as document the location and quality in the child’s medical records.

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note?

Appropriate mastery of developmental milestones

Pitting periorbital edema

Bounding pulse

Preference to resting on the right side

Bounding pulse Explanation: A bounding pulse is characteristic of patent ductus arteriosis or aortic regurgitation. Narrow or thready pulses may occur in children with heart failure or severe aortic stenosis. A normal pulse would not be expected with aortic regurgitation.

The nurse is auscultating heart sounds of a child with a mitral valve prolapse. The nurse should expect which assessment finding?

Abnormal splitting of S2 sounds

Intensifying of S2 sounds

Mild to late ejection click at the apex

Clicks on the upper left sternal border

A mild to late ejection click at the apex Explanation: A mild to late ejection click at the apex is typical of a mitral valve prolapse. Abnormal splitting or intensifying of S2 sounds occurs in children with r heart problems, not mitral valve prolapse. Clicks on the upper left sternal border are related to the pulmonary area

The nurse performs a cardiac assessment and notes a loud heart murmur with a precordial thrill. This murmur would be classified as a:

Grade II.

Grade I.

Grade IV.

Grade III.

Grade IV Explanation: A heart murmur characterized as loud with a precordial thrill is classified as Grade IV. Grade II is soft and easily heard. Grade I is soft and hard to hear. Grade III is loud without thrill

The nurse is conducting a physical examination of an infant with a suspected cardiovascular disorder. Which assessment finding is suggestive of sudden ventricular distention?

Decreased blood pressure

Heart murmur

Cool, clammy, pale extremities

Accentuated third heart sound

Accentuated third heart sound Explanation: An accentuated third heart sound is suggestive of sudden ventricular distention. Decreased blood pressure, cool, clammy, and pale extremities, and a heart murmur are all associated with cardiovascular disorders; however, these findings do not specifically indicate sudden ventricular distention.

The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents ask the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the the nurse?

"Oxygen isn’t always the best treatment for your child’s condition. Surgery is necessary."

"I can only place oxygen on your child if the doctor orders oxygen."

"This is something we should talk with the physician about. Maybe it would help your baby."

"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help."

"While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help." Explanation: For children with congenital defects with increased pulmonary blood flow, oxygen supplementation is not helpful. Oxygen acts as a pulmonary vasodilator. If pulmonary dilation occurs, pulmonary blood flow is even greater, causing tachypnea, increasing lung fluid retention, and eventually causing a much greater problem with oxygenation; therefore, preventing the development of pulmonary disease via early surgical correction is essential. Although oxygen must be ordered by the physician and it isn’t the best treatment, the nurse stating, "While it seems that oxygen would help, it actually makes the condition worse. Treating the cause of the disease will help" best answers the question while also showing empathy.

The nurse is caring for a pediatric c;ient diagnosed with tetralogy of Fallot. After speaking with the physician, the parents state to the nurse, "The doctor said something about our child having too many red blood cells. We don’t understand how that could happen?" What is the best response by the nurse?

"The doctor was talking about polycythemia. It’s common with this type of heart disorder."

"I’m not really sure what red blood cells have to do with the heart defect your child has. We should ask your doctor."

"It is a very complicated process. Since your child has tetralogy of Fallot, their body is overtaxed with everything it does. The amount of red blood cells being produced is just one more thing the heart has to deal with."

"Your child’s body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder."

"Your child’s body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder." Explanation: To compensate for low blood oxygen levels, the kidneys produce the hormone erythropoietin to stimulate the bone marrow to produce more red blood cells (RBCs). This increase in RBCs is called polycythemia. Polycythemia can lead to an increase in blood volume and possibly blood viscosity, further taxing the workload of the heart. The correct response is the clearest and easiest description for the parents to understand. Telling the parents the doctor was discussing polycythemia with them doesn’t answer their question.

The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don’t understand why their child isn’t gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond?

"Are you sure you are making nutrient dense foods?"

"Maybe your child doesn’t really like the foods your making. This could lead to not gaining sufficient weight."

"It’s hard to get your child to eat enough at this age to maintain their weight since they are expending so much energy with the heart condition."

"It’s great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain."

"It’s great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain." Explanation: Small, frequent feedings will reduce the amount of energy required to feed or eat and prevents overtiring the child. Questioning if the parents are making nutritious foods or foods the child likes does not address the issue of energy expenditure when eating 3 larger meals per day. Just stating that it is "hard to get your child to eat enough" also does not address the situation

The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements? Select all that apply.

"Our child will be so excited to get back to soccer league in a few days."

"We will be sure to not allow our child to ride a bicycle for at least 2 weeks."

"We know how important our child’s medications are so we will write out a schedule to be sure medications are taken as prescribed."

"We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any."

"It’s wonderful that our child will never have an abnormal heart rhythm again."

• "We know how important our child’s medications are so we will write out a schedule to be sure medications are taken as prescribed." • "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." • "We will be sure to not allow our child to ride a bicycle for at least 2 weeks." Explanation: With the Gore® Helex device, strenuous activity should be avoided for 2 weeks after the procedure, so neither soccer or bicycle riding would be allowed. Children should be monitored for the possible presence of atrial arrhythmias (lifelong) after surgical closure for the defect. Infection is a complication that must be monitored for and reported to the physician, and medications must be given as prescribe

The nurse is caring for a 10-year-old girl with a suspected heart dysrhythmia. The nurse would expect to prepare the child for which test to identify and quantitate the dysrhythmia?

Arteriogram

Ambulatory electrocardiographic monitoring

Echocardiogram

Chest radiograph

Ambulatory electrocardiographic monitoring Explanation: Ambulatory electrocardiographic monitoring is indicated to identify and quantitate arrhythmias in a 24-hour period during normal daily activities. An echocardiogram is done to provide a specific diagnosis of structural defects, to determine hemodynamics, and to detect valvular defects. A chest radiograph is indicated to detect abnormalities of structures within the chest. An arteriogram is ordered to observe blood flow to parts of the body and detect lesions and confirm a diagnosis.

A healthcare provider and other health team members are discussing congenital heart disorders which increase pulmonary blood flow. Which disorders are topics for this discussion? Select all that apply.

Ventricular septal defect

Coarctation of the aorta

Atrioventricular canal defect

Pulmonary stenosis

Patent ductus arteriosus

• Ventricular septal defect • Patent ductus arteriosus • Atrioventricular canal defect Explanation: Congenital heart defects classified as disorders with increased pulmonary blood flow include ventricular septal defect, patent ductus arteriosus, and atrioventricular canal defect. Pulmonary stenosis and coarctation of the aorta are classified as disorders with obstruction to blood flow.

The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant’s heart rate?

80 to 105 bpm

60 to 68 bpm

70 to 80 bpm

90 to 160 bpm

90 to 160 bpm Explanation: The normal infant heart rate averages 90 to 160 beats per minute (bpm); the toddler’s or preschooler’s is 80 to 115, the school-age child’s is 60 to 100 bpm.

A child will be undergoing a Holter monitor test. Which statement by the mother indicates the need for further instruction?

"This test will monitor my child for about 24 hours."

"We do not need to alter our activities during the testing period."

"Wearing a snug shirt the day of the test will be helpful."

"My child cannot have any thing to eat or drink after midnight the day of the test."

"My child cannot have any thing to eat or drink after midnight the day of the test." Explanation: Ambulatory electrocardiographic monitoring (Holter) testing is an exam that spans approximately 24 hours. The test is done to review the activity of the heart. The individual is encouraged to follow their normal activities during the test. There is no need for the child to be NPO prior to or during the test.

A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis?

Tetralogy of Fallot

Pulmonary stenosis

Aortic stenosis

Coarctation of aorta

Tetralogy of Fallot Explanation: Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis

The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder?

Cardiomyopathy

Infective endocarditis

Heart failure

Kawasaki Disease

Heart failure Explanation: Infective endocarditis would present with intermittent, unexplained low-grade fever, fatigue, anorexia, weight loss, or flu-like symptoms. Characteristics of cardiomyopathy include respiratory distress, fatigue, poor growth (dilated), chest pain, dizziness, and syncope. Abdominal pain, joint pain, fever, irritability are signs of Kawasaki disease.

The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse?

"It is a difficult process to understand. Rest assured that we are doing everything in your child’s best interest."

"We have standardized care plans for children with congenital heart defects and this nursing diagnosis is on the care plan."

"The heart is a pump and it isn’t pumping effectively."

"Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs."

"Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." Explanation: This response best explains the meaning of the nursing diagnosis and it’s cause. Although there are standardized care plans as a guide, each care plan must be individualized to the client. Stating, "The heart is a pump and it isn’t pumping effectively" does not explain the nursing diagnosis. Telling the parents not to worry does not help in educating them.

The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?

"He walks very quickly and never stops moving."

"He likes to stop and squat wherever he walks."

"He takes one nap a day and is fairly active."

"He does not seem to have difficulty breathing."

"He likes to stop and squat wherever he walks." Explanation: The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance. Constant movement and quick walking are normal for a toddler. Activity level with a daily nap is typical of a toddler. Difficulty breathing would suggest a problem.

Tetralogy of Fallot consists of the following four anomalies: aortic stenosis, atrial septal defect, dextroposition (overriding) of the aorta, and hypertrophy of the left ventricle.

True

False

False Explanation: Tetralogy of Fallot consists of four anomalies: pulmonary stenosis, ventricular septal defect (usually large), dextroposition (overriding) of the aorta, and hypertrophy of the right ventricle.

The nurse is reviewing nutritional recommendations with the parents of a teen diagnosed with hyperlipidemia. Which statements indicate an understanding of the recommended diet for this condition? Select all that apply.

"Cooking with palm oil will be helpful."

"I should plan to have vegetables with each evening meal served."

"My child loves chicken and I can still serve it but I need to remove the skin."

"I need to limit fat intake in meals to 40%."

"Adding fresh fruits to my child’s lunch is a good idea."

• "I should plan to have vegetables with each evening meal served." • "Adding fresh fruits to my child’s lunch is a good idea." • "My child loves chicken and I can still serve it but I need to remove the skin." Explanation: Hyperlipidemia refers to high levels of lipids (fats/cholesterol) in the blood. High lipid levels are a risk factor for the development of atherosclerosis, which can result in coronary artery disease, a serious cardiovascular disorder occurring in adults. Dietary management is the first step in the prevention and management of hyperlipidemia in children older than 2 years of age. The diet should consist primarily of fruits, vegetables, low-fat dairy products, whole grains, beans, lean meat, poultry, and fish. As in adults, fat should account for no more than 30% of daily caloric intake. Fat intake may vary over a period of days, as many young children are picky eaters. Limit saturated fats by choosing lean meats, removing skin from poultry before cooking, and avoiding palm, palm kernel, and coconut oils as well as hydrogenated fats

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure?

"He seems to have a normal appetite."

"He gets sweaty when he eats."

"He does not seem sick."

"He does not seem short of breath."

"He gets sweaty when he eats." Explanation: Diaphoresis with nipple feeding indicates heart failure. Shortness of breath would suggest heart failure. Children with heart failure experience subtle signs that suggest that something is wrong. Children with heart failure often display subtle signs such as difficulty feeding.

The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy?

94 to 112/56 to 60 mm Hg

100 to 120/70 to 80 mm Hg

80 to 90/40 to 64 mm Hg

80 to 100/64 to 80 mm Hg

100 to 120/70 to 80 mm Hg Explanation: The normal adolescent’s blood pressure averages 100 to 120/70 to 80 mm Hg. The average infant’s blood pressure is about 80/55 mm Hg. The toddler or preschooler’s blood pressure averages 90 to 110/55 to 75 mm Hg. The normal school-ager’s blood pressure averages 100 to 120/60 to 75 mm Hg

The nurse is caring for a child who has been experiencing hypercyanotic episodes. Which treatments will be effective in managing them? Select all that apply.

Apply a cool cloth the child’s forehead.

Provide supplemental oxygen.

Administer Demerol as prescribed.

Reduce intravenous fluids.

Assist the child to a knee chest position.

• Provide supplemental oxygen. • Assist the child to a knee chest position. Explanation: When hypercyanotic episodes are encountered there are treatments that can be administered by the nurse to provide supportive care to the child. These interventions include providing supplemental oxygen. This measure promotes increased perfusion to the body. Placing the child in a knee-chest position will reduce workload on the heart and promotes perfusion. There is no reason to utilize a cloth to the child’s head. Demerol is not administered. If medications are used, morphine would be the narcotic of choice. With hypercyanotic episodes intravenous fluids are increased not decreased.

The parents of a 2-year-old newly diagnosed with tricuspid atresia ask the nurse, "I don’t understand why our child’s fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is most likely to be understood by the parents?

"The number of red blood cells has significantly increased from the heart defect, resulting in the cells pooling in the fingertips."

"Chronic hypoxia from your child’s heart defect causes effects in various parts of the body, including the fingers."

"This is a common complication of tricuspid atresia. Unfortunately there is nothing we can do to treat it."

"The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes."

"The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." Explanation: Clubbing (which is what the parents are describing) of fingertips or toes can occur from the chronic hypoxia that occurs with disorders with decreased pulmonary blood flow, such as tricuspid atresia. Using the term "low oxygen levels in the blood" rather than "chronic hypoxia" is a better way to explain what is happening to the parents. Red blood cell pooling is not the cause of clubbing. Although clubbing is a possible result of tricuspid atresia, telling the parents this is a "common complication" does not address the parent’s concerns.

The nurse is assessing a child with aortic stenosis. Which findings would the nurse most likely assess? Select all that apply.

Blood pressure in arms significantly higher than in legs

Thrill palpated at base of heart

Moderately loud systolic murmur at the base of the heart

Dizziness with prolonged standing

Chest pain with activity

• Dizziness with prolonged standing • Chest pain with activity • Thrill palpated at base of heart Explanation: Assessment findings associated with aortic stenosis include angina or chest pain with activity, dizziness with prolonged standing, and a thrill palpated at the base of the heart. A moderately loud systolic murmur at the base of the heart and blood pressure that is significantly higher in the arms than in the legs, possibly 20 mm Hg or higher, suggests coarctation of the aorta.

The physician suspects a 13-month-old may have a ventricular septal defect based on the signs and symptoms displayed. The parents ask the nurse what tests the physician may order to determine if their child has this diagnosis. The nurse is correct when telling the parents that common diagnostic testing for this disorder includes which tests?

Cardiac catheterization

CT scan

Echocardiogram

PET scan

MRI

• MRI • Echocardiogram • Cardiac catheterization Explanation: An abnormal opening between the right and left ventricles in ventricular septal defect. Magnetic resonance imaging (MRI) or echocardiogram with color flow Doppler may reveal the opening as well as the extent of left-to-right shunting. These studies also may identify right ventricular hypertrophy and dilation of the pulmonary artery resulting from the increased blood flow. Cardiac catheterization may be used to evaluate the extent of blood flow being pumped to the pulmonary circulation and to evaluate hemodynamic pressures.

The nurse is caring for a 3 month old with history of congenital heart disease. The infant is brought to the emergency department with nausea and vomiting for 3 days. Admission labs confirm dehydration. The nurse realizes that the dehydrated infant is at risk for:

jaundice.

seizure activity.

tachycardia.

a cerebrovascular accident.

a cerebrovascular accident. Explanation: Children who have polycythemia from cardiovascular disease can develop thrombi if they become dehydrated.

The child has returned to the nurse’s unit following a cardiac catheterization. The insertion site is located at the right groin. Peripheral pulses were easily palpated in bilateral lower extremities prior to the procedure. Which finding should be reported to the child’s physician?

The child is reporting nausea.

The right groin is soft without edema.

The child has a temperature of 102.4° F (39.1° C).

The child has a runny nose.

The child’s right foot is cool with a pulse assessed only with the use of a Doppler.

• The child has a temperature of 102.4° F (39.1° C). • The child is reporting nausea. • The child’s right foot is cool with a pulse assessed only with the use of a Doppler. Explanation: The following information should be reported to the physician following a cardiac catheterization because they are indicative of possible complications: Negative changes to the child’s peripheral vascular circulatory status (cool foot with poor pulse), a fever over 100.4° F (37.8° C), and nausea or vomiting.

The nurse is caring for a newborn who is scheduled for cardiac surgery to correct a diagnosed defect. Which statements by the mother demonstrate understanding of the situation? Select all that apply.

"I’m sure it is likely that my baby will be in intensive care after surgery. I believe I can pump so he can still receive my milk."

"I know my child uses up a lot of energy feeding but it doesn’t seem to cause distress when I breast feed."

"Since having the surgery my baby sometimes nurses for almost an hour."

"I have read that human milk fortifier can be added to my breast milk for additional calorie needs if necessary."

"I hope my baby doesn’t have to have feeding through a feeding tube after surgery, but I know that is a possibility."

• "I know my child uses up a lot of energy feeding but it doesn’t seem to cause distress when I breast feed." • "I’m sure it is likely that my baby will be in intensive care after surgery. I believe I can pump so he can still receive my milk." • "I hope my baby doesn’t have to have feeding through a feeding tube after surgery, but I know that is a possibility." • "I have read that human milk fortifier can be added to my breast milk for additional calorie needs if necessary." Explanation: Children with congenital heart defects typically have increased nutritional needs due to the increased energy expenditure associated with increased cardiac and respiratory workloads. Most infants do well with breast feeding as long as feeding does not last for periods of more than about 20 minutes. Gavage is sometimes necessary postoperatively, and this can be accomplished with pumped breast milk, as well as human milk fortifier when necessary for calorie needs.

The nurse is caring for a child who is preparing to undergo an exercise stress test. Which interventions will be included in the care?

Assess blood glucose level prior to the start of the test and one hour after.

Remind child to verbalize any feelings of discomfort during the test.

Monitor vital signs at completion of the test.

Monitor vital signs prior to the start of the test.

Complete EKG one hour after test is completed.

• Monitor vital signs prior to the start of the test. • Remind child to verbalize any feelings of discomfort during the test. • Monitor vital signs at completion of the test. Explanation: The exercise stress test monitors heart rate, blood pressure, ECG, and oxygen consumption at rest and during exercise. Vital signs are taken prior to, during and after the test period. An EKG is taken prior to the test. Serum glucose levels are not associated with this test.

A child is suspected of having tricuspid atresia. Which findings are consistent with this disorder? Select all that apply.

Bilateral crackles in lung fields

Bradypnea

Tachypnea

Peripheral cyanosis in the first few hours after birth

Weak infant sucking

• Tachypnea • Weak infant sucking • Bilateral crackles in lung fields Explanation: Tricuspid atresia is a congenital heart defect in which the valve between the right atrium and right ventricle fails to develop. As a result, there is no opening to allow blood to flow from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs. Related findings include tachypnea, respiratory crackles or wheezes, and diminished sucking reflex. Peripheral cyanosis in the immediate hours after birth is a normal finding for many infants and is not specific to this disorder.

A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series of laboratory tests have been ordered. Which findings are consistent with this disease? Select all that apply.

Reduced white blood cell count

Negative C reactive protein levels

Reduced hemoglobin levels

Reduced platelet levels

Elevated erythrocyte sedimentation rate (ESR)

• Reduced hemoglobin levels • Elevated erythrocyte sedimentation rate (ESR) Explanation: Kawasaki disease is an acute systemic vasculitis occurring mostly in children 6 months to 5 years of age. It is the leading cause of acquired heart disease among children. The CBC count may reveal mild to moderate anemia, an elevated white blood cell count during the acute phase, and significant thrombocytosis (elevated platelet count [500,000 to 1 million]) in the later phase. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level are elevated.

Which findings are major criteria used to help the physician diagnose acute rheumatic fever in a child? Select all that apply.

Heart block with a prolonged PR interval

Temperature of 101.2° F(38.4° C)

Painless nodules located on the wrists

Elevated erythrocyte sedimentation rate

Pericarditis with the presence of a new heart murmur

• Painless nodules located on the wrists • Pericarditis with the presence of a new heart murmur Explanation: Subcutaneous nodules and carditis are considered major criteria used in the diagnosing of acute rheumatic fever. The other options are minor criteria.

A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits?

Semi-Fowler

Lithotomy

Side lying

Prone

Semi-Fowler Explanation: Due to the hemodynamic changes accompanying the underlying structural defect, oxygenation is key. Provide frequent ongoing assessment of the child’s cardiopulmonary status. Assess airway patency and suction as needed. Position the child in the Fowler or semi-Fowler position to facilitate lung expansion.

The young child had a chest tube placed during cardiac surgery. Which findings may indicate the development of cardiac tamponade? Select all that apply.

The child’s heart rate has increased from 88 beats per minute to 126 beats per minute.

The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube.

The child is resting quietly.

The child’s apical heart rate is strong and easily auscultated.

The child’s right atrial filling pressure has decreased.

• The child’s heart rate has increased from 88 beats per minute to 126 beats per minute. • The chest tube drainage had been averaging 15 to 25 mL out per hour and now there is no drainage from the chest tube. Explanation: Abrupt cessation of chest tube output and an increased heart rate are indicators that the child may have developed cardiac tamponade. The child’s right atrial filling pressure will increase. The child may be anxious and their apical heart rate may be faint and difficult to auscultate.

A child has been prescribed spironolactone. Which laboratory values should be reviewed when following up on this medication? Select all that apply.

Serum sodium levels

Serum chloride levels

Serum calcium levels

Serum magnesium levels

Serum potassium levels

• Serum sodium levels • Serum potassium levels Explanation: Spironolactone is a potassium sparing diuretic that competes with aldosterone to result in increased water and sodium excretion (spares potassium). Used to manage edema due to heart failure and for treatment of hypertension. Serum potassium and sodium levels should be evaluated in someone taking this medication.