ch23 adaptive quiz

Question 1

What is the major cause of death in the first year of life besides preterm birth?
1
Asthma
2
Cystic fibrosis
3
Congestive heart failure
 Correct4
Congenital heart defect

Answer 1

The major cause of death besides preterm birth during the first year of life is congenital heart defect. Asthma, cystic fibrosis, and congestive heart failure are not the major causes of death in the first year of life.

Question 2

In which procedure for cardiac diagnosis are radiopaque catheters placed in a peripheral blood vessel and advanced into the heart to measure pressures and oxygen levels in heart chambers?
1
ECG
2
Cardiac MRI
3
Exercise stress test
 Correct4
Cardiac catheterization

Answer 2

In cardiac catheterization, radiopaque catheters are placed in a peripheral blood vessel and advanced into the heart as a means of measuring pressures and oxygen levels in heart chambers. The electrocardiogram (ECG) is a graphic measure of the electrical activity of the heart. Cardiac magnetic resonance imaging (MRI) is a noninvasive imaging technique used to evaluate the vascular anatomy outside the heart. The exercise stress test is used to assess heart function at rest and during progressively more demanding exercise on a treadmill or bicycle.

Question 3

After cardiac catheterization of a child, which assessment finding is a cause of concern to the nurse?
Incorrect1
The pulse distal to the catheterization site is weak.
Correct2
The affected extremity feels cool when touched.
3
The child has resumed oral intake with clear liquids.
4
The child is in bed with the affected extremity straight.

Answer 3

If the affected extremity feels cool when touched, arterial obstruction may be present. The health care provider must be notified immediately. A weak pulse distal to the site for the first few hours after catheterization is not a cause for concern. However, the pulse should gradually increase in strength. The child’s usual diet can be resumed as soon as tolerated, beginning with sips of clear liquids and advancing as the condition allows. The child must take in enough fluids to ensure adequate hydration. Blood loss, nothing by mouth (NPO) status, and diuretic actions of dyes used during the procedure increase the risk for hypovolemia and dehydration. The child must be kept in bed, with the affected extremity maintained straight for several hours, to promote healing of the cannulated vessel.

Question 4

The nurse should explain to the parents that their child is receiving furosemide for severe congestive heart failure because of which effect?
 Correct1
A diuretic
2
A β-blocker
3
An ACE inhibitor
4
A form of digitalis

Answer 4

Furosemide is a diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated with congestive heart failure. Furosemide is not a β-blocker. Furosemide is not a form of digitalis. Furosemide is not an angiotensin-converting enzyme (ACE) inhibitor.

Question 5

What is the name for defects in which blood exiting the heart meets an area of anatomic narrowing?
1
Mixed
2
Cyanotic
3
Acyanotic
4
Obstructive

Answer 5

Obstructive defects are those in which blood exiting the heart meets an area of anatomic narrowing, causing obstruction to blood flow. Acyanotic defect is a classification of heart defects in which children do not have symptoms of cyanosis. Cyanotic defect is a classification of heart defects in which children have symptoms of cyanosis. Mixed defect is the term used to describe cardiac defects in which saturated and desaturated blood flow mixes.

Test-Taking Tip: Do not read too much into the question or worry that it is a “trick.” If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures.

Question 6

A child presents to the emergency department with an urticarial rash and laryngeal edema. What do these clinical symptoms suggest?
1
Shock
2
Anaphylaxis
3
Septic shock
4
Toxic shock syndrome

Answer 6

An urticarial rash and laryngeal edema suggest anaphylaxis. Shock is circulatory failure that results in hypotension, tissue hypoxia, and metabolic acidosis. Septic shock results in vasodilation and increased capillary permeability. Toxic shock syndrome resembles septic shock and can cause acute multisystem organ failure.

Test-Taking Tip: Make educated guesses when necessary.

Question 7

What condition is defined as sepsis with organ dysfunction and hypotension?
1
Anaphylaxis
 Correct2
Septic shock
3
Massive vasodilation
4
Toxic shock syndrome

Answer 7

Septic shock is defined as sepsis with organ dysfunction and hypotension. Anaphylaxis is an acute clinical syndrome resulting from the interaction of an allergen and a patient who is hypersensitive to that allergen. Massive vasodilation is a symptom of sepsis, but it is not the defining term for sepsis with organ dysfunction and hypotension. Toxic shock syndrome is a rare condition caused by the toxins produced by the Staphylococcus bacteria.

Question 8

Which term describes the thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia?
 Correct1
Clubbing
2
Polycythemia
3
Hypercyanotic spells
4
Raynaud phenomenon

Answer 8

Clubbing is a thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia and polycythemia. Polycythemia is an increased number of red blood cells. Hypercyanotic, or “blue,” spells are often seen in infants with tetralogy of Fallot; the affected infant becomes acutely cyanotic and hyperpneic. Raynaud phenomenon is an autoimmune disease.

Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function.

Question 9

What is a priority patient outcome for a child with congestive heart failure?
1
The child will have a rapid heart rate.
2
The child will have skin that is cool to the touch.
Correct3
The child will not have distended neck veins.
4
The child will sleep with the head down and feet elevated

Answer 9

A lack of distended neck veins is an appropriate patient outcome for a child with congestive heart failure. The child should have a heart rate that is acceptable for the child’s age rather than rapid. The skin should be warm to the touch rather than cool. The child should sleep with the head elevated rather than with the head down and the feet elevated.

Question 10

What is the primary therapy for secondary hypertension in children?
1
A low-salt diet
2
Weight reduction
 Correct3
Treatment of the cause
4
Improved exercise and fitness

Answer 10

Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension can be resolved. Weight reduction, a low-salt diet, and improved exercise and fitness are usually effective in managing essential hypertension.

Question 11

What should the nurse recognize as an early clinical sign of compensated shock in a child?
Incorrect1
Confusion
2
Sleepiness
3
Hypotension
 Correct4
Apprehensiveness

Answer 11

Apprehensiveness is indicative of compensated shock. Confusion is indicative of uncompensated shock. Sleepiness is not an indication of shock. Hypotension is a symptom of irreversible shock.

Question 12

What is an important nursing responsibility when a dysrhythmia is suspected?
Incorrect1
Ordering an immediate electrocardiogram
2
Counting the radial pulse every minute five times
3
Having someone else take the radial pulse simultaneously with the apical pulse
Correct4
Counting the apical pulse for 1 full minute and comparing the rate with the radial pulse rate

Answer 12

Counting the apical pulse is the nurse’s first action. If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate. Ordering an electrocardiogram may be indicated after the nurse has conferred with the practitioner. The radial pulse rate needs to be compared with the apical pulse rate but does not need to be counted for 1 minute five times. Only one nurse is needed to carry out the action of taking the radial pulse simultaneously with the apical pulse.

Question 13

What is an early sign of congestive heart failure that the nurse should recognize?
 Correct1
Tachypnea
2
Bradycardia
3
Inability to sweat
4
Increased urine output

Answer 13

Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child with congestive heart failure may be diaphoretic and exhibit decreased urine output.

Question 14

What position does the nurse caring for a young child with tetralogy of Fallot see the child assuming in an attempt to compensate for the congenital heart defect?
1
Prone
2
Supine
 Correct3
Knee-chest
4
Low Fowler

Answer 14

The squatting or knee-chest position decreases the amount of blood returning to the heart and allows the child time to compensate. The prone and supine positions do not offer any advantages to the child with cardiac compromise. The low Fowler position would assist with respiratory issues but not with cardiac compensation.

Test-Taking Tip: Avoid choosing answers that use words such as always, never, must, all, and none. If you are confused about the question, read the choices, label them true or false, and choose the answer that is the odd one out (i.e., the one false one or the one true one). When a question is framed in the negative, such as “When assessing for pain, you should not,” the false option is the correct choice.

Question 15

What nursing intervention is the most important in preventing complications of digoxin administration?
1
Assessing blood pressure in all extremities
2
Assessing blood pressure with the patient lying, sitting, and standing
Correct3
Checking the apical pulse for 60 seconds before administering the medication
4
Checking the carotid pulse for 30 seconds before administering the medication

Answer 15

The child’s apical pulse should be assessed for 60 seconds before the medication is administered; the medication should be held if the apical pulse is below 90 to 110 beats/min in infants and young children or below 70 beats/min in older children. Assessing the blood pressure or the carotid pulse before giving digoxin is not necessary.

Question 16

The nurse is assessing the cholesterol levels of the patient and finds that the patient has low-density lipoprotein (LDL) levels of 140 mg/dL. What instruction would be most appropriate for the nurse to give to the patient?
1
“You should consume cheese all three meals of the day.”
2
“You should reduce the fiber content in your everyday diet.”
3
“You should perform 20 minutes of exercise once per week.”
Correct4
“You should include olive oil and green vegetables in your diet.”

Answer 16

The patient’s LDL level is 140, higher than normal, which should be less than 110 mg/dL. Olive oil and green vegetables contain monounsaturated fats, which help to reduce LDL levels and provide proper nutrition to the patient. Cheese contains excess amount of lipids, which may increase the LDL levels. Therefore, the nurse does not instruct the patient to eat cheese three times a day. Fiber is essential for proper growth and development and should not be reduced. Performing 20 minutes of exercise once a week would not be sufficient for this patient; the patient should exercise 60 minutes a day, 5 days a week.

Question 17

Which heart defect causes narrowing of the aortic valve?
 Correct1
Aortic stenosis
2
Atrial septal defect
3
Coarctation of the aorta
4
Patent ductus arteriosus

Answer 17

Aortic stenosis causes narrowing of the aortic valve, which in turn results in resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Atrial septal defect is an abnormal opening between the atria that allows blood from the higher-pressure left atrium to flow into the lower-pressure right atrium. Coarctation of the aorta is an obstructive defect in which there is narrowing near the insertion of the ductus arteriosus. Patent ductus arteriosus is the failure of the fetal ductus arteriosus to close during the first few weeks of life.

Question 18

What should the nurse teach the parents of a child who has a history of bacterial infective endocarditis (IE)?
Correct1
Institute prophylactic antibiotic therapy.
2
Treat with short-term oral drug therapy.
3
Treat a cold with over-the-counter drugs.
4
Take blood culture before dental work.

Answer 18

The parents must take adequate measures to prevent infection. The child must be administered prophylactic antibiotic therapy 1 hour before certain procedures, such as dental work. Treatment of IE requires long-term parenteral drug therapy. Intravenous antibiotics may be administered at home with nursing supervision. Any unexplained fever, weight loss, lethargy, malaise, or anorexia must be reported to the health care provider. Such symptoms should not be self-diagnosed as a cold or flu, nor should they be treated with over-the-counter drugs. Early diagnosis and treatment are important in preventing further cardiac damage, embolic complications, and growth of resistant organisms. Blood cultures must be taken periodically to evaluate the response to antibiotic therapy.

Question 19

After a patient returns from cardiac catheterization the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). What is the most appropriate nursing intervention?
1
Elevating the affected extremity
2
Notifying the health care provider of the finding
3
Applying warm compresses to the insertion site
Correct4
Documenting the findings and continuing to monitor the child

Answer 19

The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization but should gradually increase in strength. The extremity is kept straight and immobile, but elevation is not necessary. Because a weaker pulse is an expected finding, the nurse should document and continue to monitor it. There is no need to notify the physician. The insertion site is kept dry. Warm compresses would increase the risk of bleeding from the insertion site.

Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

Question 20

What postoperative care should the nurse include for a child immediately after surgery?
1
Count the heart rate and respirations for 30 seconds.
2
Auscultate the lungs bilaterally once every 2 hours.
Correct3
Ensure the child is warm immediately after surgery.
4
Provide fluids in the immediate postoperative period.

Answer 20

Hypothermia is expected immediately after surgery from hypothermia procedures, effects of anesthesia, and loss of body heat to the cool environment. The operating room is kept fairly cold, and this adds to the hypothermia. During this period, the child is kept warm to prevent additional heat loss. Heart rate and respirations are counted for 1 full minute, compared with the electrocardiogram monitor, and recorded with activity. The heart rate is normally increased after surgery. The lungs are auscultated for breath sounds hourly. Diminished or absent sounds need further assessment. Fluids are restricted during the immediate postoperative period. This is done to prevent hypervolemia, which places additional demands on the myocardium, predisposing the child to cardiac failure.

STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind’s efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency

Question 21

What does nursing care of the infant and child with congestive heart failure include?
1
Forcing fluids appropriate to age
Incorrect2
Monitoring respirations during active periods
Correct3
Organizing activities to permit uninterrupted sleep
4
Giving larger feedings less often to conserve energy

Answer 21

The child needs to be well rested before feeding. The child’s needs should be met to minimize crying. The nurse must organize care to decrease energy expenditure. The child in congestive heart failure has an excess of fluid, so forcing fluids is contraindicated. Monitoring of vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings; small, frequent feedings should be given to the child in congestive heart failure.

Question 22

While reviewing the laboratory reports of a patient, the nurse finds that the patient has a total cholesterol level of 220 mg/dL and low-density lipoprotein (LDL) level of 140 mg/dL. Which instruction does the nurse give to the patient after reviewing his or her prescription?
1
“Take the medication with grapefruit juice.”
Correct2
“Take the statin medications in the evening.”
3
“Drink lots of water with the medication if your urine is dark.”
4
“Take the medication immediately if you have any new muscle aches.”

Answer 22

The normal level of total cholesterol is less than 170 mg/dL and LDL is less than 110 mg/dL. The patient is prescribed statin therapy due to hypercholesterolemia. Statins are most effective when taken in the evenings, because they effectively optimize LDL levels. Grapefruit juice interferes with the absorption of medication, and is contraindicated. Patients should discontinue the medication and contact the provider if they develop dark urine or experience new muscle aches, not drink excess water.

Question 23

What should the nurse teach the parents of a child with heart failure who has been prescribed furosemide?
 Correct1
Record output as soon as the drug is given.
2
Do not give foods high in potassium.
3
Observe for signs of hypertension.
Incorrect4
Observe for skin rash and drowsiness.

Answer 23

Furosemide (Lasix) is a diuretic used in heart failure. It blocks the reabsorption of sodium and water in the proximal renal tubule. Output should be recorded as soon as the medication is administered, and the child must be monitored for dehydration. Lasix causes excretion of chloride and potassium. Therefore, the child must be encouraged to have foods high in potassium or given potassium supplements. One of the side effects of Lasix is postural hypotension. Skin rash and drowsiness are side effects seen in children who receive spironolactone (Aldactone).

Question 24

A nurse is preparing to administer digoxin to a 2-year-old child. What is the most appropriate action when the nurse is administering digoxin?
1
Giving an extra dose if one is missed
2
Mixing the dose with juice to disguise the taste
Correct3
Checking the apical heart rate and holding the medication if the pulse is below 70 beats/min
Incorrect4
Checking the apical heart rate and holding the medication if the pulse is below 90 to 110 beats/min

Answer 24

The most appropriate nursing action when digoxin is being administered is checking the apical heart rate and holding the medication if the pulse is below 70 beats/min. Never give an extra dose if one is missed, and never mix digoxin with foods or other fluids. Holding the drug if the apical pulse is below 90 to 110 beats/min is appropriate for an infant, not a 2-year-old child.

Test-Taking Tip: A psychologic technique used to boost your test-taking confidence is to look into a mirror whenever you pass one and say out loud, “I know the material, and I’ll do well on the test.” Try it; many students have found that it works because it reduces “test anxiety.”

Question 25

A diagnosis of rheumatic fever is being ruled out in a child. Which laboratory test is the most reliable?
1
Throat culture
2
C-reactive protein
 Correct3
Antistreptolysin-O titer
Incorrect4
Increased white blood cell count

Answer 25

The most reliable and best standardized lab for antistreptococcal antibodies is an Antistreptolysin-O (ASO) titer. A throat culture indicates a current streptococcal infection. The C-reactive protein (CRP) lab test indicates inflammation. An increased white blood cell (WBC) count may indicate an but does not identify a causative agent.

Question 26

Congenital heart defects have traditionally been divided into acyanotic and cyanotic defects. The nurse knows which information about this system in clinical practice?
1
Helpful because it explains the hemodynamics involved
2
Problematic because cyanosis is rarely present in children
3
Helpful because children with cyanotic defects are easily identified
Correct4
Problematic because children with acyanotic heart defects may experience cyanosis

Answer 26

This classification is problematic. Children with traditionally named acyanotic defects may become cyanotic, and children with traditionally classified cyanotic defects may be pink at times. The classification does not reflect the blood flow within the heart. Cardiac defects are best described by their actual pathophysiologic processes and mechanisms. Children with cyanosis may be easily identified, but that does not aid diagnosis. Cyanosis is present when children have defects in which there is mixing of oxygenated and unoxygenated blood.

Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.

Question 27

What is the priority nursing intervention for reducing the chance of perfusion problems after cardiac catheterization?
1
Resuming the regular diet without restrictions
Incorrect2
Using acetaminophen or ibuprofen to relieve pain
Correct3
Checking the pulses distal to the catheterization site
4
Monitoring the site for redness, swelling, drainage, bleeding, temperature, and color

Answer 27

Monitoring the pulses distal to the catheterization site helps reduce the chance of perfusion problems after cardiac catheterization. Resuming a regular diet, using acetaminophen or ibuprofen for pain, and monitoring the site for redness, swelling, drainage, bleeding, temperature, and color are appropriate nursing interventions but will not reduce the chance of perfusion problems after cardiac catheterization.

Question 28

The nurse is caring for a child with a bedside cardiac monitor for electrocardiogram (ECG). What intervention should the nurse perform for this child?
Incorrect1
Change electrodes on the patient every 12 hours.
2
Assess the cardiac monitor frequently for heart sounds.
3
Ensure that the black electrode is placed on the abdomen.
Correct4
Ensure that the white electrode is on the right of the chest.

Answer 28

Electrodes for cardiac monitoring are often color coded. White electrodes are placed on the right side of the chest, above the level of the heart. Electrodes should be changed every 1 or 2 days because they irritate the skin. Bedside monitors assist in patient care. However, the nurse should assess the patient and not the cardiac monitor for auscultation of heart sounds. The ground electrode is green or red and is placed on the abdomen.

STUDY TIP: A helpful method for decreasing test stress is to practice self-affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself—preferably out loud—”I know this material, and I will do well on the test.” After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for performing skills in clinical as well, as long as you have practiced the skill sufficiently.

Question 29

The patient has had a persistent fever for the last 5 days, inflammation of lips and conjunctiva, and reddening of the tongue. The patient also has cervical lymphadenopathy and erythema in the palms and soles. What diagnosis does the nurse expect to find in the medical record?
1
Cardiomapathy
2
Rheumatic fever
 Correct3
Kawasaki disease
4
Bacterial endocarditis

Answer 29

The patient’s symptoms suggest Kawasaki disease. A patient with Kawasaki disease may have cardiomyopathy; however, a persistent fever for 5 days, inflammation of the lips and conjunctiva, and a strawberry tongue are not symptoms of cardiomyopathy. Rheumatic fever is not associated with lymphadenopathy and erythema in the palms and soles. Bacterial endocarditis is associated with weight loss, anorexia, and splinter hemorrhages, none of which are symptoms in this patient.