Alterations in Cardiovascular Function in Children

Signs and symptoms of congenital heart disease in infants include (Select all that apply)

A. Dyspnea with crying or eating

B. Pink blood-tinged phlegm

C. Pallor

D. Poor feeding

E. Sweating

F. Elevated blood pressure

G. Murmur

H. Cyanosis with crying or eating

I. Fatigue

J. No weight gain

K. Irritable

L. Vomiting

ACDEGHIJK

Which of the following should the nurse expect to note as a frequent complication for a child with congenital heart disease?

A. Susceptibility to respiratory infection

B. Bleeding tendencies

C. Frequent vomiting and diarrhea

D. Seizure disorder

A

Match the following congenital heart defects with the correct descriptor. There is only one descriptor per each defect.

1. Tetralogy of Fallot (TOF)

2. Atrial Septal Defect (ASD)

3. Truncus Arteriosus (TA)

4. Coarctation of the Aorta (COA)

5. Atrioventricular Septal Defect

6. Transposition of the Great Arteries (TGA)

7. Patent Ductus Arteriosus (PDA)

A. Aorta is lined up just over the hole between the bottom two chambers of the heart.

B. There is a hole between the top two chambers of the heart.

C. One large blood vessel with a single valve leaves the heart.

D. There is a narrowing of the major artery from the heart to the body.

E. There is a hole between the top two chambers and the bottom two chambers of the heart. Common with Down syndrome.

F. The pulmonary artery and the aorta are in opposite position of where they should be. Two noncommunicating circulatory systems—a condition incompatible with life.

G. There is an open connection between the aorta and the pulmonary artery.

1 - A

2 - B

3 - C

4 - D

5 - E

6 - F

7 - G

With acyanotic heart defects, there is a left-to-right shunt. There is increased pulmonary blood flow and the blood is oxygenated.

True or false?

True

With cyanotic heart defects, there is a right-to-left shunt: blood is shunted from the right side of the heart (pulmonary) to the left (systemic) side. Pulmonary circulation is bypassed.

True or false?

True

A school-age child is admitted with a suspected acyanotic heart disease. After learning that the heart defect is a congenital disorder, the parents ask the nurse how they could have missed the problem all these years. The nurse's response should include the information that:

A. Acyanotic heart disease may be asymptomatic.

B. The child would only be cyanotic with great exertion.

C. The parents should have recognized the symptoms associated with an acyanotic heart defect.

D. The parents were probably ignoring the symptoms and hoping they would go away.

A

The nurse has admitted a child with a ventricular septal defect (VSD) to the unit. An appropriate nursing diagnosis for this child is

A. Impaired Gas Exchange Related to Pulmonary Congestion Secondary to the Increased Pulmonary Blood Flow.

B. Deficient Fluid Volume Related to Hyperthermia Secondary to the Congenital Heart Defect.

C. Acute Pain Related to the Effects of a Congenital Heart Defect.

D. Hypothermia Related to Decreased Metabolic State.

A

The laboratory finding that would be seen in the cyanotic heart disease client but not in the acyanotic heart disease client would be a(an):

A. Elevated pO2.

B. Elevated red blood cell count.

C. Decreased hematocrit.

D. Decreased pCO2.

B

In assessing children with congenital heart defects, the nurse would expect to see clubbing of the fingers and toes in the child diagnosed with:

A. Tetralogy of Fallot.

B. Atrial septal defect.

C. Coarctation of the aorta.

D. Patent ductus arteriosus.

A

In a normal heart, the blood follows this cycle: body-heart-lungs-heart-body. When a child has this congenital heart defect, the blood leaving the heart does not follow this path. It has only one vessel, instead of two separate ones for the lungs and body. With only one artery, there is no specific path to the lungs for oxygen before returning to the heart to deliver oxygen to the body. In addition, there is usually a hole between the two lower chambers of the heart known as a ventricular septal defect. As a result of this heart defect, oxygen-poor blood that should go to the lungs and oxygen-rich blood that should go to the rest of the body are mixed together. This creates severe circulatory problems. What is the name of this congenital heart defect?

A. Atroventricular canal defect

B. Hypoplastic left heart syndrome

C. Tetralogy of Fallot

D. Truncus arteriosus

E. Transposition of the great arteries

D

The pediatric nurse understands that spironolactone (aldactone): (select all that apply)

A. Decreases preload

B. Decreases afterload

C. Increases contractility of the heart

D. Has side effects of nausea, vomiting, anorexia, and bradycardia

E. Has side effects of hypokalemia, metabolic alkalosis, and hypotension

F. Has side effects of hyperkalemia and hypotension

G. Is a potassium-sparing maintenance diuretic

AFG

The pediatric nurse understands that furosemide (Lasix): (select all that apply)

A. Decreases preload

B. Decreases afterload

C. Increases contractility of the heart

D. Has side effects of nausea, vomiting, anorexia, and bradycardia

E. Has side effects of hypokalemia, metabolic alkalosis, and hypotension

F. Has side effects of hyperkalemia and hypotension

G. Promotes rapid diuresis by blocking reabsorption of sodium and water in the renal tubules.

AEG

The pediatric nurse understands that captopril (Capoten), an ACE-inhibitor: (Select all that Apply)

A. Decreases preload

B. Decreases afterload

C. Increases contractility of the heart

D. Has side effects of nausea, vomiting, and anorexia

E. Has side effects of hypokalemia, metabolic alkalosis, and hypotension

F. Has side effects of hyperkalemia and hypotension

G. Promotes vascular relaxation and reduced peripheral vascular resistance

BFG

The pediatric nurse understands that lanoxin (digoxin): (select all that apply)

A. Decreases preload

B. Decreases afterload

C. Increases contractility of the heart

D. Has side effects of nausea, vomiting, anorexia, and bradycardia

E. Has side effects of hypokalemia, metabolic alkalosis, and hypotension

F. Has side effects of hyperkalemia and hypotension

G. Can interact with over-the-counter medications, herbal preparations, and antibiotics.

CDG

The pediatric nurse understands that aspirin: (select all that apply)

A. Is used on a prophylactic basis to prevent heart attack and stroke in children

B. Is used to prevent blood clots from forming in the coronary arteries during the acute phase of Kawasaki disease

C. Is used to treat fever in viral illness in children

D. Is used to treat joint pain and inflammation in rheumatic fever

E. Is used to treat infection in rheumatic fever

F. Can be associated with Reye's syndrome, a serious and potentially deadly condition in children and teenagers

G. Decreases platelet aggregation and inhibits thrombus formation

BDFG

The pediatric nurse understands that sildenafil (Revatio, Viagra) is prescribed to

A. Decrease systemic blood pressure (afterload).

B. Decrease the stickiness of the platelets in the blood.

C. Decrease heart rate and increase contractility.

D. Increase the central venous pressure (preload).

E. Relax and widen the blood vessels in the lungs.

E

The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities. The next assessment the nurse should perform is to check:

A. Pedal pulses.

B. Pulse oximetry level.

C. Hemoglobin and hematocrit values.

D. Blood pressure of the four extremities.

D

Hypoplastic left heart syndrome consists of hypoplasia (i.e., underdevelopment or incomplete development) of the left ventricle and ascending aorta, maldevelopment and hypoplasia of the aortic and mitral valves (frequently aortic atresia is present), an atrial septal defect, and a large patent ductus arteriosus. Unless normal closure of the patent ductus arteriosus is prevented with prostaglandin infusion, cardiogenic shock and death ensue. The only cure is heart transplantation. This condition can be palliated through three-stage open-heart surgical procedures. This is not a cure, as the child's circulation is made to work with only two of the heart's four chambers.

True or false?

True

A newborn with possible hypoplastic left heart disease is to be admitted to the nursing unit. Which drug should be available for use?

A. Digitoxin (Crystodigin).

B. Prostaglandin E1 (Prostin VR).

C. Morphine Sulfate.

D. Testosterone (Andro).

B

Tetrology of Fallot is characterized by which cardiac defects? (Select all that apply)

A. Overriding aorta

B. Patent ductus arteriosus

C. Right ventricular hypertrophy

D. Ventricular septal defect

E. Coarctation of the Aorta

F. Tricuspid atresia (TA)

G. Pulmonary stenosis

ACDG

An infant with tetralogy of Fallot is having a hypercyanotic episode ("tet" spell). Appropriate management of a tet spell in these children include: (Select all that apply).

A. Place the child in knee-chest position.

B. Draw blood for a serum hemoglobin.

C. Administer oxygen.

D. Administer morphine and propranolol intravenously as ordered.

E. Administer Benadryl as ordered.

ACD

A 2-year-old child is being discharged home and will have palliative surgery for tetralogy of Fallot at a later date. The mother wants to know about how much physical activity she can allow for the child. The nurse's best answer is:

A. "Allow the child to regulate her activity."

B. "Keep her on complete bedrest."

C. "Limit her activities to a few hours."

D. "Keep the child from crying."

A

A baby is observed at birth to be noncyanotic. On physical examination the patient is found to have a continuous "machinery-type" murmur that is present in both systole and diastole. A nonsteroidal anti-inflammatory drug is prescribed, and on follow-up the murmur has disappeared. Which of the following is the most likely congenital lesion?

A. Patent ductus arteriosus

B. Tetralogy of Fallot

C. Transposition of the great arteries

D. Truncus arteriosus

A

The nurse is teaching the parents of a group of cardiac patients. The nurse includes in the information that a child who has undergone cardiac surgery

A. Should be restricted from most play activities.

B. Should be evaluated to determine if prophylactic antibiotics for dental, oral, or upper-respiratory-tract procedures are necessary.

C. Should not receive routine immunizations.

D. Can be expected to have a fever for several weeks following the surgery.

B

After a pediatric client has a cardiac catheterization, which intervention should have the highest priority in the immediate postoperative period?

A. Encourage intake of small amounts of fluid.

B. Teach the parents signs of congestive heart failure.

C. Monitor the site for signs of infection.

D. Observe cath insertion site for bleeding. If bleeding is found, the nurse should immediately glove, and apply direct manual pressure to the site (without leaving the patient's bedside) until hemostasis is obtained.

D

A 5 year old child has been transferred to the pediatric unit after a cardiac catheterization. The nurse has checked the sheath insertion site for bleeding, oozing, or hematoma. In order of priority, which of the following interventions should the nurse do next?

A. Monitor the child's comfort level

B. Position the child's leg so that it is straight

C. Assess the strength and presence of the distal pulses

D. Take the vital signs, including blood pressure and oxygen saturation

C

The nurse is checking peripheral perfusion to a child's extremity following a cardiac catheterization. If there is adequate peripheral circulation, the nurse should find that the extremity

A. Has a capillary refill of greater than three seconds.

B. Has a palpable dorsalis pedis pulse but a weak posterior tibial pulse.

C. Has decreased sensation with a weakened dorsalis pedis pulse.

D. Is warm, with a capillary refill of two seconds or less.

D

A child is being seen in the ambulatory clinic for a sore throat diagnosed as caused by group A beta hemolytic streptococcus. The nurse provides care with the understanding that the risk of developing rheumatic fever is greatest:

A. Two weeks later.

B. Prior to the administration of an antibiotic.

C. Once the child has begun antibiotic therapy.

D. With the onset of the strep infection.

A

A 7-year-old client is diagnosed with rheumatic fever. The physician orders throat cultures of all family members. The nurse explains that:

A. "Family members can carry streptococcus and be asymptomatic."

B. The child must have infected others."

C. "Rheumatic fever is familial."

D. "Family members can carry the virus for rheumatic fever."

A

A client is admitted with a diagnosis of "rule out rheumatic fever." Based on Jones criteria, the nurse assesses for

A. Polyarthritis and dental caries.

B. Fever, headache, and low red blood cell count.

C. Chorea, muscle weakness, and decreased erythrocyte sedimentation rate.

D. Erythema, polyarthritis, and elevated antistreptolysin-O (ASO) titer.

D

A 16 month old child diagnosed with Kawasaki Disease (KD) is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. Which of the following should the nurse interpret as the priority?

A. applying lotions to the hands and feet

B. offering foods the toddler likes

C. placing the toddler in a quiet environment

D. encouraging the parents to get some rest

C

The nurse is developing a discharge teaching plan for the family of a child with Kawasaki's disease. Which of the following is the first priority?

A. Teaching parents to administer aspirin and watch for side effects.

B. Monitoring the child's temperature and notifying the doctor if it is over 98.6 degrees F.

C. Recommending the child avoid contact sports.

D. Establishing home schooling for 6 months.

A

On initial exam of a child with newly diagnosed Kawasaki disease, the nurse should expect to document:

A. Dry, swollen, fissured lips.

B. Non-palpable lymph nodes.

C. Conjunctivitis with exudates.

D. Cyanosis of the hands and feet.

A

Which assessment data is most indicative of a potential complication of Kawasaki's disease?

A. Dermatitis of extremities; desquamation of the hands and feet.

B. Strawberry tongue; redness of the mucous membranes and sores in the mouth.

C. Change in blood pressure, pulse, and skin color; complaints of pain in the chest.

D. Fever over 5 days; redness and swelling of the eyes.

C

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

A. Weight loss.

B. Bradycardia.

C. Tachycardia.

D. Increased blood pressure.

C

Nursing interventions to promote a balanced dietary intake of food and fluids in an infant with congestive heart failure include: (select all that apply)

A. Keep coaxing the infant to suck on the bottle and to drink all the formula until the bottle is empty, no matter how long it takes.

B. Weigh the child daily.

C. Hold the infant at a 90-degree angle while feeding.

D. Use firm nipples with small openings to slow feedings.

E. Use high-calorie concentrated formula.

F. Space feedings 3 hours apart.

G. Use supplemental tube feedings if the infant is too fatigued to ingest a sufficient amount by mouth.

H. Provide large feedings every 5 hours to allow the infant to rest.

I. Limit bottle feedings to 20-30 minutes.

J. Provide small, frequent feedings

BEFGIJ

A nurse is caring for a 14 year-old child who has been diagnosed with Congestive Heart Failure (CHF). Treatment began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear and equal bilaterally, and heart rate is 70 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes that the child's urine output is

A. 0.4 mL/kg/hr

B. 1 mL/kg/hr

C. 2 mL/kg/hr

D. 3 mL/kg/hr

E. 30 mL/hr

F. 1 ounce/hr

B

A toddler has been started on digoxin (Lanoxin) for cardiac failure. If the child develops digoxin (Lanoxin) toxicity, the first sign the nurse notes should be

A. Lowered blood pressure.

B. Tinnitus.

C. Ataxia.

D. A change in heart rhythm.

D

Which evaluation would indicate a toxic dose of digoxin?

A. Tachycardia and dysrhythmia.

B. Headache and diarrhea.

C. Bradycardia and nausea and vomiting.

D. Tinnitus and nuchal rigidity.

C

The mother of a child with a heart defect is questioning the nurse about the child's medication. When discussing the diuretic the child is on, the nurse should place an emphasis on teaching about:

A. Close monitoring of output.

B. The digitalization process.

C. The possibility that pulses in the child might be weak.

D. The child's increased appetite.

A

The pediatric nurse understands that characteristics of pulmonary hypertension include (select all that apply):

A. The causes are lung disease and some congenital heart diseases.

B. Characterized by mean pulmonary arterial pressure (PAP) less than 25 mmHg.

C. Caused by narrowing of the pulmonary arterioles within the lung; the narrowing of the arteries creates resistance and an increased work load for the heart.

D. Symptoms include chest pain, weakness, shortness of breath, and fatigue.

E. Untreated, the disease usually develops into cyanotic heart defect and right-to-left shunting.

F. Must treat this condition early while still reversible to prevent permanent destructive pulmonary vascular remodeling.

G. Treatments include sildenafil, calcium channel blockers, diuretics, nitric oxide, and lung transplantation.

ACDFG

An athletic activity the nurse should recommend for a school-age child with pulmonary-artery hypertension is

A. Cross-country running.

B. Soccer.

C. Golf.

D. Basketball.

C