Chapter 25: The Child with Cardiovascular Dysfunction MULTIPLE CHOICE 1.
A chest radiograph film is ordered for a child with suspected cardiac problems. The
child’s parent asks the nurse, “What will the radiograph show
...
Chapter 25: The Child with Cardiovascular Dysfunction MULTIPLE CHOICE 1.
A chest radiograph film is ordered for a child with suspected cardiac problems. The
child’s parent asks the nurse, “What will the radiograph show about the heart?” The nurse’s response should be based on knowledge that the x-ray film will show: a.
bones of chest but not the heart.
b. measurement of electrical potential generated from heart muscle. c.
permanent record of heart size and configuration.
d. computerized image of heart vessels and tissues. ANS: C A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated from heart muscle. Echocardiography will produce a computerized image of the heart vessels and tissues by using sound waves.
PTS: 1 DIF: Cognitive Level: Understand REF: 835
TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
2. The nurse is assessing a child after a cardiac catheterization. Which complication
should the nurse be assessing for? a.
Cardiac arrhythmia
b. Hypostatic pneumonia c. Heart failure
d. Rapidly increasing blood pressure ANS: A
Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.
PTS: 1 DIF: Cognitive Level: Apply REF: 853
TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
3. José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching
should be: a.
directed at his parents because he is too young to understand.
b. c.
detailed in regard to the actual procedures so he will know what to expect. done several days before the procedure so that he will be prepared.
d. adapted to his level of development so that he can understand. ANS: DPreoperative teaching should always be directed at the child’s stage of development. The
caregivers also benefit from the same explanations. The parents may ask additional questions,
which should be answered, but the child needs to receive the information based on
developmental level. Preschoolers will not understand in-depth descriptions and should be
prepared close to the time of the cardiac catheterization.
PTS: 1
DIF: Cognitive Level: Apply
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
4. Which explanation regarding cardiac catheterization is appropriate for a preschool
child?
a.
Postural drainage will be performed every 4 to 6 hours after the test.
b.
It is necessary to be completely “asleep” during the test.
c. The test is short, usually taking less than 1 hour.
d. When the procedure is done, you will have to keep your leg straight for at least 4
hours.
ANS: D
The child’s leg will have to be maintained in a straight position for approximately 4 hours.
Younger children can be held in the parent’s lap with the leg maintained in the correct
position. Postural drainage will not be performed unless the child has corresponding
pulmonary problems. The child should be sedated to lie still, but being completely asleep is
not necessary. The test will vary in length of time from start to finish.
PTS: 1
DIF: Cognitive Level: Apply
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance
5.
The nurse is caring for a school-age child who has had a cardiac catheterization. The
child tells the nurse that the bandage is “too wet.” The nurse finds the bandage and bed soaked
with blood. The most appropriate initial nursing action is to:
a. notify physician.
b. apply new bandage with more pressure.
c.
place the child in Trendelenburg position.
d. apply direct pressure above catheterization site.
ANS: D
If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the
percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and
applying a new bandage can be done after pressure is applied. The nurse can have someone
else notify the physician while the pressure is being maintained. It is not a helpful intervention
to place the girl in the Trendelenburg position. It would increase the drainage from the lower
extremities.
PTS: 1
DIF: Cognitive Level: Apply
REF: 823
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
6.
The nurse is preparing an adolescent for discharge after a cardiac catheterization.
Which statement by the adolescent would indicate a need for further teaching?
REF: 823
REF: 822a.
b.
c.
“I should avoid tub baths but may shower.”
“I have to stay on strict bed rest for 3 days.”
“I should remove the pressure dressing the day after the procedure.”
d. “I may attend school but should avoid exercise for several days.”
ANS: B
The child does not need to be on strict bed rest for 3 days. Showers are recommended;
children should avoid a tub bath. The pressure dressing is removed the day after the
catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity
must be avoided for several days, but the child can return to school.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 823
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
7.
Surgical closure of the ductus arteriosus would:
a. stop the loss of unoxygenated blood to the systemic circulation.
b.
decrease the edema in legs and feet.
c.
increase the oxygenation of blood.
d. prevent the return of oxygenated blood to the lungs.
ANS: D
The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-
pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no
additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary
artery. The aorta carries oxygenated blood to the systemic circulation. Because of the higher
pressure in the aorta, blood is shunted into the pulmonary artery and the pulmonary
circulation. Edema in the legs and feet is usually a sign of heart failure. This repair would not
directly affect the edema. Increasing the oxygenation of blood would not interfere with the
return of oxygenated blood to the lungs.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 825
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
8. Which defect results in increased pulmonary blood flow?
a.
Pulmonic stenosis
b. Tricuspid atresia
c. Atrial septal defect
d. Transposition of the great arteries
ANS: C
Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left
atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the
pulmonary artery. Pulmonic stenosis is an obstruction to blood flowing from the ventricles.
Tricuspid atresia results in decreased pulmonary blood flow. Transposition of the great arteries
results in mixed blood flow.
PTS: 1
DIF: Cognitive Level: Understand
REF: 825
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation9.
The nurse is conducting a staff in-service on congenital heart defects. Which structural
defect constitutes tetralogy of Fallot?
a.
Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
b.
Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
c. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy
d. Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular
hypertrophy
ANS: A
Tetralogy of Fallot has these four characteristics: pulmonic stenosis, ventricular septal defect,
overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not atrial
stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy,
is present in tetralogy of Fallot. Tetralogy of Fallot has right ventricular hypertrophy, not left
ventricular hypertrophy, and an atrial septal defect, not aortic hypertrophy.
PTS: 1
DIF: Cognitive Level: Understand
REF: 830
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
10. A nurse is teaching nursing students the physiology of congenital heart defects. Which
defect results in decreased pulmonary blood flow?
a.
Atrial septal defect
b. Tetralogy of Fallot
c. Ventricular septal defect
d. Patent ductus arteriosus
ANS: B
Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis
increases the pressure in the right ventricle, causing the blood to go from right to left across
the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus
result in increased pulmonary blood flow.
PTS: 1
DIF: Cognitive Level: Understand
REF: 830
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
11. Which is best described as the inability of the heart to pump an adequate amount of
blood to the systemic circulation at normal filling pressures?
a.
Pulmonary congestion
b. Congenital heart defect
c. Heart failure
d. Systemic venous congestion
ANS: C
The definition of heart failure is the inability of the heart to pump an adequate amount of
blood to the systemic circulation at normal filling pressures to meet the body’s metabolic
demands. Pulmonary congestion is an excessive accumulation of fluid in the lungs.
Congenital heart defect is a malformation of the heart present at birth. Systemic venous
congestion is an excessive accumulation of fluid in the systemic vasculature.PTS: 1
DIF: Cognitive Level: Understand
REF: 830
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
12. Which is a clinical manifestation of the systemic venous congestion that can occur
with heart failure?
a.
Tachypnea
b. Tachycardia
c.
Peripheral edema
d. Pale, cool extremities
ANS: C
Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous
congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool
extremities are clinical manifestations of impaired myocardial function.
PTS: 1
DIF: Cognitive Level: Understand
REF: 835
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
13.
The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart
failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)?
a.
It decreases edema.
b.
c.
It decreases cardiac output.
It increases heart size.
d. It increases venous pressure.
ANS: A
Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous
pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size
and venous pressure are decreased by digoxin.
PTS: 1
DIF: Cognitive Level: Understand
REF: 835
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
14. A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor.
Which drug should the nurse be administering?
a.
Captopril (Capoten)
b. Furosemide (Lasix)
c.
Spironolactone (Aldactone)
d. Chlorothiazide (Diuril)
ANS: A
Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Spironolactone blocks the action
of aldosterone. Chlorothiazide works on the distal tubules.
PTS: 1
DIF: Cognitive Level: Remember
REF: 835
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy15. An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the
practitioner and withhold the medication if the apical pulse is less than _____ beats/min.
a.
60
b.
c.
70
90
d. 100
ANS: B
If a 1-minute apical pulse is less than 70 beats/min for an older child, the digoxin is withheld;
60 beats/min is the cut-off for holding the digoxin dose in an adult. A pulse below 90 to 110
beats/min is the determination for not giving a digoxin dose to infants and young children.
PTS: 1
DIF: Cognitive Level: Apply
REF: 836
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
16. A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the
practitioner and withhold the medication if the apical pulse is less than _____ beats/min.
a.
60
b.
c.
70
90 to 110
d. 110 to 120
ANS: C
If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a
6-month-old. 60 beats/min is the cut-off for holding the digoxin dose in an adult. 70 beats/min
is the determining heart rate to hold a dose of digoxin for an older child. 110 to 120 beats/min
is an acceptable heart rate to administer digoxin to a 6-month-old.
PTS: 1
DIF: Cognitive Level: Apply
REF: 836
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
17.
The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a
common sign of digoxin toxicity?
a.
Seizures
b. Vomiting
Bradypnea
c.
d. Tachycardia
ANS: B
Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin
toxicity. The child will have a slower heart rate, not respiratory rate. The heart rate will be
slower, not faster.
PTS: 1
DIF: Cognitive Level: Understand
REF: 839
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
18.
The parents of a young child with heart failure tell the nurse that they are “nervous”
about giving digoxin (Lanoxin). The nurse’s response should be based on which statement?
a.
It is a safe, frequently used drug.b.
c.
It is difficult to either overmedicate or undermedicate with digoxin.
Parents lack the expertise necessary to administer digoxin.
d. Parents must learn specific, important guidelines for administration of digoxin.
ANS: D
Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and
lethal doses is very small. Specific guidelines are available for parents to learn how to
administer the drug safely and to monitor for side effects. Digoxin is a frequently used drug,
but it has a narrow therapeutic range. Small amounts of the liquid are given to infants, making
it easy to overmedicate or undermedicate. Parents may lack the necessary expertise to
administer the drug at first, but with discharge preparation, they should be prepared to
administer the drug safely.
PTS: 1
DIF: Cognitive Level: Apply
REF: 839
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
19.
The nurse is talking to a parent of an infant with heart failure about feeding the infant.
Which statement about feeding the child is correct?
a.
“You may need to increase the caloric density of your infant’s formula.”
b.
c.
“You should feed your baby every 2 hours.”
“You may need to increase the amount of formula your infant eats with each
feeding.”
d. “You should place a nasal oxygen cannula on your infant during and after each
feeding.”
ANS: A
The metabolic rate of infants with heart failure is greater because of poor cardiac function and
increased heart and respiratory rates. Their caloric needs are greater than those of the average
infants, yet their ability to take in the calories is diminished by their fatigue. Infants with heart
failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest, and a 4-
hour schedule is too long. Fluids must be carefully monitored because of the heart failure.
Infants do not require supplemental oxygen with feedings.
PTS: 1
DIF: Cognitive Level: Apply
REF: 838-839
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
20. As part of the treatment for heart failure, the child takes the diuretic furosemide
(Lasix). As part of teaching home care, the nurse encourages the family to give the child foods
such as bananas, oranges, and leafy vegetables. These foods are recommended because they
are high in:
a. chlorides.
b.
potassium.
c. sodium.
d. vitamins.
ANS: B
Diuretics that work on the proximal and distal renal tubules contribute to increased losses of
potassium. The child’s diet should be supplemented with this electrolyte. With this type of
diuretic, potassium must be monitored and supplemented as needed.PTS: 1
DIF: Cognitive Level: Understand
REF: 840
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
21. An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The
nurse’s first action should be to:
a. assess for neurologic defects.
b.
place the child in the knee-chest position.
c.
begin cardiopulmonary resuscitation.
d. prepare family for imminent death.
ANS: B
The first action is to place the infant in the knee-chest position. Blow-by oxygen may be
indicated. Neurologic defects are unlikely. The child should be assessed for airway, breathing,
and circulation. Often, calming the child and administering oxygen and morphine can alleviate
the hypercyanotic spell.
PTS: 1
DIF: Cognitive Level: Apply
REF: 841-842
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
22.
The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect.
The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an
important objective to decrease this risk?
a. Minimize seizures.
b.
Prevent dehydration.
c.
Promote cardiac output.
d. Reduce energy expenditure.
ANS: B
In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in
hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting
cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular
accidents.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 841
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
23.
Parents of a 3-year-old child with congenital heart disease are afraid to let their child
play with other children because of possible overexertion. The nurse’s reply should be based
on which statement?
a.
Child needs opportunities to play with peers.
b.
c.
Child needs to understand that peers’ activities are too strenuous.
Parents can meet all of the child’s needs.
d. Constant parental supervision is needed to avoid overexertion.
ANS: AThe child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence. The child will be able to regulate activities.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Psychosocial Integrity
24. Which should the nurse consider when preparing a school-age child and the family for heart surgery? a.
Unfamiliar equipment should not be shown. b. Let child hear the sounds of an ECG monitor. c. Avoid mentioning postoperative discomfort and interventions.
d. Explain that an endotracheal tube will not be needed if the surgery goes well. ANS: B The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous (IV) lines, incision, and endotracheal tube.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance
25. Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F.
Which action should the nurse take? a.
Keep child warm with blankets. b. Apply a hypothermia blanket. c. Record temperature on nurses’ notes.
d. Report findings to physician. ANS: D
In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or continues after this period, it is most likely a sign of an infection and immediate investigation is indicated. Blankets should be removed from the child to keep the temperature from increasing. Hypothermia blanket is not indicated for this level of temperature. The temperature should be recorded, but the physician must be notified for evaluation. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are avoided by using appropriate technique.
PTS: 1 DIF: Cognitive Level: Apply REF: 846
TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
REF: 845 REF: 843
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