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Flashcards in Chapter 25 Deck (15):
1

What procedure uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures?
a. Echocardiography
b. Electrocardiography
c. Cardiac catheterization
d. Electrophysiology

Ans: A
Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, a diagnosis can sometimes be made without cardiac catheterization.
Electrocardiography is an electrical tracing of the depolarization of myocardial cells.
Cardiac catheterization is an invasive procedure where a catheter is threaded into the heart, a contrast medium is injected, and the heart and its vessels are visualized.
Electrophysiology is an invasive procedure where catheters with electrodes record the impulses of the heart directly from the conduction system.

2

After a patient returns from cardiac catheterization, the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). The most appropriate nursing intervention is to
a. elevate the affected extremity.
b. document the findings and continue to monitor.
c. notify the healthcare provider of the finding.
d. apply warm compresses to the insertion site.

Ans: B
The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. It 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 it 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.

3

Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse’s knowledge of congenital heart defects, this system in clinical practice is
a. helpful, because it explains the hemodynamics involved.
b. helpful, because children with cyanotic defects are easily identified.
c. problematic, because cyanosis is rarely present in children.
d. problematic, because children with acyanotic heart defects may develop cyanosis.

Ans: D
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 using the actual pathophysiologic process and mechanism.
Children with cyanosis may be easily identified, but that does not help with the diagnosis.
Cyanosis is present when children have defects where there is mixing of oxygenated blood with unoxygenated blood.

4

Surgical repair for patent ductus arteriosus (PDA) is done to prevent the complication of
a. pulmonary infection.
b. right-to-left shunt of blood.
c. decreased workload on left side of heart.
d. increased pulmonary vascular congestion.

Ans: D
A PDA allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary vascular congestion can occur.
The increased pulmonary vascular congestion is the primary complication; pulmonary infection may occur, but it is not the priority complication.
A PDA involves a left-to-right shunt of blood.
The decreased workload on the left side of the heart is not a priority complication of a PDA.

5

A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is
a. the low Fowler position.
b. the prone position.
c. the supine position.
d. the squatting position.

Ans: D
The squatting or knee–chest position increases the return of blood flow to the heart for oxygenation in a child with a defect that consists of decreased pulmonary blood flow.
The low Fowler position does not offer any physiologic advantage to the child related to cardiac compensation.
The prone position does not offer any physiologic advantage to the child related to cardiac compensation.
The supine position does not offer any physiologic advantage to the child related to cardiac compensation.

6

What is considered a mixed cardiac defect?
a. Pulmonic stenosis
b. Atrial septal defect
c. Patent ductus arteriosus
d. Transposition of the great arteries

Ans: D
Transposition of the great arteries allows the mixing of both oxygenated and unoxygenated blood in the heart.
Pulmonic stenosis is classified as an obstructive defect.
Atrial septal defect is classified as a defect with increased pulmonary blood flow.
Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow

7


What is an early sign of congestive heart failure that the nurse should recognize?
a. Tachypnea
b. Bradycardia
c. Inability to sweat
d. Increased urinary output

Ans: A
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 may be diaphoretic if experiencing congestive heart failure.
There will usually be decreased urinary output in a child experiencing congestive heart failure.

8

The nurse should explain to the parents that their child is receiving furosemide (Lasix) for severe congestive heart failure because of its effects as
a. a diuretic.
b. a beta blocker.
c. a form of digitalis.
d. an ACE inhibitor.

Ans: A
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 beta blocker.
Furosemide is not a form of digitalis.
Furosemide is not an ACE inhibitor.

9

The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose; 4 mL of the drug is to be drawn up. Based on the nurse’s knowledge of this medication and safe pediatric dosages, the most appropriate action by the nurse is
a. do not draw-up dose; suspect dosage error.
b. mix dose with juice to disguise its taste.
c. check heart rate; administer dose by placing it to the back and side of mouth.
d. check heart rate; administer dose by letting infant suck it through a nipple.

Ans: A
Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. As a potentially dangerous drug, digoxin has precise administration guidelines. Some institutions require that digoxin dosages be checked with another professional before administration.
The nurse has drawn up too much medication and should not give it to the child.
This is a correct procedure, but too much medication is prepared, so it should not be given to the child.
This is a correct procedure, but too much medication is prepared, so it should not be given to the child.

10

Nursing care of the infant and child with congestive heart failure includes
a. force fluids appropriate to age.
b. monitor respirations during active periods.
c. organize activities to allow for uninterrupted sleep.
d. give larger feedings less often to conserve energy.

Ans: C
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.

11

What should nurses stress when counseling parents regarding the home care of the child with a cardiac defect before corrective surgery?
a. The importance of reducing caloric intake to decrease cardiac demands
b. The importance of relaxing discipline and limit setting to prevent crying
c. The need to be extremely concerned about cyanotic spells
d. The desirability of promoting normalcy within the limits of the child's condition

Ans: D
The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child.
The child needs increased caloric intake after cardiac surgery.
The child needs discipline and appropriate limit setting, as would be done with any other child his or her age.
Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern.

12

What is an important nursing responsibility when a dysrhythmia is suspected?
a. Order an immediate electrocardiogram.
b. Count the radial pulse every 1 minute for five times.
c. Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate.
d. Have someone else take the radial pulse simultaneously with the apical pulse.

Ans: C
This is the nurse's first action. If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate.
This may be indicated after conferring with the practitioner.
The radial pulse rate needs to be compared with the apical pulse rate. It does not need to be counted for 1 minute five times.
Only one nurse is needed to carry out this action.

13

The primary therapy for secondary hypertension in children is
a. weight reduction.
b. low-salt diet.
c. increased exercise and fitness.
d. treatment of underlying cause.

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

14

What should the nurse recognize as an early clinical sign of compensated shock in a child?
a. Confusion
b. Sleepiness
c. Hypotension
d. Apprehensiveness

Ans: D
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.

15

A diagnosis of rheumatic fever is being ruled out for a child. Which lab test(s) is/are the most reliable? (Select all that apply.)
a. Throat culture
b. C-reactive protein (CRP)
c. Antistreptolysin-O titer (ASO) titer
d. Elevated white blood count (WBC)
e. Erythrocyte sedimentation rate (ESR)

Ans: C