Chapter 46: The Child with a Cardiovascular Alteration My Nursing Test Banks

Chapter 46: The Child with a Cardiovascular Alteration

Test Bank

MULTIPLE CHOICE

1. Which postoperative intervention should be questioned for a child after a cardiac catheterization?

a.

Continue intravenous (IV) fluids until the infant is tolerating oral fluids.

b.

Check the dressing for bleeding.

c.

Assess peripheral circulation on the affected extremity.

d.

Keep the affected leg flexed and elevated.

ANS: D

Feedback

A

IV fluid administration continues until the child is taking and retaining adequate amounts of oral fluids.

B

The insertion site dressing should be observed frequently for bleeding. The nurse should also look under the child to check for pooled blood.

C

Peripheral perfusion is monitored after catheterization. Distal pulses should be palpable, although they may be weaker than in the contralateral extremity.

D

The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 1212-1213

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. Which information should be included in the nurses discharge instructions for a child who underwent a cardiac catheterization earlier in the day?

a.

Pressure dressing is changed daily for the first week.

b.

The child may soak in the tub beginning tomorrow.

c.

Contact sports can be resumed in 2 days.

d.

The child can return to school on the third day after the procedure.

ANS: D

Feedback

A

The day after the cardiac catheterization, the pressure dressing is removed and replaced with a Band-Aid. The catheter insertion site is assessed daily for healing. Any bleeding or sign of infection, such as drainage, must be reported to the cardiologist.

B

Bathing is limited to a shower, a sponge bath, or a brief tub bath (no soaking) for the first 1 to 3 days after the procedure.

C

Strenuous exercise such as contact sports, swimming, or climbing trees is avoided for up to 1 week after the procedure.

D

The child can return to school on the third day after the procedure. It is important to emphasize follow-up with the cardiologist.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1213

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

3. The nurse is admitting a child to the hospital for a cardiac workup. What is the first step in a cardiac assessment?

a.

Percussion

b.

Palpation

c.

Auscultation

d.

History and inspection

ANS: D

Feedback

A

Percussion of the chest is usually deferred.

B

Palpation can be threatening to the child because it requires a significant amount of physical contact. For this reason it is not the initial step in a cardiac assessment.

C

Auscultation requires touching the child and is not the initial step in a cardiac assessment.

D

The assessment should begin with the least threatening interventionsthe history and inspection. Assessment progression includes inspection, auscultation, and palpation because each step includes more touching.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1210 | Table 46-2

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

4. In which situation is there a risk that a newborn infant will have a congenital heart defect (CHD)?

a.

Trisomy 21 detected on amniocentesis

b.

Family history of myocardial infarction

c.

Father has type 1 diabetes mellitus

d.

Older sibling born with Turner syndrome

ANS: A

Feedback

A

The incidence of congenital heart disease is approximately 50% in children with trisomy 21 (Down syndrome).

B

A family history of congenital heart disease, not acquired heart disease, increases the risk of giving birth to a child with CHD.

C

Infants born to mothers who are insulin dependent have an increased risk of CHD.

D

Infants identified as having certain genetic defects, such as Turner syndrome, have a higher incidence of CHD. A family history is not a risk factor.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1201

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

5. Before giving a dose of digoxin (Lanoxin), the nurse checked an infants apical heart rate and it was 114 bpm. What should the nurse do next?

a.

Administer the dose as ordered.

b.

Hold the medication until the next dose.

c.

Wait and recheck the apical heart rate in 30 minutes.

d.

Notify the physician about the infants heart rate.

ANS: A

Feedback

A

The infants heart rate is above the lower limit for which the medication is held. The dose can be given.

B

A dose of Lanoxin is withheld for a heart rate less than 100 bpm in an infant.

C

The infants heart rate is acceptable for administering Lanoxin. It is unnecessary to recheck the heart rate at a later time.

D

The infants heart rate is acceptable. The physician should be notified for a heart rate less than 100 bpm in an infant.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1204

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

6. What intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?

a.

Weigh the infant every day on the same scale at the same time.

b.

Notify the physician when weight gain exceeds more than 20 g/day.

c.

Put the infant in a car seat to minimize movement.

d.

Administer digoxin (Lanoxin) as ordered by the physician.

ANS: A

Feedback

A

Excess fluid volume may not be overtly visible. Weight changes may indicate fluid retention. Weighing the infant on the same scale at the same time each day ensures consistency.

B

An excessive weight gain for an infant is an increase of more than 50 g/day.

C

With fluid volume excess, skin will be edematous. The infants position should be changed frequently to prevent undesirable pooling of fluid in certain areas.

D

Lanoxin is used in the treatment of congestive heart failure to improve cardiac function. Diuretics will help the body get rid of excess fluid.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1204

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

7. The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect?

a.

Pulmonary stenosis

b.

Patent ductus arteriosus

c.

Ventricular septal defect

d.

Coarctation of the aorta

ANS: B

Feedback

A

A systolic ejection murmur that may be accompanied by a palpable thrill is a manifestation of pulmonary stenosis.

B

The classic murmur associated with patent ductus arteriosus is a machinery-like one that can be heard throughout both systole and diastole.

C

The characteristic murmur associated with ventricular septal defect is a loud, harsh, holosystolic murmur.

D

A systolic murmur that is accompanied by an ejection click may be heard on auscultation when coarctation of the aorta is present.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1214 | Table 46-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

8. What is an expected assessment finding in a child with coarctation of the aorta?

a.

Orthostatic hypotension

b.

Systolic hypertension in the lower extremities

c.

Blood pressure higher on the left side of the body

d.

Disparity in blood pressure between the upper and lower extremities

ANS: D

Feedback

A

Orthostatic hypotension is not present with coarctation of the aorta.

B

Systolic hypertension may be detected in the upper extremities.

C

The left arm may not accurately reflect systolic hypertension because the left subclavian artery can be involved in the coarctation.

D

The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1217 | Table 46-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this childs laboratory values, the nurse is not surprised to notice which abnormality?

a.

Polycythemia

b.

Infection

c.

Dehydration

d.

Anemia

ANS: A

Feedback

A

Polycythemia is a compensatory response to chronic hypoxia. The body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood.

B

Infection is not a clinical consequence of cyanosis.

C

Although dehydration can occur in cyanotic heart disease, it is not a compensatory mechanism for chronic hypoxia. It is not a clinical consequence of cyanosis.

D

Anemia may develop as a result of increased blood viscosity. Anemia is not a clinical consequence of cyanosis.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1208

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

10. Which statement made by a parent indicates understanding of restrictions for a child after cardiac surgery?

a.

My child needs to get extra rest for a few weeks.

b.

My son is really looking forward to riding his bike next week.

c.

Im so glad we can attend religious services as a family this coming Sunday.

d.

I am going to keep my child out of daycare for 6 weeks.

ANS: D

Feedback

A

The child should resume his regular bedtime and sleep schedule after discharge.

B

Activities during which the child could fall, such as riding a bicycle, are avoided for 4 to 6 weeks after discharge.

C

Large crowds of people should be avoided for 4 to 6 weeks after discharge, including public worship.

D

Settings where large groups of people are present should be avoided for 4 to 6 weeks after discharge, including day care.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1224

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

11. A child had an aortic stenosis defect surgically repaired 6 months ago. Which antibiotic prophylaxis is indicated for an upcoming tonsillectomy?

a.

No antibiotic prophylaxis is necessary.

b.

Amoxicillin is taken orally 1 hour before the procedure.

c.

Oral penicillin is given for 7 to 10 days before the procedure.

d.

Parenteral antibiotics are administered for 5 to 7 days after the procedure.

ANS: B

Feedback

A

Antibiotic prophylaxis is indicated for the first 5 months after surgical repair.

B

The standard prophylactic agent is amoxicillin given orally 1 hour before the procedure.

C

Antibiotic prophylaxis is not given for this period of time.

D

The treatment for infective endocarditis involves parenteral antibiotics for 2 to 8 weeks.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1225

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

12. The nurse discovers a heart murmur in an infant 1 hour after birth. She is aware that fetal shunts are closed in the neonate at what point?

a.

When the umbilical cord is cut

b.

Within several days of birth

c.

Within a month after birth

d.

By the end of the first year of life

ANS: B

Feedback

A

With the neonates first breath, gas exchange is transferred from the placenta to the lungs. The separation of the fetus from the umbilical cord does not contribute to the establishment of neonatal circulation.

B

In the normal neonate, fetal shunts functionally close in response to pressure changes in the systemic and pulmonary circulations and to increased oxygen content. This process may take several days to complete.

C

The fetal shunts normally close within several days of birth.

D

Fetal shunts normally close soon after birth but may take several days.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1199

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

13. When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure?

a.

The right arm

b.

The left arm

c.

All four extremities

d.

Both arms while the child is crying

ANS: C

Feedback

A

Blood pressure measurements for upper and lower extremities are compared during an assessment for CHDs.

B

Discrepancies in blood pressure between the upper and lower extremities cannot be determined if blood pressure is not measured in all four extremities.

C

When a CHD is suspected, the blood pressure should be measured in all four extremities while the child is quiet. Discrepancies between upper and lower extremities may indicate cardiac disease.

D

Blood pressure measurements when the child is crying are likely to be elevated; thus the readings will be inaccurate. Also, all four extremities need to be measured.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1210 | Table 46-2

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

14. What is the nurses first action when planning to teach the parents of an infant with a CHD?

a.

Assess the parents anxiety level and readiness to learn.

b.

Gather literature for the parents.

c.

Secure a quiet place for teaching.

d.

Discuss the plan with the nursing team.

ANS: A

Feedback

A

Any effort to organize the right environment, plan, or literature is of no use if the parents are not ready to learn or have high anxiety. Decreasing level of anxiety is often needed before new information can be processed.

B

A baseline assessment of prior knowledge should be taken into consideration before developing any teaching plan.

C

Locating a quiet place for meeting with parents is appropriate; however, an assessment should be done before any teaching is done.

D

Discussing a teaching plan with the nursing team is appropriate after an assessment of the parents knowledge and readiness.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1205

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

15. Before preparing a teaching plan for the parents of an infant with ductus arteriosus, it is important that the nurse understands this condition. Which statement best describes patent ductus arteriosus?

a.

Patent ductus arteriosus involves a defect that results in a right-to-left shunting of blood in the heart.

b.

Patent ductus arteriosus involves a defect in which the fetal shunt between the aorta and the pulmonary artery fails to close.

c.

Patent ductus arteriosus is a stenotic lesion that must be surgically corrected at birth.

d.

Patent ductus arteriosus causes an abnormal opening between the four chambers of the heart.

ANS: B

Feedback

A

Patent ductus arteriosus allows blood to flow from the high-pressure aorta to the low-pressure pulmonary artery, resulting in a left-to-right shunt.

B

Patent ductus arteriosus is failure of the fetal shunt between the aorta and the pulmonary artery to close.

C

Patent ductus arteriosus is not a stenotic lesion. Patent ductus arteriosus can be closed both medically and surgically.

D

Atrioventricular defect occurs when fetal development of the endocardial cushions is disturbed, resulting in abnormalities in the atrial and ventricular septa and the atrioventricular valves.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1214 | Table 46-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

16. For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?

a.

To decrease inflammation

b.

To control pain

c.

To decrease respirations

d.

To improve oxygenation

ANS: D

Feedback

A

Prostaglandin E1 is used to maintain a patent ductus arteriosus, thus increasing pulmonary blood flow.

B

Prostaglandin E1 is administered to infants with a right-to-left shunt to keep the ductus arteriosus patent, thus increasing pulmonary blood flow.

C

Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent to increase pulmonary blood flow.

D

Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1217 | Table 46-3

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

17. Which CHD results in increased pulmonary blood flow?

a.

Ventricular septal defect

b.

Coarctation of the aorta

c.

Tetralogy of Fallot

d.

Pulmonary stenosis

ANS: A

Feedback

A

Ventricular septal defect causes a left-to-right shunting of blood, thus increasing pulmonary blood flow.

B

Coarctation of the aorta is a stenotic lesion that causes increased resistance to blood flow from the proximal to distal aorta.

C

The defects associated with tetralogy of Fallot result in a right-to-left shunting of blood, thus decreasing pulmonary blood flow.

D

Pulmonary stenosis causes obstruction of blood flow from the right ventricle to the pulmonary artery. Pulmonary blood flow is decreased.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1215 | Table 46-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

18. Which statement suggests that a parent understands how to correctly administer digoxin?

a.

I measure the amount I am supposed to give with a teaspoon.

b.

I put the medicine in the babys bottle.

c.

When she spits up right after I give the medicine, I give her another dose.

d.

I give the medicine at 8 in the morning and evening every day.

ANS: D

Feedback

A

To ensure the correct dosage, the medication should be measured with a syringe.

B

The medication should not be mixed with formula or food. It is difficult to judge whether the child received the proper dose if the medication is placed in food or formula.

C

To prevent toxicity, the parent should not repeat the dose without contacting the childs physician.

D

For maximum effectiveness, the medication should be given at the same time every day.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1207

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

19. What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well?

a.

Recheck the infants blood pressure.

b.

Alert the physician.

c.

Withhold oral feeding.

d.

Increase the oxygen rate.

ANS: B

Feedback

A

Although this may be indicated, it is not the priority action.

B

These are signs of early congestive heart failure, and the physician should be notified.

C

Withholding the infants feeding is an incomplete response to the problem.

D

Increasing oxygen may alleviate symptoms, but medications such as digoxin and furosemide are necessary to improve heart function and fluid retention. Notifying the physician is the priority nursing action.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1205

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

20. Nursing care for the child in congestive heart failure includes

a.

Counting the number of saturated diapers

b.

Putting the infant in the Trendelenburg position

c.

Removing oxygen while the infant is crying

d.

Organizing care to provide rest periods

ANS: D

Feedback

A

Diapers must be weighed for an accurate record of output.

B

The head of the bed should be raised to decrease the work of breathing.

C

Oxygen should be administered during stressful periods such as when the child is crying.

D

Nursing care should be planned to allow for periods of undisturbed rest.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1205

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

21. Which strategy is appropriate when feeding the infant with congestive heart failure?

a.

Continue the feeding until a sufficient amount of formula is taken.

b.

Limit feeding time to no more than 30 minutes.

c.

Always bottle feed every 4 hours.

d.

Feed larger volumes of concentrated formula less frequently.

ANS: B

Feedback

A

The infant with congestive heart failure may tire easily. If the infant does not consume an adequate amount of formula in 30 minutes, gavage feedings should be considered.

B

The infant with congestive heart failure may tire easily, so the feeding should not continue beyond 30 minutes. If inadequate amounts of formula are taken, gavage feedings should be considered.

C

Infants with congestive heart failure may be breastfed. Feedings every 3 hours is a frequently used interval. If the infant were fed less frequently than every 3 hours, more formula would need to be consumed and would tire the infant.

D

The infant is fed smaller volumes of concentrated formula every 3 hours.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1207

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

22. A nurse is teaching an adolescent about primary hypertension. Which statement made by the adolescent indicates an understanding of primary hypertension?

a.

Primary hypertension should be treated with diuretics as soon as it is detected.

b.

Congenital heart defects are the most common cause of primary hypertension.

c.

Primary hypertension may be treated with weight reduction.

d.

Primary hypertension is not affected by exercise.

ANS: C

Feedback

A

Primary hypertension is usually treated with weight reduction and exercise. If ineffective, pharmacologic intervention may be needed.

B

Primary hypertension is considered to be an inherited disorder.

C

Primary hypertension in children may be treated with weight reduction and exercise programs.

D

An exercise program in conjunction with weight reduction can be effective in managing primary hypertension in children.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1234

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

23. An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality. The initial treatment of secondary hypertension initially involves

a.

Weight control and diet

b.

Treating the underlying disease

c.

Administration of digoxin

d.

Administration of beta-adrenergic receptor blockers

ANS: B

Feedback

A

Weight control and diet is a non-pharmacologic treatment for primary hypertension.

B

Identification of the underlying disease should be the first step in treating secondary hypertension.

C

Digoxin is indicated in the treatment of congestive heart failure.

D

Beta-adrenergic receptor blockers are indicated in the treatment of primary hypertension.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1235

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

24. What should the nurse include in discharge teaching as the highest priority for the child with a cardiac dysrhythmia?

a.

CPR instructions

b.

Repeating digoxin if the child vomits

c.

Resting if dizziness occurs

d.

Checking the childs pulse after digoxin administration

ANS: A

Feedback

A

This could potentially be life-saving for the child. The parents and significant others in the childs life should have CPR training.

B

The digoxin dose is not repeated if the child vomits.

C

Dizziness is a symptom the child should be taught to report to adults so that the physician can be notified. It is not the priority intervention.

D

The childs pulse should be counted before the medication is given. The dose is withheld if the pulse is below the parameters set by the physician.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1228

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

25. A nurse is assigned to care for an infant with an unrepaired tetralogy of Fallot. What should the nurse do first when the baby is crying and becomes severely cyanotic?

a.

Place the infant in a knee-chest position.

b.

Administer oxygen.

c.

Administer morphine sulfate.

d.

Calm the infant.

ANS: D

Feedback

A

Placing the infant in a knee-chest position will decrease venous return so that smaller amounts of highly saturated blood reach the heart. This should be done after calming the infant.

B

Administering oxygen is indicated after placing the infant in a knee-chest position.

C

Administering morphine sulfate calms the infant. It may be indicated some time after the infant has been calmed.

D

Calming the crying infant is the first response. An infant with unrepaired tetralogy of Fallot who is crying and agitated may eventually lose consciousness.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1209

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

26. The nurse caring for a child diagnosed with acute rheumatic fever should assess the child for

a.

Sore throat

b.

Elevated blood pressure

c.

Desquamation of the fingers and toes

d.

Tender, warm, inflamed joints

ANS: D

Feedback

A

The child may have had a sore throat previously associated with a group A beta-hemolytic streptococcal infection a few weeks earlier. A sore throat is not a manifestation of rheumatic fever.

B

Hypertension is not associated with rheumatic fever.

C

Desquamation of the fingers and toes is a manifestation of Kawasaki syndrome.

D

Arthritis, characterized by tender, warm, erythematous joints, is one of the major manifestations of acute rheumatic fever in the first 1 to 2 weeks of the illness.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1229

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

27. The nurse is admitting a child who has been diagnosed with Kawasaki disease. What is the most serious complication for which the nurse should assess in Kawasaki disease?

a.

Cardiac valvular disease

b.

Cardiomyopathy

c.

Coronary aneurysm

d.

Rheumatic fever

ANS: C

Feedback

A

Cardiac valvular disease can occur in rheumatic fever.

B

Cardiomyopathies are diseases of the heart muscle, which can occur as a result of congenital heart disease, coronary artery disease, or other systemic disease.

C

Coronary artery aneurysms are seen in 20% to 25% of children with untreated Kawasaki disease.

D

Rheumatic fever is not a complication of Kawasaki disease.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1232

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

28. A nurse is conducting a class for nursing students about fetal circulation. Which statement is accurate about fetal circulation and should be included in the teaching session?

a.

Oxygen is carried to the fetus by the umbilical arteries.

b.

Blood from the inferior vena cava is shunted directly to the right ventricle through the foramen ovale.

c.

Pulmonary vascular resistance is high because the lungs are filled with fluid.

d.

Blood flows from the ductus arteriosus to the pulmonary artery.

ANS: C

Feedback

A

Oxygen and nutrients are carried to the fetus by the umbilical vein.

B

The inferior vena cava empties blood into the right atrium. The direction of blood flow and the pressure in the right atrium propel most of this blood through the foramen ovale into the left atrium.

C

Resistance in the pulmonary circulation is very high because the lungs are collapsed and filled with fluid.

D

Most of the blood in the pulmonary artery flows though the ductus arteriosus into the descending aorta.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1198

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

29. 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

Feedback

A

Pulmonic stenosis is an obstruction to blood flowing from the ventricles.

B

Tricuspid atresia results in decreased pulmonary blood flow.

C

The 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.

D

Transposition of the great arteries results in mixed blood flow.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1214 | Table 46-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

30. A beneficial effect of administering digoxin (Lanoxin) is that it

a.

Decreases edema

b.

Decreases cardiac output

c.

Increases heart size

d.

Increases venous pressure

ANS: A

Feedback

A

Digoxin has a rapid onset and is useful increasing cardiac output, decreasing venous pressure, and as a result, decreasing edema.

B

Cardiac output is increased by digoxin.

C

Heart size is decreased by digoxin.

D

Digoxin decreases venous pressure.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1203

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

31. Which drug is an angiotensin-converting enzyme (ACE) inhibitor?

a.

Captopril (Capoten)

b.

Furosemide (Lasix)

c.

Spironolactone (Aldactone)

d.

Chlorothiazide (Diuril)

ANS: A

Feedback

A

Capoten is a drug in an ACE inhibitor.

B

Lasix is a loop diuretic.

C

Aldactone blocks the action of aldosterone.

D

Diuril works on the distal tubules.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1203

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

32. What is the most common causative agent of bacterial endocarditis?

a.

Staphylococcus albus

b.

Streptococcus hemolyticus

c.

Staphylococcus albicans

d.

Streptococcus viridans

ANS: D

Feedback

A

S. albus is not a common causative agent.

B

Streptococcus hemolyticus is not a common causative agent.

C

S. albicans is not a common causative agent.

D

S. viridans and S. aureus are the most common causative agents in bacterial (infective) endocarditis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1224

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

33. The primary nursing intervention to prevent bacterial endocarditis is

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

Feedback

A

Dental procedures should be done to maintain a high level of oral health. Prophylactic antibiotics are necessary.

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.

C

Observing children for complications should be done, but maintaining good oral health and prophylactic antibiotics is important.

D

Encouraging restricted mobility should be done, but maintaining good oral health and prophylactic antibiotics is important.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1225

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

34. A common, serious complication of rheumatic fever is

a.

Seizures

b.

Cardiac dysrhythmias

c.

Pulmonary hypertension

d.

Cardiac valve damage

ANS: D

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A

Seizures are not common complications of rheumatic fever.

B

Cardiac dysrhythmias are not common complications of rheumatic fever.

C

Pulmonary hypertension is not a common complication of rheumatic fever.

D

Cardiac valve damage is the most significant complication of rheumatic fever.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1229

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE

1. As a nurse working in the newborn nursery, you notice an infant who is having circumoral cyanosis. Which CHD do you suspect the child may have? Select all that apply.

a.

Patent ductus arteriosus (PDA)

b.

Tetralogy of Fallot

c.

Pulmonary atresia

d.

Transposition of the great arteries

e.

Ventricular septal defect

ANS: B, C, D

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Correct

Tetralogy of Fallot is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Pulmonary atresia is a cyanotic lesion with decreased pulmonary blood flow. The hypoxia results in baseline oxygen saturations as low as 75% to 85%. Even with oxygen administration, saturations do not reach the normal range. Transposition of the great arteries is a cyanotic lesion with increased pulmonary blood flow.

Incorrect

PDA is failure of the fetal shunt between the aorta and the pulmonary artery to close. PDA is not classified as a cyanotic heart disease. Prostaglandin E1 is often given to maintain ductal patency in children with cyanotic heart diseases. VSD is the most common type of cardiac defect. The VSD is a left-to-right shunting defect; however, it may be accompanied by other defects.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 1217-1221 | Table 46-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. A child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to the child and the childs parents? Select all that apply.

a.

Replace whole milk for 2% or 1% milk.

b.

Increase servings of red meat.

c.

Increase servings of fish.

d.

Avoid excessive intake of fruit juices.

e.

Limit servings of whole grain.

ANS: A, C, D

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Correct

A low-fat diet includes using nonfat or low-fat dairy products, limiting red meat intake, and increasing intake of fish, vegetables, whole grains, and legumes.

Incorrect

Children should avoid excessive intake of fruit juices and other sweetened drinks, sugars, and saturated fats.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1237

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

3. A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what condition occurs? Select all that apply.

a.

Respiratory rate of 36 at rest

b.

Appetite slowly increasing

c.

Temperature above 37.7 C (100 F)

d.

New, frequent coughing

e.

Turning blue or bluer than normal

ANS: C, D, E

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Correct

The parents should be instructed to notify the physician after their infants cardiac surgery for a temperature above 37.7 C; new, frequent coughing; and any episodes of the infant turning blue or bluer than normal.

Incorrect

A respiratory rate of 36 at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1224

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

COMPLETION

1. Elevated blood pressure in the blood vessels of the lungs is a condition known as PAH or _____________________ __________________ .

ANS:

Pulmonary hypertension

Pulmonary hypertension is diagnosed when the mean arterial pressure exceeds 20 mm Hg (normal is 15 mm Hg). The most common cause of pulmonary hypertension in children is congenital heart disease.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 1207

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

TRUE/FALSE

1. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding, or provision of breast milk by bottle, for the first 4 to 6 months of life, preferably until the child reaches 1 year of age or beyond. This does not include infants with congenital heart disease who have difficulty maintaining breastfeeding due to poor oxygenation and fatigue. Is this statement true or false?

ANS: F

The AAP states that breastfeeding should not be precluded for most high-risk neonates and infants, including those with congenital heart disease. The benefits of breastfeeding these infants includes; higher and more stable oxygen saturation measurements, improved weight gain, and shorter hospital stays.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1206

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

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