Chapter 29: The Child with Cardiovascular Dysfunction My Nursing Test Banks

Chapter 29: The Child with Cardiovascular Dysfunction

MULTIPLE CHOICE

1. What term is defined as the volume of blood ejected by the heart in 1 minute?

a.

Afterload

b.

Cardiac cycle

c.

Stroke volume

d.

Cardiac output

ANS: D

Cardiac output is defined as the volume of blood ejected by the heart in 1 minute. Cardiac output = Heart rate x Stroke volume. Afterload is the resistance against which the ventricles must pump when ejecting blood (ventricular ejection). A cardiac cycle is the sequential contraction and relaxation of both the atria and ventricles. Stroke volume is the amount of blood ejected by the heart in any one contraction.

DIF: Cognitive Level: Understanding REF: p. 1254 TOP: Nursing Process: Diagnosis

MSC: Client Needs: Physiological Integrity

2. A chest radiography examination is ordered for a child with suspected cardiac problems. The childs parent asks the nurse, What will the x-ray show about the heart? The nurses response should be based on knowledge that the radiograph provides which information?

a.

Shows bones of the chest but not the heart

b.

Evaluates the vascular anatomy outside of the heart

c.

Shows a graphic measure of electrical activity of the heart

d.

Supplies information on heart size and pulmonary blood flow patterns

ANS: D

Chest radiographs provide information on the size of the heart and pulmonary blood flow patterns. The bones of the chest are visible on chest radiographs, but the heart and blood vessels are also seen. Magnetic resonance imaging is a noninvasive technique that allows for evaluation of vascular anatomy outside of the heart. A graphic measure of electrical activity of the heart is provided by electrocardiography.

DIF: Cognitive Level: Understanding REF: p. 1256

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

3. A 6-year-old child is scheduled for a cardiac catheterization. What consideration is most important in planning preoperative teaching?

a.

Preoperative teaching should be directed at his parents because he is too young to understand.

b.

Preoperative teaching should be adapted to his level of development so that he can understand.

c.

Preoperative teaching should be done several days before the procedure so he will be prepared.

d.

Preoperative teaching should provide details about the actual procedures so he will know what to expect.

ANS: B

Preoperative teaching should always be directed to the childs stage of development. The caregivers also benefit from these explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. This age group will not understand in-depth descriptions. School-age children should be prepared close to the time of the cardiac catheterization.

DIF: Cognitive Level: Applying REF: p. 1259

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

4. After returning from cardiac catheterization, the nurse monitors the childs vital signs. The heart rate should be counted for how many seconds?

a.

15

b.

30

c.

60

d.

120

ANS: C

The heart rate is counted for a full minute to determine whether arrhythmias or bradycardia is present. Fifteen to 30 seconds are too short for accurate assessment. Sixty seconds is sufficient to assess heart rate and rhythm.

DIF: Cognitive Level: Applying REF: p. 1260

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

5. After returning from cardiac catheterization, the nurse determines that the pulse distal to the catheter insertion site is weaker. How should the nurse respond?

a.

Elevate the affected extremity.

b.

Notify the practitioner of the observation.

c.

Record data on the assessment flow record.

d.

Apply warm compresses to the insertion site.

ANS: C

The pulse distal to the catheterization site may be weaker for the first few hours after catheterization but should gradually increase in strength. Documentation of the finding provides a baseline. The extremity is maintained straight for 4 to 6 hours. This is an expected change. The pulse is monitored. If there are neurovascular changes in the extremity, the practitioner is notified. The site is kept dry. Warm compresses are not indicated.

DIF: Cognitive Level: Applying REF: p. 1260

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

6. The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is too wet. The nurse finds the bandage and bed soaked with blood. What nursing action is most appropriate to institute initially?

a.

Notify the physician.

b.

Place the child in Trendelenburg position.

c.

Apply a new bandage with more pressure.

d.

Apply direct pressure above the catheterization site.

ANS: D

When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified, and a new bandage with more pressure can be applied after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. Trendelenburg positioning would not be a helpful intervention. It would increase the drainage from the lower extremities.

DIF: Cognitive Level: Analyzing REF: p. 1259

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

7. What statement best identifies the cause of heart failure (HF)?

a.

Disease related to cardiac defects

b.

Consequence of an underlying cardiac defect

c.

Inherited disorder associated with a variety of defects

d.

Result of diminished workload imposed on an abnormal myocardium

ANS: B

HF 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. HF is not a disease but rather a result of the inability of the heart to pump efficiently. HF is not inherited. HF occurs most frequently secondary to congenital heart defects in which structural abnormalities result in increased volume load or increased pressures on the ventricles.

DIF: Cognitive Level: Understanding REF: p. 1262

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

8. The nurse finds that a 6-month-old infant has an apical pulse of 166 beats/min during sleep. What nursing intervention is most appropriate at this time?

a.

Administer oxygen.

b.

Record data on the nurses notes.

c.

Report data to the practitioner.

d.

Place the child in the high Fowler position.

ANS: C

One of the earliest signs of HF is tachycardia (sleeping heart rate >160 beats/min) as a direct result of sympathetic stimulation. The practitioner needs to be notified for evaluation of possible HF. Although oxygen or a semiupright position may be indicated, the first action is to report the data to the practitioner.

DIF: Cognitive Level: Analyzing REF: p. 1267

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

9. What drug is an angiotensin-converting enzyme (ACE) inhibitor?

a.

Furosemide (Lasix)

b.

Captopril (Capoten)

c.

Chlorothiazide (Diuril)

d.

Spironolactone (Aldactone)

ANS: B

Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Chlorothiazide works on the distal tubules. Spironolactone blocks the action of aldosterone and is a potassium-sparing diuretic.

DIF: Cognitive Level: Understanding REF: p. 1305

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

10. A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate?

a.

60 beats/min

b.

90 beats/min

c.

100 beats/min

d.

120 beats/min

ANS: B

If a 1-minute apical pulse is less than 90 beats/min for an infant or young child, the digoxin is withheld. Sixty beats/min is the cut-off for holding the digoxin dose in an adult. One hundred to 120 beats/min is an acceptable pulse rate for the administration of digoxin.

DIF: Cognitive Level: Understanding REF: p. 1313

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

11. What clinical manifestation 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 and is often unrelated to feedings. Seizures are not associated with digoxin toxicity. The child will have a slower (not faster) heart rate but not a slower respiratory rate.

DIF: Cognitive Level: Understanding REF: p. 1266

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

12. The parents of a young child with heart failure (HF) tell the nurse that they are nervous about giving digoxin. The nurses response should be based on which knowledge?

a.

It is a safe, frequently used drug.

b.

Parents lack the expertise necessary to administer digoxin.

c.

It is difficult to either overmedicate or undermedicate with digoxin.

d.

Parents need to 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. Parents may lack the expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.

DIF: Cognitive Level: Analyzing REF: p. 1267

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

13. What nutritional component should be altered in the infant with heart failure (HF)?

a.

Decrease in fats

b.

Increase in fluids

c.

Decrease in protein

d.

Increase in calories

ANS: D

Infants with HF have a greater metabolic rate because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of average infants, yet their ability to take in calories is diminished by their fatigue. The diet should include increased protein and increased fat to facilitate the childs intake of sufficient calories. Fluids must be carefully monitored because of the HF.

DIF: Cognitive Level: Analyzing REF: p. 1268 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

14. Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infants status, which finding is indicative of achieving this goal?

a.

Irritability when awake

b.

Capillary refill of more than 5 seconds

c.

Appropriate weight gain for age

d.

Positioned in high Fowler position to maintain oxygen saturation at 90%

ANS: C

Appropriate weight gain for an infant is indicative of successful feeding and a reduction in caloric loss secondary to the HF. Irritability is a symptom of HF. The child also uses additional energy when irritable. Capillary refill should be brisk and within 2 to 3 seconds. The child needs to be positioned upright to maintain oxygen saturation at 90%. Positioning is helping to decrease respiratory effort, but the infant is still having difficulty with oxygenation.

DIF: Cognitive Level: Analyzing REF: p. 1268 TOP: Nursing Process: Evaluation

MSC: Client Needs: Physiological Integrity

15. The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. What strategy 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.

DIF: Cognitive Level: Analyzing REF: p. 1273

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

16. A 3-month-old infant has a hypercyanotic spell. What should be the nurses first action?

a.

Assess for neurologic defects.

b.

Prepare the family for imminent death.

c.

Begin cardiopulmonary resuscitation.

d.

Place the child in the kneechest position.

ANS: D

The first action is to place the infant in the kneechest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. Preparing the family for imminent death or beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

DIF: Cognitive Level: Applying REF: p. 1273

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

17. A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition?

a.

Cyanosis

b.

Heart failure

c.

Decreased pulmonary blood flow

d.

Bounding pulses in upper extremities

ANS: B

As blood is shunted into the right side of the heart, there is increased pulmonary blood flow and the child is at high risk for heart failure. Cyanosis usually occurs in defects with decreased pulmonary blood flow. Bounding upper extremity pulses are a manifestation of coarctation of the aorta.

DIF: Cognitive Level: Applying REF: p. 1262

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

18. What blood flow pattern occurs in a ventricular septal defect?

a.

Mixed blood flow

b.

Increased pulmonary blood flow

c.

Decreased pulmonary blood flow

d.

Obstruction to blood flow from ventricles

ANS: B

The opening in the septal wall allows for blood to flow from the higher pressure left ventricle into the lower pressure right ventricle. This left-to-right shunt creates increased pulmonary blood flow. The shunt is one way, from high pressure to lower pressure; oxygenated and unoxygenated blood do not mix. The outflow of blood from the ventricles is not affected by the septal defect.

DIF: Cognitive Level: Understanding REF: p. 1276

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

19. The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication?

a.

Hypoxemia

b.

Right-to-left shunt of blood

c.

Decreased workload on the left side of the heart

d.

Pulmonary vascular congestion

ANS: D

In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular congestion. Hypoxemia usually results from defects with mixed blood flow and decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure would stop this. There is increased workload on the left side of the heart with a PDA.

DIF: Cognitive Level: Applying REF: p. 1278 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

20. What cardiovascular defect results in obstruction to blood flow?

a.

Aortic stenosis

b.

Tricuspid atresia

c.

Atrial septal defect

d.

Transposition of the great arteries

ANS: A

Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Tricuspid atresia results in decreased pulmonary blood flow. The atrial septal defect results in increased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

DIF: Cognitive Level: Understanding REF: p. 1279

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

21. What structural defects constitute tetralogy of Fallot?

a.

Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

b.

Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

c.

Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy

d.

Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

ANS: A

Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.

DIF: Cognitive Level: Understanding REF: p. 1280

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

22. The 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. How should the nurse reply to this concern?

a.

The parents should meet all the childs needs.

b.

The child needs opportunities to play with peers.

c.

Constant parental supervision is needed to avoid overexertion.

d.

The child needs to understand that peers activities are too strenuous.

ANS: B

The child needs opportunities for social development. Children are able to regulate and limit their activities based on their energy level. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence.

DIF: Cognitive Level: Analyzing REF: p. 1285

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

23. What preparation should the nurse consider when educating a school-age child and the family for heart surgery?

a.

Unfamiliar equipment should not be shown.

b.

Let the child hear the sounds of a cardiac monitor, including alarms.

c.

Explain that an endotracheal tube will not be needed if the surgery goes well.

d.

Discussion of postoperative discomfort and interventions is not necessary before the procedure.

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 family and child should make the decision about a tour of the unit if it is an option. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous lines, incision, endotracheal tube, expected discomfort, and management strategies.

DIF: Cognitive Level: Applying REF: p. 1286

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

24. Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4 C (101.1 F). What action should the nurse perform?

a.

Report findings to the practitioner.

b.

Apply a hypothermia blanket.

c.

Keep the child warm with blankets.

d.

Record the temperature on the assessment flow sheet.

ANS: A

In the first 24 to 48 hours after surgery, the body temperature may increase to 37.8 C (100 F) as part of the inflammatory response to tissue trauma. If the temperature is higher or fever continues after this period, it is most likely a sign of an infection, and immediate investigation is indicated. A hypothermia blanket is not indicated for this level of temperature. Blankets should be removed from the child to keep the temperature from increasing. The temperature should be recorded, but the practitioner must be notified for evaluation.

DIF: Cognitive Level: Applying REF: p. 1289

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

25. What nursing consideration is important 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.

Expect symptoms of respiratory distress when suctioning.

d.

Administer supplemental oxygen before and after suctioning.

ANS: D

When 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 and very carefully to avoid vagal stimulation. The child should be suctioned for no more than 5 seconds at a time. Symptoms of respiratory distress are avoided by using appropriate technique.

DIF: Cognitive Level: Applying REF: p. 1289

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

26. The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be the nurses initial intervention?

a.

Apply warming blankets.

b.

Notify the practitioner of these findings.

c.

Give additional pain medication per protocol.

d.

Encourage child to cough, turn, and deep breathe.

ANS: B

The practitioner is notified immediately. Increases of chest tube drainage to more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and tachycardia may indicate cardiac tamponadeblood or fluid in the pericardial space constricting the heartwhich is a life-threatening complication. Warming blankets are not indicated at this time. Additional pain medication can be given before the practitioner drains the fluid, but the notification is the first action. Encouraging the child to cough, turn, and deep breathe should be deferred until after evaluation by the practitioner.

DIF: Cognitive Level: Applying REF: p. 1291

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

27. A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38 C (100.4 F), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother?

a.

Immediately bring the child to the clinic for evaluation.

b.

Come to the clinic next week on a scheduled appointment.

c.

Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness.

d.

Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.

ANS: A

These are the insidious symptoms of bacterial endocarditis. Because the child is in a high-risk group for this disorder (VSD repair), immediate evaluation and treatment are indicated to prevent cardiac damage. With appropriate antibiotic therapy, bacterial endocarditis is successfully treated in approximately 80% of the cases. The childs complaints should not be dismissed. The low-grade fever is not a symptom that the child can fabricate.

DIF: Cognitive Level: Applying REF: p. 1277

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

28. What primary nursing intervention should be implemented to prevent bacterial endocarditis?

a.

Counsel parents of high-risk children.

b.

Institute measures to prevent dental procedures.

c.

Encourage restricted mobility in susceptible children.

d.

Observe children for complications, such as embolism and heart failure.

ANS: A

The objective of nursing care is to counsel the parents of high-risk children about the need for both prophylactic antibiotics for dental procedures and 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. Restricted mobility in susceptible children is not indicated. Parents are taught to observe for unexplained fever, weight loss, or change in behavior.

DIF: Cognitive Level: Applying REF: p. 1273 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

29. What sign/symptom is a major clinical manifestation of rheumatic fever (RF)?

a.

Fever

b.

Polyarthritis

c.

Osler nodes

d.

Janeway spots

ANS: B

Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation. The affected joints will change every 1 or 2 days. The large joints are primarily affected. Fever is considered a minor manifestation of RF. Osler nodes and Janeway spots are characteristic of bacterial endocarditis.

DIF: Cognitive Level: Analyzing REF: p. 1296

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

30. What action by the school nurse is important in the prevention of rheumatic fever (RF)?

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 prevention, primarily in screening school-age children for sore throats caused by group A streptococci. They can actively participate in throat culture screening or refer children with possible streptococcal sore throats for testing. Routine cholesterol screenings 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.

DIF: Cognitive Level: Applying REF: p. 1298

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

31. When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care?

a.

Aspirin is contraindicated.

b.

The principal area of involvement is the joints.

c.

The childs fever is usually responsive to antibiotics within 48 hours.

d.

Therapeutic management includes administration of gamma globulin and salicylates.

ANS: D

High-dose intravenous gamma globulin and salicylate therapy are indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. The fever of Kawasaki disease is unresponsive to antibiotics. It is responsive to anti-inflammatory doses of aspirin and antipyretics.

DIF: Cognitive Level: Applying REF: p. 1298

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

32. Nursing care of the child with Kawasaki disease is challenging because of which occurrence?

a.

The childs irritability

b.

Predictable disease course

c.

Complex antibiotic therapy

d.

The childs ongoing requests for food

ANS: A

Patient irritability is a hallmark of Kawasaki disease and is the most challenging problem. A quiet environment is necessary to promote rest. The diagnosis is often difficult to make, and the course of the disease can be unpredictable. Intravenous gamma globulin and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to eat. Soft foods and fluids should be offered to prevent dehydration.

DIF: Cognitive Level: Understanding REF: p. 1298

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

33. The diagnosis of hypertension depends on accurate assessment of blood pressure (BP). What is the appropriate technique to measure a childs BP?

a.

Assess BP while the child is standing.

b.

Compare left arm with left leg BP readings.

c.

Use a narrow cuff to ensure that the readings are correct.

d.

Measure BP with the child in the sitting position on three separate occasions.

ANS: D

The diagnosis of hypertension is made after the BP is elevated on three separate occasions. Take the BP in a quiet area with the appropriate size cuff and the child sitting. Although left arm and left leg BP readings may be compared, it is not the procedure to diagnose hypertension. The appropriate size cuff is indicated. The most common cause of inaccurate readings is the use of a cuff that is too small.

DIF: Cognitive Level: Applying REF: p. 1303

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

34. What type of drug reduces hypertension by interfering with the production of angiotensin II?

a.

Diuretics

b.

Vasodilators

c.

Beta-blockers

d.

Angiotensin-converting enzyme (ACE) inhibitors

ANS: D

ACE inhibitors act by interfering with the production of angiotensin II, which is a potent vasoconstrictor. Diuretics lower blood pressure by increasing fluid output. Vasodilators act on the vascular smooth muscle. By causing arterial dilation, blood pressure is lowered. Beta-blockers interfere with beta stimulation and depress renin output.

DIF: Cognitive Level: Understanding REF: p. 1307

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

35. Selective cholesterol screening is recommended for children older than the age of 2 years with which risk factor?

a.

Body mass index (BMI) = 95th percentile

b.

Blood pressure = 50th percentile

c.

Parent with a blood cholesterol level of 200 mg/dl

d.

Recently diagnosed cardiovascular disease in a 75-year-old grandparent

ANS: A

Obesity is an indication for cholesterol screening in children. A BMI in the 95th percentile or higher is considered obese. Children who are hypertensive meet the criteria for screening, but blood pressure in the 50th percentile is within the normal range. A parent or grandparent with a cholesterol level of 240 mg/dl or higher places the child at risk. Early cardiovascular disease in a first- or second-degree relative is a risk factor. Age 75 years is not considered early.

DIF: Cognitive Level: Applying REF: p. 1303 TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

36. What condition 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 transplant 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.

DIF: Cognitive Level: Understanding REF: p. 1316

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

37. The nurse is giving discharge instructions to the parent of a 6-year-old child who had a cardiac catheterization 4 hours ago. What statement by the parent indicates a correct understanding of the teaching?

a.

My child should not attend school for the next 5 days.

b.

I should change the bandage every day for the next 2 days.

c.

My child can take a tub bath but should avoid taking a shower for the next 4 days.

d.

I should expect the site to be red and swollen for the next 3 days.

ANS: B

Discharge instructions for a parent of a child who recently had a cardiac catheterization should include changing the bandage every day for the next 2 days. The child should avoid strenuous exercise but can go back to school. The child should avoid a tub bath, but an older child could take a shower the first day after the catheterization. The site should not have swelling or redness; if there is, it should be reported to the health care practitioner.

DIF: Cognitive Level: Analyzing REF: p. 1260

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

38. A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which?

a.

Serum sodium

b.

Serum potassium

c.

Serum glucose

d.

Serum chloride

ANS: B

A fall in the serum potassium level enhances the effects of digoxin, increasing the risk of digoxin toxicity. Increased serum potassium levels diminish digoxins effect. Therefore, serum potassium levels (normal range, 3.55.5 mmol/L) must be carefully monitored.

DIF: Cognitive Level: Applying REF: p. 1267

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

39. An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented?

a.

Leukopenia

b.

Polycythemia

c.

Anemia

d.

Increased platelet level

ANS: B

Persistent hypoxemia that occurs with tetralogy of Fallot stimulates erythropoiesis, which results in polycythemia, an increased number of red blood cells.

DIF: Cognitive Level: Analyzing REF: p. 1267

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

40. What child has a cyanotic congenital heart defect?

a.

An infant with patent ductus arteriosus

b.

A 1-year-old infant with atrial septal defect

c.

A 2-month-old infant with tetralogy of Fallot

d.

A 6-month-old infant with repaired ventricular septal defect

ANS: C

Tetralogy of Fallot is a cyanotic congenital heart defect. Patent ductus arteriosus, atrial septal defect, and ventricular septal defect are acyanotic congenital heart defects.

DIF: Cognitive Level: Analyzing REF: p. 1261

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

41. The nurse is teaching parents about administering digoxin (Lanoxin). What instructions should the nurse tell the parents?

a.

If the child vomits, give another dose.

b.

Give the medication at regular intervals.

c.

If a dose is missed, give a give an extra dose.

d.

Give the medication mixed with the childs formula.

ANS: B

The family should be taught to administer digoxin at regular intervals. If a dose is missed, an extra dose should not be given; the same schedule should be maintained. If the child vomits, do not give a second dose. The drug should not be mixed with foods or other fluids because refusal to consume these would result in inaccurate intake of the drug.

DIF: Cognitive Level: Applying REF: p. 1265

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

42. Heart failure (HF) is a problem after the child has had a congenital heart defect repaired. The nurse knows a sign of HF is what?

a.

Wheezing

b.

Increased blood pressure

c.

Increased urine output

d.

Decreased heart rate

ANS: A

A clinical manifestation of heart failure is wheezing from pulmonary congestion. The blood pressure decreases, urine output decreases, and heart rate increases.

DIF: Cognitive Level: Analyzing REF: p. 1264

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

43. The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication?

a.

Pulmonary hypertension

b.

Right-to-left shunt of blood

c.

Pulmonary embolism

d.

Left ventricular hypertrophy

ANS: A

Congenital heart defects with a large left-to-right shunt (e.g., in ventricular septal defect, patent ductus arteriosus, or complete AV canal), which cause increased pulmonary blood flow, may result in pulmonary hypertension. If these defects are not repaired early, the high pulmonary flow will cause changes in the pulmonary artery vessels, and the vessels will lose their elasticity. The blood does not shunt right to left, a pulmonary embolism is not a complication of ventricular septal defect, and the left ventricle does not hypertrophy.

DIF: Cognitive Level: Analyzing REF: p. 1277 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

44. A 1-year-old has been admitted for complete repair of a tetralogy of Fallot. What assessment finding should the nurse expect to be documented?

a.

Weight gain

b.

Pale skin color

c.

Increasing cyanosis

d.

Decrease in hemoglobin and hematocrit

ANS: C

Elective repair of tetralogy of Fallot is usually performed in the first year of life. Indications for repair include increasing cyanosis and the development of hypercyanotic spells. The child would not have a weight gain, pale skin color, or decrease in hemoglobin and hematocrit.

DIF: Cognitive Level: Analyzing REF: p. 1280

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

45. A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what?

a.

Tetralogy of Fallot

b.

Coarctation of the aorta

c.

Pulmonary stenosis

d.

Ventricular septal defect

ANS: D

Heart failure is common with ventricular septal defect that causes failure to thrive, respiratory infections, and an increase in exhaustion during feedings. There is a characteristic murmur. The other defects do not have left-to-right shunting.

DIF: Cognitive Level: Analyzing REF: p. 1314

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

46. An infant is diagnosed with transposition of the great vessels. Prostaglandin E1 is given intravenously. The parents ask how long the child will remain on the prostaglandin E1. What is the appropriate response by the nurse?

a.

Prostaglandin E1 will be given intermittently until corrective surgery is performed.

b.

Prostaglandin E1 will be given continuously until corrective surgery is performed.

c.

Prostaglandin E1 will be given continuously throughout the preoperative and postoperative periods until the child is stable.

d.

Prostaglandin E1 will be given intermittently throughout the preoperative and postoperative periods until the child is stable.

ANS: B

To provide intracardiac mixing for a child with transposition of the great arteries, intravenous prostaglandin E1 is administered continuously to keep the ductus arteriosus open to temporarily increase blood mixing and provide an oxygen saturation of 75% or to maintain cardiac output until surgery. It is discontinued after surgery.

DIF: Cognitive Level: Applying REF: p. 1273

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

47. What medication used to treat heart failure (HF) is a diuretic?

a.

Captopril (Capten)

b.

Digoxin (Lanoxin)

c.

Hydrochlorothiazide (Diuril)

d.

Carvedilol (Coreg)

ANS: C

Hydrochlorothiazide is a diuretic. Captopril is an ACE inhibitor, digoxin is a digital glycoside, and carvedilol is a beta-blocker.

DIF: Cognitive Level: Analyzing REF: p. 1305

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

48. The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose and draws up 4 ml of the drug. The most appropriate nursing action is which?

a.

Mix the dose with juice to disguise its taste.

b.

Do not give the dose; suspect a dosage error.

c.

Check the heart rate; administer digoxin if the rate is greater than 100 beats/min.

d.

Check the heart rate; administer digoxin if the rate is greater than 80 beats/min.

ANS: B

Infants rarely receive more than 1 ml (50 mcg, or 0.05 mg) of digoxin in one dose; a higher dose is an immediate warning of a dosage error. To ensure safety, compare the calculation with that of another staff member before giving digoxin.

DIF: Cognitive Level: Applying REF: p. 1313

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

49. A 12-year-old child with Down syndrome is admitted to the hospital for surgical correction of a heart defect. The boys mental age is that of a 3-year-old child. The nurse should prepare the child and family for surgery by what method?

a.

Extend preoperative teaching over several days.

b.

Explain the surgery to the child and the parents in detail.

c.

Exclude the child from preoperative teaching; teach only the parents.

d.

Provide teaching to the parents, keeping the information to the child simple.

ANS: D

Important factors to consider in planning preparation strategies before cardiac surgery are the childs cognitive developmental level, previous hospital experiences, temperament and coping style, the timing of the preparation, and the involvement of the parents. The teaching should be provided to the parents, keeping the information simple to the child with a mental age of 3 years old.

DIF: Cognitive Level: Applying REF: p. 1277

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

50. Bacterial infective endocarditis (IE) should be treated with which protocol?

a.

Oral antibiotics for 6 months

b.

Oral antibiotics (penicillin) for 10 full days

c.

IV antibiotics, diuretics, and digoxin

d.

IV antibiotics (penicillin type) for 2 to 8 weeks

ANS: D

Treatment for IE includes the administration of high-dose antibiotics given intravenously for 2 to 8 weeks to completely eradicate the infecting microorganism.

DIF: Cognitive Level: Understanding REF: p. 1295 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

51. A child is recovering from Kawasaki disease (KD). The child should be monitored for which?

a.

Anemia

b.

Electrocardiograph (ECG) changes

c.

Elevated white blood cell count

d.

Decreased platelets

ANS: B

The most serious complication of KD is the development of coronary artery aneurysms and the potential for myocardial infarction in children with aneurysm formation. The nurse should monitor any ECG changes.

DIF: Cognitive Level: Applying REF: p. 1299

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

52. The test that provides the most reliable evidence of recent streptococcal infection is which?

a.

Throat culture

b.

Mantoux test

c.

Antistreptolysin O test

d.

Elevation of liver enzymes

ANS: C

Antistreptolysin O (ASLO) titers measure the concentration of antibodies formed in the blood against this product. Normally, the titers begin to rise about 7 days after onset of the infection and reach maximum levels in 4 to 6 weeks. Therefore, a rising titer demonstrated by at least two ASLO tests is the most reliable evidence of recent streptococcal infection.

DIF: Cognitive Level: Applying REF: p. 1297

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. The nurse is caring for a child with Kawasaki disease in the acute phase. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

a.

Osler nodes

b.

Cervical lymphadenopathy

c.

Strawberry tongue

d.

Chorea

e.

Erythematous palms

f.

Polyarthritis

ANS: B, C, E

Clinical manifestations of Kawasaki disease in the acute phase include cervical lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic fever.

DIF: Cognitive Level: Applying REF: p. 1298

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

2. The nurse is caring for a child after cardiac surgery. What interventions should the nurse implement with regard to chest tubes placed to a water-seal drainage system? (Select all that apply.)

a.

Maintain sterility.

b.

Check for tube patency.

c.

Do not interrupt the water-seal drainage system.

d.

Clamp the chest tube when ambulating the child.

e.

Measure the drainage by emptying the collection chamber every shift.

ANS: A, B, C

Nursing considerations with regard to chest tubes attached to a water-seal drainage system include (1) do not interrupt water-seal drainage unless the chest tube is clamped, (2) check for tube patency (fluctuation in the water-seal chamber), and (3) maintain sterility. The chest tube should not be clamped when ambulating the child and the drainage is measured in the collection chamber, not emptied.

DIF: Cognitive Level: Applying REF: p. 1315

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

3. The nurse is caring for a child with secondary hypertension. What renal disorders are associated with secondary hypertension? (Select all that apply.)

a.

Renal tumor

b.

Hydronephrosis

c.

Vesicoureteral reflux

d.

Glomerulonephritis

e.

Urinary tract infection

ANS: A, B, D

Renal disorders that can cause secondary hypertension include a renal tumor, hydronephrosis, and glomerulonephritis. Vesicoureteral reflux or urinary tract infections do not cause secondary hypertension.

DIF: Cognitive Level: Analyzing REF: p. 1303

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

4. The nurse is teaching an adolescent with hypertension foods recommended on the DASH diet. What foods should the nurse include in the teaching session? (Select all that apply.)

a.

Green beans

b.

Energy drinks

c.

Low-fat yogurt

d.

Chocolate milk

e.

Whole grain bread

ANS: A, C, E

The DASH diet provides a lower salt diet that has been associated with improvement in BP and is believed to be beneficial for all patients with hypertension. DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet is plentiful in vegetables, fruits, whole grains, and low-fat dairy products and low in sugar and salt. Energy drinks are high in sugar, and chocolate milk is high in fat.

DIF: Cognitive Level: Applying REF: p. 1304

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

5. An adolescent is being placed on an ACE inhibitor. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.)

a.

Stay well hydrated.

b.

Increase intake of potassium.

c.

Avoid rapid position changes.

d.

Take the medication with meals.

e.

Side effects may include a cough.

ANS: A, C, E

The adolescent should be instructed to stay well hydrated and avoid rapid position changes and that side effects may include a cough when on ACE inhibitors. ACE inhibitors do not deplete potassium, and they should be taken 1 hour before meals to increase absorption.

DIF: Cognitive Level: Applying REF: p. 1305

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

6. An adolescent is being placed on a beta-blocker. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.)

a.

Medication may cause fatigue.

b.

Side effects may include impotence.

c.

Side effects may include bradycardia.

d.

Take the medication 1 hour before meals.

e.

Side effects may include peripheral edema.

ANS: A, B, C

The adolescent should be instructed that the medication may cause fatigue, impotence, and bradycardia. The medications should be taken with meals and side effects do not include peripheral edema.

DIF: Cognitive Level: Applying REF: p. 1305

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

7. An adolescent is being placed on a calcium channel blocker. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.)

a.

The medication may cause fatigue.

b.

The medication may increase heart rate.

c.

The medication may cause constipation.

d.

The medication may cause cold extremities.

e.

The medication may cause peripheral edema.

ANS: B, C, E

Calcium channel blockers may cause an increase in heart rate, constipation, and peripheral edema. Beta-blockers can cause fatigue and cold extremities, but calcium channel blockers do not cause these potential side effects.

DIF: Cognitive Level: Applying REF: p. 1307

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

8. The nurse is teaching an adolescent with elevated triglycerides foods that should be decreased. What foods should the nurse include in the teaching? (Select all that apply.)

a.

Avocados

b.

Canola oil

c.

White flour

d.

White rice

e.

Sugary cereals

ANS: C, D, E

If triglycerides are elevated, dietary recommendations include decreasing the intake of foods high in simple carbohydrates such as white flour, white rice, white bread, white pasta, sugary cereals, juice, and soda. Avocados and canola oil have beneficial effects on HDL, which is the good cholesterol.

DIF: Cognitive Level: Applying REF: p. 1309

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

9. What interventions should the nurse anticipate being administered to a child with supraventricular tachycardia (SVT)?

a.

Bed rest

b.

Applying ice to the face

c.

Administration of atropine

d.

Administration of adenosine (Adenocor)

e.

Having the child perform a Valsalva maneuver

ANS: B, D, E

The treatment of SVT depends on the degree of compromise imposed by the dysrhythmia. In some instances, vagal maneuvers, such as applying ice to the face, massaging the carotid artery (on one side of the neck only), or having an older child perform a Valsalva maneuver (e.g., exhaling against a closed glottis, blowing on the thumb as if it were a trumpet for 30 to 60 seconds), can reverse the SVT. When vagal maneuvers fail, adenosine may be used to end the episode of SVT by impairing AV node conduction. IV adenosine is the first-line pharmacologic measure for termination of SVT in infants and children in the emergency setting. Administration of atropine or bed rest will not resolve SVT.

DIF: Cognitive Level: Applying REF: p. 1311

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

COMPLETION

1. A health care provider prescribes furosemide (Lasix), 10 mg intravenously (IV) now, for a child with heart failure. The medication label states: Furosemide (Lasix) 20 mg/2 ml. The nurse prepares to administer the dose. How many milliliters will the nurse prepare to administer the dose? Fill in the blank. Record your answer in a whole number.

________________

ANS:

1

Follow the formula for dosage calculation.

Desired

Volume = ml per dose

Available

10 mg

2 ml = 2 ml

20 mg

DIF: Cognitive Level: Applying REF: p. 1266

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

2. A health care provider prescribes hydroxyzine (Atarax), 0.6 mg/kg PO every 4 to 6 hours as needed for pruritus for a child with Kawasaki disease. The medication label states: Hydroxyzine 10 mg/5 ml. The child weighs 20 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.

________________

ANS:

6

Follow the formula for dosage calculation.

Multiply 0.6 mg 20 kg to get the dose = 12 mg

Desired

Volume = ml per dose

Available

12 mg

5 ml = 6 ml

10 mg

DIF: Cognitive Level: Applying REF: p. 1298

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

3. A health care provider prescribes captopril (Capoten), 2.5 mg PO every 12 h for a child with heart failure. The medication label states: Captopril 5 mg/5 ml. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.

________________

ANS:

2.5

Follow the formula for dosage calculation.

Desired

Volume = ml per dose

Available

2.5 mg

5 ml = 2.5 ml

5 mg

DIF: Cognitive Level: Applying REF: p. 1266

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

4. A health care provider prescribes acetaminophen (Tylenol) gtt, 10 mg/kg/dose PO every 4 to 6 hours as needed for fever for a child with rheumatic fever. The child weighs 8 kg. The medication label states: Acetaminophen 80 mg/0.8 ml. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.

________________

ANS:

0.8

Follow the formula for dosage calculation.

Multiply 10 mg 8 kg to get the dose = 80 mg

Desired

Volume = ml per dose

Available

80 mg

0.8 ml = 0.8 ml

80 mg

DIF: Cognitive Level: Applying REF: p. 1290

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

MATCHING

Match the cardiac terms with their definitions.

a.

Mitral valve

b.

Tricuspid valve

c.

Atria

d.

Ventricles

1. The two upper chambers of the heart

2. Has two leaflets

3. Has three leaflets

4. The two bottom chambers of the heart

1. ANS: C DIF: Cognitive Level: Understanding REF: p. 1251

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. ANS: A DIF: Cognitive Level: Understanding REF: p. 1251

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. ANS: B DIF: Cognitive Level: Understanding REF: p. 1251

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. ANS: D DIF: Cognitive Level: Understanding REF: p. 1251

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Match the normal findings of an ECG with their definitions.

a.

P wave

b.

QRS complex

c.

T wave

d.

Q-T interval

e.

ST segment

5. Represents ventricular repolarization

6. Represents atrial depolarization

7. Represents ventricular depolarization and repolarization

8. Represents ventricular depolarization

9. Represents the time that the ventricles are in the absolute refractory period

5. ANS: C DIF: Cognitive Level: Understanding REF: p. 1257

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

6. ANS: A DIF: Cognitive Level: Understanding REF: p. 1257

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

7. ANS: D DIF: Cognitive Level: Understanding REF: p. 1257

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

8. ANS: B DIF: Cognitive Level: Understanding REF: p. 1257

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

9. ANS: E DIF: Cognitive Level: Understanding REF: p. 1257

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

Leave a Reply