Chapter 25 The Child With Cardiovascular Dysfunction

Chapter 25: The Child with Cardiovascular Dysfunction
MULTIPLE CHOICE
1. A chest radiograph film is ordered for a child with suspected cardiac problems. The childs
parent asks the nurse, What will the radiograph show about the heart? The nurses response
should be based on knowledge that the x-ray film will show:
a. bones of chest but not the heart.
b. measurement of electrical potential generated from heart muscle.
c. permanent record of heart size and configuration.
d. computerized image of heart vessels and tissues.
ANS: C
A chest radiograph will provide information on the heart size and pulmonary blood-flow
patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as
the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated
from heart muscle. Echocardiography will produce a computerized image of the heart vessels
and tissues by using sound waves.
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
3. Jos is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should
be:
a. directed at his parents because he is too young to understand.
b. detailed in regard to the actual procedures so he will know what to expect.
c. done several days before the procedure so that he will be prepared.
d. adapted to his level of development so that he can understand.
ANS: D
Preoperative teaching should always be directed at the childs stage of development. The
caregivers also benefit from the same explanations. The parents may ask additional questions,
which should be answered, but the child needs to receive the information based on
developmental level. Preschoolers will not understand in-depth descriptions and should be
prepared close to the time of the cardiac catheterization.

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 childs leg will have to be maintained in a straight position for approximately 4 hours.
Younger children can be held in the parents 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.

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.

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?
a. I should avoid tub baths but may shower.
b. I have to stay on strict bed rest for 3 days.
c. I should remove the pressure dressing the day after the procedure.
d. I may attend school but should avoid exercise for several days.
ANS: B
The child does not need to be on strict bed rest for 3 days. Showers are recommended;
children should avoid a tub bath. The pressure dressing is removed the day after the
catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity
must be avoided for several days, but the child can return to school.
PTS: 1 DIF: Cognitive Level: Analyze REF: 823

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.

TOP: Integrated Process: Nursing Process: Planning
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.

9. 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.

10. A nurse is teaching nursing students the physiology of congenital heart defects. Which defect
results in decreased pulmonary blood flow?
a. Atrial septal defect
b. Tetralogy of Fallot
c. Ventricular septal defect
d. Patent ductus arteriosus
ANS: B
Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis
increases the pressure in the right ventricle, causing the blood to go from right to left across
the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus
result in increased pulmonary blood flow.

11. Which is best described as the inability of the heart to pump an adequate amount of blood to
the systemic circulation at normal filling pressures?
a. Pulmonary congestion
b. Congenital heart defect
c. Heart failure
d. Systemic venous congestion
ANS: C
The definition of heart failure is the inability of the heart to pump an adequate amount of
blood to the systemic circulation at normal filling pressures to meet the bodys metabolic
demands. Pulmonary congestion is an excessive accumulation of fluid in the lungs.
Congenital heart defect is a malformation of the heart present at birth. Systemic venous
congestion is an excessive accumulation of fluid in the systemic vasculature.
12. Which is a clinical manifestation of the systemic venous congestion that can occur with heart
failure?
a. Tachypnea
b. Tachycardia
c. Peripheral edema
d. Pale, cool extremities
ANS: C
Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous
congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool
extremities are clinical manifestations of impaired myocardial function.

13. The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure
(HF). Which is a beneficial effect of administering digoxin (Lanoxin)?
a. It decreases edema.
b. It decreases cardiac output.
c. It increases heart size.
d. It increases venous pressure.
ANS: A
Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous
pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size
and venous pressure are decreased by digoxin.

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

15. An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner
and withhold the medication if the apical pulse is less than _____ beats/min.
a. 60
b. 70
c. 90
d. 100
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.

16. A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner
and withhold the medication if the apical pulse is less than _____ beats/min.
a. 60
b. 70
c. 90 to 110
d. 110 to 120
ANS: C
If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a
6-month-old. 60 beats/min is the cut-off for holding the digoxin dose in an adult. 70 beats/min
is the determining heart rate to hold a dose of digoxin for an older child. 110 to 120 beats/min
is an acceptable heart rate to administer digoxin to a 6-month-old.

17. The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common
sign of digoxin toxicity?
a. Seizures
b. Vomiting
c. Bradypnea
d. Tachycardia
ANS: B
Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin
toxicity. The child will have a slower heart rate, not respiratory rate. The heart rate will be
slower, not faster.

18. The parents of a young child with heart failure tell the nurse that they are nervous about
giving digoxin (Lanoxin). The nurses response should be based on which statement?
a. It is a safe, frequently used drug.
b. It is difficult to either overmedicate or undermedicate with digoxin.
c. Parents lack the expertise necessary to administer digoxin.
d. Parents must learn specific, important guidelines for administration of digoxin.
ANS: D
Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and
lethal doses is very small. Specific guidelines are available for parents to learn how to
administer the drug safely and to monitor for side effects. Digoxin is a frequently used drug,
but it has a narrow therapeutic range. Small amounts of the liquid are given to infants, making
it easy to overmedicate or undermedicate. Parents may lack the necessary expertise to
administer the drug at first, but with discharge preparation, they should be prepared to
administer the drug safely.

19. The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which
statement about feeding the child is correct?
a. You may need to increase the caloric density of your infants formula.
b. You should feed your baby every 2 hours.
c. You may need to increase the amount of formula your infant eats with each
feeding.
d. You should place a nasal oxygen cannula on your infant during and after each
feeding.
ANS: A
The metabolic rate of infants with heart failure is greater because of poor cardiac function and
increased heart and respiratory rates. Their caloric needs are greater than those of the average
infants, yet their ability to take in the calories is diminished by their fatigue. Infants with heart
failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest, and a 4-
hour schedule is too long. Fluids must be carefully monitored because of the heart failure.
Infants do not require supplemental oxygen with feedings.
PTS: 1 DIF: Cognitive Level: Apply REF: 838-839

20. As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As
part of teaching home care, the nurse encourages the family to give the child foods such as
bananas, oranges, and leafy vegetables. These foods are recommended because they are high
in:
a. chlorides.
b. potassium.
c. sodium.
d. vitamins.
ANS: B
Diuretics that work on the proximal and distal renal tubules contribute to increased losses of
potassium. The childs diet should be supplemented with this electrolyte. With this type of
diuretic, potassium must be monitored and supplemented as needed.
21. An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurses first
action should be to:
a. assess for neurologic defects.
b. place the child in the knee-chest position.
c. begin cardiopulmonary resuscitation.
d. prepare family for imminent death.
ANS: B
The first action is to place the infant in the knee-chest position. Blow-by oxygen may be
indicated. Neurologic defects are unlikely. The child should be assessed for airway, breathing,
and circulation. Often, calming the child and administering oxygen and morphine can alleviate
the hypercyanotic spell.

22. The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The
nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an
important objective to decrease this risk?
a. Minimize seizures.
b. Prevent dehydration.
c. Promote cardiac output.
d. Reduce energy expenditure.
ANS: B
In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in
hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting
cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular
accidents.

23. Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with
other children because of possible overexertion. The nurses reply should be based on which
statement?
a. Child needs opportunities to play with peers.
b. Child needs to understand that peers activities are too strenuous.
c. Parents can meet all of the childs needs.
d. Constant parental supervision is needed to avoid overexertion.
ANS: A
The child needs opportunities for social development. Children usually limit their activities if
allowed to set their own pace. The child will limit activities as necessary. Parents must be
encouraged to seek appropriate social activities for the child, especially before kindergarten.
The child needs to have activities that foster independence. The child will be able to regulate
activities.

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.

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.

26. Which is an important nursing consideration when suctioning a young child who has had heart
surgery?
a. Perform suctioning at least every hour.
b. Suction for no longer than 30 seconds at a time.
c. Administer supplemental oxygen before and after suctioning.
d. Expect symptoms of respiratory distress when suctioning.
ANS: C
If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation
bag before and after the procedure to prevent hypoxia. Suctioning should be done only as
indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at
one time. Symptoms of respiratory distress are avoided by using appropriate technique.

27. The nurse is caring for a child after heart surgery. Which should the nurse do if evidence is
found of cardiac tamponade?
a. Increase analgesia.
b. Apply warming blankets.
c. Immediately report this to physician.
d. Encourage child to cough, turn, and breathe deeply.
ANS: C
If evidence is noted of cardiac tamponade, which is blood or fluid in the pericardial space
constricting the heart, the physician is notified immediately of this life-threatening
complication. Increasing analgesia may be done before the physician drains the fluid, but the
physician must be notified. Warming blankets are not indicated at this time. Encouraging the
child to cough, turn, and breathe deeply should be deferred till after the evaluation by the
physician.

28. Which is an important nursing consideration when chest tubes will be removed from a child?
a. Explain that it is not painful.
b. Explain that only a Band-Aid will be needed.
c. Administer analgesics before procedure.
d. Expect bright red drainage for several hours after removal.
ANS: C
It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-
acting medications can be used that are administered through an existing IV line. A sharp,
momentary pain is felt. This should not be misrepresented to the child. A petroleum gauze, air-
tight dressing will be needed, but it is not a pain-free procedure. Little or no drainage should
be found on removal.

29. Which is the most common causative agent of bacterial endocarditis?
a. Staphylococcus albus
b. Streptococcus hemolyticus
c. Staphylococcus albicans
d. Streptococcus viridans
ANS: D
S. viridans is the most common causative agent in bacterial (infective) endocarditis.
Staphylococcus albus, Streptococcus hemolyticus, and Staphylococcus albicans are not
common causative agents.

30. Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in
bacterial endocarditis?
a. Osler nodes
b. Janeway lesions
c. Subcutaneous nodules
d. Aschoff nodes
ANS: A
Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial
endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial
endocarditis. Subcutaneous nodules are nontender swellings, located over bony prominences,
commonly found in rheumatic fever. Aschoff nodules are small nodules composed of cells and
leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.

31. The primary nursing intervention to prevent bacterial endocarditis is to:

a. institute measures to prevent dental procedures.
b. counsel parents of high-risk children about prophylactic antibiotics.
c. observe children for complications, such as embolism and heart failure.
d. encourage restricted mobility in susceptible children.
ANS: B
The objective of nursing care is to counsel the parents of high-risk children about both the
need for prophylactic antibiotics for dental procedures and the necessity of maintaining
excellent oral health. The childs dentist should be aware of the childs cardiac condition.
Dental procedures should be done to maintain a high level of oral health. Prophylactic
antibiotics are necessary. Children should be observed for complications such as embolism
and heart failure and restricted mobility should be encouraged in susceptible children, but
maintaining good oral health and prophylactic antibiotics is important.

32. Which is a common, serious complication of rheumatic fever?
a. Seizures
b. Cardiac arrhythmias
c. Pulmonary hypertension
d. Cardiac valve damage
ANS: D
Cardiac valve damage is the most significant complication of rheumatic fever. Seizures,
cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic
fever.

33. The nurse is conducting a staff in-service on childhood-acquired heart diseases. Which is a
major clinical manifestation of rheumatic fever?
a. Polyarthritis
b. Osler nodes
c. Janeway spots
d. Splinter hemorrhages of distal third of nails
ANS: A
Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation of
rheumatic fever. The affected joints will change every 1 to 2 days. Primarily the large joints
are affected. Osler nodes, Janeway spots, and splinter hemorrhages are characteristic of
infective endocarditis.

34. The nurse is admitting a child with rheumatic fever. Which therapeutic management should
the nurse expect to implement?
a. Administering penicillin
b. Avoiding salicylates (aspirin)
c. Imposing strict bed rest for 4 to 6 weeks
d. Administering corticosteroids if chorea develops
ANS: A
The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is
the drug of choice. Salicylates can be used to control the inflammatory process, especially in
the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile
stage, but it does not need to be strict. The chorea is transient and will resolve without
treatment.

35. Which action by the school nurse is important in the prevention of rheumatic fever?
a. Encourage routine cholesterol screenings.
b. Conduct routine blood pressure screenings.
c. Refer children with sore throats for throat cultures.
d. Recommend salicylates instead of acetaminophen for minor discomforts.
ANS: C
Nurses have a role in preventionprimarily in screening school-age children for sore throats
caused by group A -hemolytic streptococci. They can achieve this by actively participating in
throat culture screening or by referring children with possible streptococcal sore throats for
testing. Cholesterol and blood pressure screenings do not facilitate the recognition and
treatment of group A -hemolytic streptococci. Salicylates should be avoided routinely
because of the risk of Reye syndrome after viral illnesses.

36. When discussing hyperlipidemia with a group of adolescents, the nurse should explain that
cardiovascular disease can be prevented by high levels of:
a. cholesterol.
b. triglycerides.
c. low-density lipoproteins (LDLs).
d. high-density lipoproteins (HDLs).
ANS: D
HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high
levels of proteins. It is thought that HDLs protect against cardiovascular disease. Cholesterol,
triglycerides, and LDLs are not protective against cardiovascular disease.

37. Which is the leading cause of death after heart transplantation?

a. Infection
b. Rejection
c. Cardiomyopathy
d. Heart failure
ANS: B
The posttransplant course is complex. The leading cause of death after cardiac transplantation
is rejection. Infection is a continued risk secondary to the immunosuppression necessary to
prevent rejection. Cardiomyopathy is one of the indications for cardiac transplant. Heart
failure is not a leading cause of death.

38. When caring for the child with Kawasaki disease, the nurse should know which information?
a. A childs fever is usually responsive to antibiotics within 48 hours.
b. The principal area of involvement is the joints.
c. Aspirin is contraindicated.
d. Therapeutic management includes administration of gamma globulin and aspirin.
ANS: D
High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of
coronary artery abnormalities when given within the first 10 days of the illness. The fever of
Kawasaki disease is unresponsive to antibiotics and antipyretics. Mucous membranes,
conjunctiva, changes in the extremities, and cardiac involvement are seen. Aspirin is part of
the therapy.

39. The nurse is teaching nursing students about shock that occurs in children. One of the most
frequent causes of hypovolemic shock in children is:
a. sepsis.
b. blood loss.
c. anaphylaxis.
d. congenital heart disease.
ANS: B
Blood loss is the most frequent cause of hypovolemic shock in children. Sepsis causes septic
shock, which is overwhelming sepsis and circulating bacterial toxins. Anaphylactic shock
results from extreme allergy or hypersensitivity to a foreign substance. Congenital heart
disease contributes to hypervolemia, not hypovolemia.

40. Which type of shock is characterized by a hypersensitivity reaction causing massive

vasodilation and capillary leaks, which may occur with drug or latex allergy?
a. Neurogenic
b. Cardiogenic
c. Hypovolemic
d. Anaphylactic
ANS: D
Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance.
Neurogenic shock results from loss of neuronal control, such as the interruption of neuronal
transmission that occurs from a spinal cord injury. Cardiogenic shock is decreased cardiac
output. Hypovolemic shock is a reduction in the size of the vascular compartment, decreasing
blood pressure, and low central venous pressure.
PTS: 1 DIF: Cognitive Level: Understand REF: 862-863

41. Which clinical manifestation should the nurse expect to see as shock progresses in a child and
becomes decompensated shock?
a. Thirst
b. Irritability
c. Apprehension
d. Confusion and somnolence
ANS: D
Confusion and somnolence are beginning signs of decompensated shock. Thirst, irritability,
and apprehension are signs of compensated shock.

42. Which occurs in septic shock?

a. Hypothermia
b. Increased cardiac output
c. Vasoconstriction
d. Angioneurotic edema
ANS: B
Increased cardiac output, which results in warm, flushed skin, is one of the manifestations of
septic shock. Fever and chills are characteristic of septic shock. Vasodilation is more common
than vasoconstriction. Angioneurotic edema occurs as a manifestation in anaphylactic shock.

43. A child is brought to the emergency department experiencing an anaphylactic reaction to a bee
sting. While an airway is being established, the nurse should prepare which medication for
immediate administration?
a. Diphenhydramine (Benadryl)
b. Dobutamine (Dobutarex)
c. Epinephrine (Adrenalin)
d. Calcium chloride (calcium chloride)
ANS: C
After the first priority of establishing an airway, administration of epinephrine is the drug of
choice. Diphenhydramine, an antihistamine, is usually not used for severe reactions.
Dobutamine and calcium chloride are not appropriate drugs for this type of reaction.

44. Clinical manifestations of toxic shock syndrome include:

a. severe hypertension.
b. subnormal temperature.
c. erythematous macular rash.
d. papular rash over extremities.
ANS: C
One of the diagnostic criteria for toxic shock syndrome is a diffuse macular erythroderma.
Hypotension is one of the manifestations. Fever of 38.9 C or higher is a characteristic.
Desquamation of the palms and soles of the feet occurs in about 1 to 2 weeks.

45. A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can
hold the child during the procedure. The nurse should answer with which response?
a. You will be able to hold your child during the procedure.
b. Your child can be active during the procedure, but cant sit in your lap.
c. Your child must lie quietly; sometimes a mild sedative is administered before the
procedure.
d. The procedure is invasive so your child will be restrained during the
echocardiogram.
ANS: C
Although an echocardiogram is noninvasive, painless, and associated with no known side
effects, it can be stressful for children. The child must lie quietly in the standard
echocardiographic positions; crying, nursing, or sitting up often leads to diagnostic errors or
omissions. Therefore, infants and young children may need a mild sedative; older children
benefit from psychological preparation for the test. The distraction of a video or movie is
often helpful.

46. The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan
which intervention to decrease cardiac demands?
a. Organize nursing activities to allow for uninterrupted sleep.
b. Allow the infant to sleep through feedings during the night.
c. Wait for the infant to cry to show definite signs of hunger.
d. Discourage parents from rocking the infant
ANS: A
The infant requires rest and conservation of energy for feeding. Every effort is made to
organize nursing activities to allow for uninterrupted periods of sleep. Whenever possible,
parents are encouraged to stay with their infant to provide the holding, rocking, and cuddling
that help children sleep more soundly. To minimize disturbing the infant, changing bed linens
and complete bathing are done only when necessary. Feeding is planned to accommodate the
infants sleep and wake patterns. The child is fed at the first sign of hunger, such as when
sucking on fists, rather than waiting until he or she cries for a bottle because the stress of
crying exhausts the limited energy supply. Because infants with CHD tire easily and may
sleep through feedings, smaller feedings every 3 hours may be helpful.

47. The nurse is admitting a child with coarctation of the aorta. Which figure depicts this
congenital heart defect?
a. c.
b. d.
ANS: A
The figure that depicts a narrowing of the aortic arch is coarctation of the aorta. It typically
occurs past the ductal area but can occur in other areas along the aortic arch. The figure that
depicts an opening between the atria is atrial septal defect. The figure that depicts an opening
between the ventricles is ventricular septal defect. The figure that depicts an opening from the
atrium to the pulmonary artery is patent ductus arteriosus.

MULTIPLE RESPONSE
1. Nursing interventions for the child after a cardiac catheterization should include which
actions? (Select all that apply.)
a. Allow ambulation as tolerated.
b. Monitor vital signs every 2 hours.
c. Assess the affected extremity for temperature and color.
d. Check pulses above the catheterization site for equality and symmetry.
e. Remove pressure dressing after 4 hours.
f. Maintain a patent peripheral intravenous catheter until discharge.
ANS: C, F
The extremity that was used for access for the cardiac catheterization must be checked for
temperature and color. Coolness and blanching may indicate arterial occlusion. The child
should have a patent peripheral intravenous line (PIV) to ensure adequate hydration. The child
should remain on bed rest with the leg extended for a minimum of 4 hours. Initially vital signs
are taken every 15 minutes, with emphasis on a heart rate counted for 1 minute. Pulses above
the catheterization site should not be affected by the catheterization. Pulses distal to the site
should be monitored. The pressure dressings should not be removed for 24 hours.

2. Which clinical manifestation should the nurse expect to see as shock progresses in a child and
becomes decompensated shock? (Select all that apply.)
a. Thirst and diminished urinary output
b. Irritability and apprehension
c. Cool extremities and decreased skin turgor
d. Confusion and somnolence
e. Normal blood pressure and narrowing pulse pressure
f. Tachypnea and poor capillary refill time
ANS: C, D, F
Cool extremities, decreased skin turgor, confusion, somnolence, tachypnea, and poor capillary
refill time are beginning signs of decompensated shock. Thirst, diminished urinary output,
irritability, apprehension, normal blood pressure, and narrowing pulse pressure are signs of
compensated shock.

3. The nurse is conducting discharge teaching about signs and symptoms of heart failure to
parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the
nurse include? (Select all that apply.)
a. Warm flushed extremities
b. Weight loss
c. Decreased urinary output
d. Sweating (inappropriate)
e. Fatigue
ANS: C, D, E
The signs and symptoms of heart failure include decreased urinary output, sweating, and
fatigue. Other signs include pale, cool extremities, not warm and flushed, and weight gain, not
weight loss.

SHORT ANSWER
1. Which is the acceptable mg/dl level, or below this level, low density lipoprotein (LDL)
cholesterol for a child from a family with heart disease? (Record your answer in a whole
number.)
ANS:
110
The low-density lipoproteins (LDLs) contain low concentrations of triglycerides, high levels
of cholesterol, and moderate levels of protein. LDL is the major carrier of cholesterol to the
cells. Cells use cholesterol for synthesis of membranes and steroid production. Elevated
circulating LDL is a strong risk factor in cardiovascular disease. For children from families
with a history of heart disease, the LDL should be <110.
PTS: 1 DIF: Cognitive Level: Apply REF: 831 | 851

ESSAY
1. An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during
a routine blood draw. Which interventions should the nurse implement? Place in order from
the highest-priority intervention to the lowest-priority intervention. Provide answer using
lowercase letters separated by commas (e.g., a, b, c, d).
a. Administer 100% oxygen by blow-by.
b. Place infant in knee-chest position.
c. Remain calm.
d. Give morphine subcutaneously or by an existing intravenous line.
ANS:
b, a, d, c
Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in
infants with tetralogy of Fallot, may occur in any child whose heart defect includes
obstruction to pulmonary blood flow and communication between the ventricles. The infant
becomes acutely cyanotic and hyperpneic because sudden infundibular spasm decreases
pulmonary blood flow and increases right-to-left shunting. Because profound hypoxemia
causes cerebral hypoxia, hypercyanotic spells require prompt assessment and treatment to
prevent brain damage or possibly death. The infant should first be placed in the knee-chest
position to reduce blood returning to the heart. Next 100% oxygen is given to alleviate the
hypoxemia. Morphine is next administered to reduce infundibular spasms. Last, the nurse
should remain calm.

2. A child is brought to the emergency department experiencing an anaphylactic reaction to a bee

sting. Once the airway is established, the nurse should do which action? Place in correct
sequence. Provide answer using lowercase letters separated by commas (e.g., a, b, c).
a. Administer epinephrine.
b. Keep child warm and calm.
c. Obtain vascular access.
ANS:
c, a, b
The correct sequence of actions is to obtain vascular access, administer epinephrine, and then
to keep the child warm and calm.
PTS: 1 DIF: Cognitive Level: Apply REF: 841 | 863


Chapter 25 The Child With Cardiovascular Dysfunction

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Chapter 25 The Child With Cardiovascular Dysfunction

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Chapter 25: The Child with Cardiovascular Dysfunction

PTS: 1 DIF: Cognitive Level: Understand REF: 835

PTS: 1 DIF: Cognitive Level: Apply REF: 853

PTS: 1 DIF: Cognitive Level: Apply REF: 822

4. Which explanation regarding cardiac catheterization is appropriate for a preschool child?

PTS: 1 DIF: Cognitive Level: Apply REF: 823

PTS: 1 DIF: Cognitive Level: Apply REF: 823

PTS: 1 DIF: Cognitive Level: Analyze REF: 823

7. Surgical closure of the ductus arteriosus would:

PTS: 1 DIF: Cognitive Level: Analyze REF: 825

8. Which defect results in increased pulmonary blood flow?

PTS: 1 DIF: Cognitive Level: Understand REF: 825

PTS: 1 DIF: Cognitive Level: Understand REF: 830

PTS: 1 DIF: Cognitive Level: Understand REF: 830

PTS: 1 DIF: Cognitive Level: Understand REF: 835

PTS: 1 DIF: Cognitive Level: Understand REF: 835

14. A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which

PTS: 1 DIF: Cognitive Level: Remember REF: 835

PTS: 1 DIF: Cognitive Level: Apply REF: 836

PTS: 1 DIF: Cognitive Level: Apply REF: 836

PTS: 1 DIF: Cognitive Level: Understand REF: 839

PTS: 1 DIF: Cognitive Level: Apply REF: 839

PTS: 1 DIF: Cognitive Level: Apply REF: 838-839

PTS: 1 DIF: Cognitive Level: Apply REF: 841-842

PTS: 1 DIF: Cognitive Level: Analyze REF: 841

PTS: 1 DIF: Cognitive Level: Analyze REF: 843

PTS: 1 DIF: Cognitive Level: Analyze REF: 845

PTS: 1 DIF: Cognitive Level: Apply REF: 846

PTS: 1 DIF: Cognitive Level: Apply REF: 846

PTS: 1 DIF: Cognitive Level: Apply REF: 846

PTS: 1 DIF: Cognitive Level: Apply REF: 846

PTS: 1 DIF: Cognitive Level: Remember REF: 848

PTS: 1 DIF: Cognitive Level: Understand REF: 848

31. The primary nursing intervention to prevent bacterial endocarditis is to:

PTS: 1 DIF: Cognitive Level: Apply REF: 848

PTS: 1 DIF: Cognitive Level: Understand REF: 849

PTS: 1 DIF: Cognitive Level: Apply REF: 850

PTS: 1 DIF: Cognitive Level: Apply REF: 849

PTS: 1 DIF: Cognitive Level: Apply REF: 849-850

PTS: 1 DIF: Cognitive Level: Apply REF: 851

37. Which is the leading cause of death after heart transplantation?

PTS: 1 DIF: Cognitive Level: Remember REF: 856

PTS: 1 DIF: Cognitive Level: Apply REF: 859

PTS: 1 DIF: Cognitive Level: Understand REF: 860

40. Which type of shock is characterized by a hypersensitivity reaction causing massive

PTS: 1 DIF: Cognitive Level: Understand REF: 862-863

PTS: 1 DIF: Cognitive Level: Understand REF: 861

42. Which occurs in septic shock?

PTS: 1 DIF: Cognitive Level: Understand REF: 864

PTS: 1 DIF: Cognitive Level: Apply REF: 862

44. Clinical manifestations of toxic shock syndrome include:

PTS: 1 DIF: Cognitive Level: Understand REF: 864

PTS: 1 DIF: Cognitive Level: Apply REF: 821

PTS: 1 DIF: Cognitive Level: Apply REF: 839

PTS: 1 DIF: Cognitive Level: Analyze REF: 827

PTS: 1 DIF: Cognitive Level: Apply REF: 822-823

PTS: 1 DIF: Cognitive Level: Analyze REF: 861

PTS: 1 DIF: Cognitive Level: Apply REF: 844

PTS: 1 DIF: Cognitive Level: Apply REF: 831 | 851

PTS: 1 DIF: Cognitive Level: Apply REF: 842

2. A child is brought to the emergency department experiencing an anaphylactic reaction to a bee

PTS: 1 DIF: Cognitive Level: Apply REF: 841 | 863

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