Cardiovascular Conditions

Question 1

Ductus venosus

Fetal Cardiac Structures

Cardiovascular Conditions

Answer 1

is a tube that bypasses the fetus’ liver; its purpose is to prevent the rich oxygenated blood from the mother from being diverted to the liver, thus allowing it to be quickly disseminated through the fetus’ body; as soon as the umbilical cord is cut, the ductus venosus ceases to function.

Question 2

Ductus arteriosus

Fetal Cardiac Structures

Cardiovascular Conditions

Answer 2

is a small fistula between the pulmonary artery and teh aorta; the lungs are not yet functioning, and therefore the pressure is higher in the pulmonary artery than in the aorta; the small amount of blood that does go to the right ventricle and up the pulmonary artery is diverted through the ductus arteriosus into the aorta and out to the body.

Question 3

Foramen ovale

Fetal Cardiac Structures

Cardiovascular Conditions

Answer 3

is an opening with a one-way flap that allows the blood flowign from the mother through the inferior vena cava into the right atrium to bypass the lungs and proceed directly to the left atrium through this foramen ovale so that the oxygenated blood from the mother can be disseminated through the fetus’ body. At birth, with the first breath, there is a pressure change in the heart, and the increased pressure on the left side forces the flap of the foramen ovale to close.

Question 4

Cardiac Pressures

Cardiovascular Conditions

Answer 4

1. Pressures on the left side of the heart are higher than on the right side after birth, with the highest internal pressure in the left ventricle.
2. In most cardiac anomalies involving communication between chambers, blood will flow from areas of high pressure to areas of low pressure; this is called a left-to-right shunt.
3. In communicating structures that do not involve chambers, such as patent ductus arteriosus, blood will also flow from high- to low-pressure areas (from aorta to pulmonary artery).
4. Increased flow to the right side causes tissue hypertrophy from increased pressure and increased blood flow to the lungs.
5. The pressure eventually equalizes between chambers as the right side of the heart begins to fail in its attempt to compensate.
6. Contraction of the heart is systole; relaxation of the heart is diastole.

Question 5

Heart Rate and Blood Pressure Changes with Age

Cardiovascular Conditions

Answer 5

1. Heart rate decreases with age.
   a. Infant: 120-130 beats/min
   b. Toddler/preschooler: 80-105 beats/min
   c. School age: 70-80 beats/min
2. BP increases with age.
   a. Infant: 80/40 mmHg
   b. Toddler: 80-100/64 mmHg
   c. School age: 94-112/56-76 mmHg

Question 6

Electrical System of the Heart

Cardiovascular Conditions

Answer 6

1. Sinoatrial (SA) node is the ehart’s pacemaker; it is in the right atrium near where the superior vena cava enters the heart.
2. Charge spreads to atrioventricular (AV) node near the atrial septum near the endocardial cushion (center core of the heart) at the bottom of the right atrium close to the ventricular septum.
3. Charge spreads to bundle of His along the sides of the ventricular septum and then to the Purkinje fibers that stimulate the ventricles to contract.

Question 7

Cyanotic Heart Defects

Introduction, General Assessments, & General Interventions

Cardiovascular Conditions

Answer 7

Introduction
1. A cyanotic heart defect is a cardiac anomaly in which oxygenated blood entering the aorta and eventual systemic circulation is mixed with deoxygenated blood.
2. It can result from any condition that increases pulmonary vascular resistance (leading to a right-to-left shunt) or from a structural defect that allows the aorta to receive blood from the right side of the heart.
3. It can lead to left-sided heart failure, decreased oxygen supply to the body, and the development of collateral circulation.

General assessment (for any cyanotic heart defect)
1. Observe for cyanosis, especially increasing with crying.
2. Assess for increased pulse and respiratory rates.
3. Note whether the complete blood cell count shows polycythemia; hypoxia stimulates the body to increase red blood cell production.
4. Review the child’s history for irritability and difficulty with feeding.
5. Observe for clubbing of digits (thickening of distal segment of fingers and toes because of chronic hypoxemia).
6. Note alterations in blood gas measurements.
7. Assess intake and output; output should be at least 1 to 2 ml/kg/hr (neonates should be 0.5-1 ml/kg/hr).
8. Tests to diagnose and assess cardiac defects include
a. Electrocardiogram (to evaluate the electrical conduction system, as well as the rate and rhythm)
b. Cardiac catheterization (to evaluate pressures and oxygen saturations within heart chambers, as well as function of heart)
c. Echocardiography (uses ultrasound to measure heart size and function)

General interventions for any cyanotic heart defect
1. Plan and implement care as you would for a child with anemia.
2. Provide oxygen; decrease oxygen demands on the child by anticipating needs and preventing distress.
3. Provide adequate hydration to prevent sequelae of polycythemia.
4. Provide passive stimulation.
5. Admin antibiotics prophylactically to prevent endocarditis.
6. Provide thorough skin care.
7. Prepare the child for cardiac catheterization.
8. Help parents understand the difference between palliative and corrective procedures.

Question 8

Electrocardiogram (ECG or EKG)

Cyanotic Heart Defects

Cardiovascular Conditions

Answer 8

to evaluate the electrical conduction system, as well as the rate and rhythm

Question 9

Cardiac catheterization

Cyanotic Heart Defects

Cardiovascular Conditions

Answer 9

to evaluate pressures and oxygen saturations within heart chambers, as well as function of heart

Question 10

Echocardiography (Echo)

Cyanotic Heart Defects

Cardiovascular Conditions

Answer 10

uses ultrasound to measure heart size and function

Question 11

Transposition of the great vessels/arteries

Cyanotic Heart Defects

Cardiovascular Conditions

Answer 11

Introduction
1. The aorta arises from the right ventricle; the pulmonary artery arises from the left ventricle.
2. Deoxygenated blood recirculates from the right side of teh heart back to the systemic circulation; oxygenated blood recirculates from the lungs to the left side of the heart and back to the lungs.
3. The child will not survive without communicaiton between these two systems.

Assessment
1. Note increasing cyanosis as the foramen ovale or ductus arteriosus closes; the foramen may remain open longer because of altered cardiac pressures.
2. Note other symptoms of a cyanotic heart defect.

Interventions
1. Prepare the child for cardiac catheterization.
2. Expect the use of prostaglandin E to keep the ductus arteriosus open.
3. Prepare the child for possible palliative surgery to provide communicatino between the right and left chambers.
4. Prepare the child for possible corrective surgery in first weeks of life (arterial switch procedure).

Question 12

Tetralogy of Fallot

Cyanotic Heart Defects

Cardiovascular Conditions

Answer 12

Introduction
1. The defect consists of pulmonary artery stenosis, ventricular septal defect (VSD), hypertrophy of the right ventricle, and an overriding aorta (dextroposition of the aorta - the placement of the aorta is closer to the ventricular septum).
2. The aorta sits over the VSD and recieves blood from the right and left ventricles.
3. Pulmonic stenosis reduces blood flow to the lungs; blood with a low oxygen concentration exists into the systemic circulation.
4. The condition results in increased pressure in the right ventricle; blood shunts right to left, forcing deoxygenated blood to the left side and up the aorta.

Assessment
1. Observe for cyanosis.
2. Note polycythemia.
3. Note dyspnea, clubbing of digits, failure to thrive, exercise intolerance, and other symptoms of cyanotic heart disease.
4. Be aware that the infant may have episodes of increasing cyanosis and hypoxia of blood going to the brain, leading to short periods of loss of consciousness (“tet spells”).

Interventions
1. Prepare the child for cardiac catheterization.
2. Prepare for complete repair during the first year or palliative treatment to increase blood flow to the lungs.
3. During a “tet spell”, place the child in a knee-to-chest position and administer oxygen. This position increases pulmonary vascular resistance and shunts blood to the pulmonary vasculature, improving oxygenation.
4. Do not interfere when the child is squatting as long as the child appears comfortable.
5. Begin other interventions as for cyanotic heart defects.

Question 13

Hypoplastic left heart syndrome

Cyanotic Heart Defects

Cardiovascular Conditions

Answer 13

Introduction
1. Hypoplastic left heart syndrome consists of aortic valve atresia, mitral atresia or stenosis, a diminutive or absent left ventricle, and severe hypoplasia of the ascending aorta and aortic arch.
2. In this condition, blood from the left atrium travels through an atrial septal defect or patent foramen ovale (left-to-right shunt) to the right ventricle and pulmonary arter, entering the system via the ductus arteriosis.

Assessment
1. Assess for increasing dyspnea, cyanosis, and tachypnea during the first few days after birth; without treatment, congestive heart failure (CHF) develops as the ductus closes.
2. Remember that the child may appear normal at birth.

Interventions
1. Prepare the child for cardiac catheterizaiton.
2. Expect the use of prostaglandin E to keep the ductus arteriosus patent.
3. Prepare the child for surgical interventions (Norwood procedure), which allows the use of the right atrium as a pumping chamber for pulmonary circulation and the right ventricle as a systemic pumping chamber; if available, the child may receive a heart transplant.
4. Be aware that death will occur in early infancy without surgery, although the childhood mortality rate is 25% with surgery.

Question 14

Acyanotic Heart Defects

Introduction, General Assessments, & General Interventions

Cardiovascular Conditions

Answer 14

Introduction
1. Blood entering the aorta is completely oxygenated.
2. Acyanotic heart defects include those in the septa that result in a left-to-right shunt (any increased blood volume on the right side of the heart causes right-sided hypertrophy and increased blood flow to the lungs) and those between structures that inhibit blood flow to the system or affect pulmonary resistance.
3. Such a defect can result in cyanosis if the right side of the heart fails or not enough oxygenated blood enters the circulation.
4. CHF is frequently seen secondary to a congenital heart defect in which structural abnormalities result in an increased volume load or increased pressure load on the ventricles. Any anomaly resulting in increased blood flow to the lungs, such as conditions resulting in a left-to-right shunt, can cause CHF. Early recognition and treatment of CHF lessens the impact on long-term growth and development.

General assessment (for any acyanotic heart defect)
1. Assess for respiratory distress, tachycardia, congested cough, diaphoresis,fatigue, and mild cyanosis which may indicate congestive heart failure from increased blood flow to the lungs.
2. Note increases in pulse and respiratory rates to compensate for increased blood flow to the lungs; assess vital signs.
3. Check for hepatomegaly; blood has difficulty entering the right side of the heart and backs up in the liver.
4. Review the child’s history for frequent respiratory infections from increased pulmonary secretions.
5. Assess for poor growth and development from increased engery expenditure for breathing.
6. Evaluate the degree of fatigue.
7. Assess for a heart murmur.

General interventions (for any acyanotic heart defect)
1. Expect to admin digoxin to decrease the pulse rate and strengthen cardiac contractions (bradycardia is a pulse of less than 100 beats/min in infants); take apical pulse for 1 minute before administration; order must specify minimum heart rate for administration.
2. Monitor fluid status.
a. Admin a diuretic, such as furosemide (Lasix), and observe for potassium loss.
b. Enforce fluid restrictions.
Monitor fluid intake and output, weigh soiled diapers; weigh the child daily.
3. Reduce oxygen demands by organizing physical care and anticipating the child’s needs.
4. Give the child high-calorie foods that are easy to ingest and digest.
5. Prevent cold stress by maintaining a normal body temperature.
6. Prevent infection; administer antibiotics prophylactically to prevent endocarditis.
7. Prepare the child for cardiac cath.

Question 15

Patent Ductus Arteriosus (PDA)

Acyanotic Heart Defects

Cardiovascular Conditions

Answer 15

Introduction
1. PDA results from failure of the fetal structure to close; it is common in premature infants.
2. PDA leads to the shunting of blood to the pulmonary artery (because pressure in the aorta is higher than in the pulmonary arterty), which increases blood flow to the lungs.

Assessment
1. Be aware that the child may be asymptomatic except for a machinelike heart murmur.
2. Assess for signs and symptoms of CHF and left ventricular hypertrophy.

Interventions
1. Prepare the child for cardiac cath.
2. Prepare for possible admin of the prostaglandin inhibitor indomethacin to achieve pharmacologic closure.
3. Prepare for possible surgical correction, which inolves ligating the PDA in a closed-heart operation.

Question 16

Ventricular Septal Defect (VSD)

Acyanotic Heart Defects

Cardiovascular Conditions

Answer 16

Introduction
1. VSD is the most common congenital cardiac anomaly.
2. It occurs when a septum fails to complete its formation between the ventricles, resulting in a left-to-right shunt.

Assessment
1. Assess for signs and symptoms of CHF with right ventricular hypertrophy.
2. Assess for failure to thrive.
3. Evaluate the degree of fatigue.
4. Review the child’s history for recurrent respiratory infections.

Interventions
1. Prepare the child for cardiac cath.
2. Prepare for possible pulmonary artery banding to prevent CHF; a permanent correction with a patch is performed later, when the heart is larger.
a. Be aware that closure of a VSD may interfere with the electrical conduction of the heart, leading to heart block.
3. Be aware that some children experience spontaneous closure of the VSD by age 3.

Question 17

Atrial Septal Defect (ASD)

Acyanotic Heart Defects

Cardiovascular Conditions

Answer 17

Introduction
1. ASD stems from a patent foramen ovale or the failure of a septum to develop completely between the atria.
2. It results in a left-to-right shunt.
3. It may resolve spontaneously by age 5.

Assessment
1. Assess for signs and symptoms of CHF.
2. Be aware that the child may be asymptomatic except for a heart murmur.

Interventions
1. Prepare the child for cardiac cath.
2. Mild defects may close spontaneously.
3. Prepare the child for surgical correction, which involves patching the hole; some ASDs can be corrected during a cardiac cath.

Question 18

Pulmonic Stenosis

Obstructive Defects

Cardiovascular Conditions

Answer 18

Introduction
1. Pulmonic stenosis involves a narrowing or fusing of the valves at the enterance of the pulmonary artery interfering with right ventricular outflow.
2. It may result in right ventricular hypertrophy and right-sided heart failure.

Assessment
1. Review the child’s history for exertional fatigue.
2. Ask about chest pain with exercise, which occurs in mild to moderate pulmonic stenosis.
3. Ask about cyanosis with exercise, which occurs in severe pulmonic stenosis.
4. Auscultate for a systolic murmur.

Interventions
1. Prepare the child for cardiac cath.
2. Prepare the child for open-heart surgery to separate the pulmonary valve leaflets; this will leave the child with a permanent residual murmur.

Question 19

Aortic Stenosis

Obstructive Defects

Cardiovascular Conditions

Answer 19

Introduction
1. Aortic stenosis involves a narrowing or fusion of the aortic valves, interfering with left ventricular outflow.
2. It may cause left ventricular hypertrophy, life-sided heart failure, and pulmonary congestion.

Assessment
1. Ask about Syncope and dizziness.
2. Reivew the child’s history of angina.
3. Ask if activities increase symptoms.
4. Find out which measures bring relief.

Interventions
1. Prepare the child for cardiac cath to assess the degree of aortic stenosis.
2. Prepare the child for surgical palliation with a valvulotomy (however, this does not prevent stenosis from recurring in adulthood.)

Question 20

Coarctation of the aorta

Obstructive Defects

Cardiovascular Conditions

Answer 20

Introduction
1. Coarctation of the aorta involves a narrowing of the aortic arch, usually distal to the ductus arteriosus beyond the left subclavian artery.
2. It decreases blood flow to the trunk and lower extremities and increases blood flow to the head and arms.
3. The condition predisposes the child to a brain attack (stroke).

Assessment
1. Assess for full bounding pulses in the arms and weak or absent pulses in the legs, but the same pulse rate in both areas.
2. Reivew the child’s history for nosebleeds, headaches, dizziness, leg cramps, and lack of energy.
3. Assess for increased blood pressure in the arms an ddecreased blood pressure in the legs.
4. Palpate for a warm upper body and a cool lower body.
5. Assess for signs and symptoms of CHF from backup pressure to the left side of the heart.

Interventions
1.Prepare the child for cardiac cath.
2.Understand that surgery for a coarctation distal to the ductus arteriosus may involve closed-heart resectionof the coarcted portion; this is usually not performed until late preschool age.

Question 21

Rheumatic Fever (RF)

Cardiovascular Conditions

Answer 21

Introduction
1. RF is an acquired autoimmune immune-complex disorder occuring 1 to 6 weeks after a group A beta-hemolytic streptococcal infection, in many cases after strep throat that is not treated with penicillin.
a. The streptococcal infection is not present in the heart.
b. With untreated strep infection, RF develops in 1% to 5% of patients.
2. The disorder is caused by the production of antibodies against the toxin of the streptococci; these antibodies attack the heart valves because of similarities in their antigenic markers.
3. RF results in antigen-antibody complexes that initiate complement formation and heart destruction.
4. According to the AHA, one major and two minor symptoms are needed for diagnosis (known as the Jones critera).

Assessment
1. Use the Jones criteria when assessing for major manifestations: carditis, polyarthritis, chorea, subcutaneous nodules, and erythema marginatum (temporary disk-shaped nonpruritic reddened macules that spread centrifugally while the skin in the center returns to normal).
a. Aschoff bodies (fibrinlike plaques) form on the heart valves causing edema and inflammation, resulting in stenosis and leakage of valves.
b. Chorea is sudden irregular movements of the extremities that are involuntary and increase with stress.
2. Use the Jones criteria when assesing for minor manifestations: history of RF, fever, arthralgia, increased erythrocyte sedimentation rate, altered electrocardiogram with a prolonged P-R interval, and evidence of a strep infection (elevated antistreptolysin-O [ASO] titer).

Interventions
1. Admin penicillin to prevent additional damage from future attacks (the child takes it for 5 years or until age 21 if no carditis or longer if carditis is present).
2. Provide bed rest until the sedimentation rate normalizes.
3. Administer anti-inflammatory medication for arthritis pain.
4. Institute safety measures for chorea; keep the environment calm, reduce stimulation, avoid the use of forks or glass, assist in walking.
5. Maintain growth and development with appropriate passive stimulation.
6. Provide emotinoal support for long-term convalescence.
7. Prevent reinfeciton.

Question 22

erythema marginatum

Cardiovascular Conditions

Answer 22

temporary disk-shaped nonpruritic reddened macules that spread centrifugally while the skin in the center returns to normal.

Question 23

Aschoff bodies

Cardiovascular Conditions

Answer 23

(fibrinlike plaques) form on the heart valves causing edema and inflammation, resulting in stenosis and leakage of valves.

Question 24

Chorea

Cardiovascular Conditions

Answer 24

is sudden irregular movements of the extremities that are involuntary and increase with stress.

Question 25

Kawasaki Syndrome

Cardiovascular Conditions

Answer 25

Introduction
1. Kawasaki syndrome results in vasculitis of the small and medium-sized blood vessels; coronary arteries are most at risk.
2. It is the leading cause of acquired heart disease in children
3. Without treatment, about 25% will suffer permanent cardiac sequelae (damage to coronary arteries or damage to heart muscle).
4. In the majority of cases, patients are under 5 years of age.
5. Etiology is unknown; not transmitted person-to-person.

Assessment
1. Assess for high, persistent fever for 5 days with:
a. Swelling of the conjunctivae without drainage
b. Inflammation of the mouth, lips, tongue (strawberry tongue)
c. Rash that varies from child to child
d. Swollen, red hands and feet
e. Cervical lymphadenopathy
2. Evaluate for signs and symptoms of myocardial infarction (abdominal pain, vomiting, restlressness, irritability without ability to console, pallor).
3. Assess for signs of fluid overload and CHF.

Interventions
1. Administer immune globulin (IVIG) intravenously to reduce incidence of coronary artery abnormalities, especially when given within 10 days of infection/symptoms.
2. Administer salicylates (aspirin).
a. First, it is given in an anti-inflammatory dose, and then it is lowered to an antiplatelet dose.
3. Administer fluids judiciously.
4. Minimize skin discomfort; provide mouth care and cool cloths or baths.

Question 26

Infective Endocarditis (Previously Referred to as Subacute Baterial Endocarditis)

Cardiovascular Conditions

Answer 26

Introduction
1. An infection of the valves and inner lining of the heart, it usually affects the mitral or aortic valves (bacterial organisms enter the blood stream from a site of localized infection and grow in the heart, usually on an area of abnormal blood flow or turbulence).
2. Those at risk include anyone with a prosthetic device in the heart and anyone with abnormal blood flow in the heart, especially due to congenital cardiac anomalies.

Assessment
1. Fever
2. Fatigue
3. Weight loss
4. Pallor
5. New or changes to an existing heart murmur

Interventions
1. IV antibiotics for 6 weeks for active infection
2. Prevention in those who are at high risk
a. Good oral hygiene

Question 27

Cardian Catheterization

Diagnostic Tests

Cardiovascular Conditions

Answer 27

1. Prepare the child by using doll play and hospital play; stress the familiar but show where the catheter is inserted; make a security object (blanket, stuffed animal) available.
2. Describe the sensations the child will experience.
3. Establish baseline data before the procedure.
   a. Weigh the child
   b. Check the child’s color, pulse rate, BP, and temperature of extremities.
   c. Check the child’s activity level.
4. Keep the affected extremity immobile after catheterization to prevent hemorrhage; observe the dressing for bleeding or hematoma formation; if bleeding occurs, apply direct pressure.
5. Monitor after catheterization; check vital signs, including the intensity of the pulse, and the color and temperature of the extremities; compare all four extremities; compare data with precatheterization baseline data; observe for bleeding or hematoma formation at site.
6. Ensure adequate intake (IV or oral) because of blood loss during the procedure and diuretic action of some dyes used.

Question 28

Vascular Access Devices

Cardiovascular Conditions

Answer 28

Peripheral Catheters
1. Allow dressing to remain in place as long as there are no signs of complication; there is no need to change on a routine basis; change when soiled, damp, or loose.
2. Change tubing every 96 hours or when contaminated.
3. Use local topical anesthesia prior to insertion if not an emergency.

Peripherally Inserted Central Catheters (PICC) and Central Line Catheters
1. Indicated for long-term intravenous access.
2. Contraindications: bleeding disorders, trauma involving an extremity, severe burns.
3. Do not use BP cuffs and/or tourniquets on extremity with PICC.
4. Use aseptic technique; placement requires barriers (mask, eyewear, cap, sterile gloves), as per hospital policy.
5. Sescure with semi-permeable dressing; change dressing every 7 days or when soiled/loose.
6. Secure IV tubing to prevent pulling and inadvertent removal.

Question 29

A 10-month-old infant with Tetralogy of Fallot experiences a cyanotic episode, or “blue spell”. To improve oxygenation during such an episode, the nurse hould place the infant in which position?

a. Knee-to-chest
b. Fowler’s
c. Tendelenburg
d. Prone

Answer 29

a

The knee-to-chest position in the child with Tetralogy of Fallot increases systemic vascular resistance thereby shunting blood to the lungs an dimproving overall oxygenation to alleviate the cyanotic event. Administering oxygen is also indicated.

Question 30

Which of the following instructions would the nurse include in a teaching plan that focuses on initial prevention of rheumatic fever?

a. Using a corticosteroid to reduce inflammation.
b. Treating streptococcal throat infection with an antibiotic.
c. Providing an antibiotic before dental work.
d. Giving penicillin to clients with rheumatic fever.

Answer 30

b

Rheumatic fever is an acquired autoimmune immune-complex disorder that occurs one to six weeks after group A beta-hemolytic infection. Antibodies are produced against the toxin streptococci which attack and destroy the heart valves. The primary prevention is teaching parents the importance of administering the complete course of antibiotics for the child with a strep throat infection. Children who develop rheumatic fever will be placed on prophylactic penicillin for many years; (5 years or until they turn 21 AND have no carditis).

Question 31

Amy is an 8-month-old having cardiac surgery to repair Tetralogy of Fallot. She has developed polycythemia. Due to this development, your best action is:

a. Allow rest periods
b. Keep her hydrated
c. Keep her in a semi-fowlers position
d. Perform passive range of motion

Answer 31

b

Polycythemia is an increased RBC count, which occurs in Tetralogy of FAllot. Polycythemia results in more viscous blood due to an increased number of cells per unit of fluid (plasma). Hydration with an isotonic fluid will hydrate the intravascular space and help to lower the RBC count.

Question 32

A child, age 4 years, is admitted with a tentative diagnosis of congenital heart disease. Wheen assessment reveals a bounding radial pulse coupled with a weak femoral pulse, the nurse suspects that the child has:

a. Patient ductus arteriosus
b. Coarctation of the aorta
c. Ventricular septal defect
d. Truncus arteriosus

Answer 32

b

Coarctation of the aorta causes increased pressure proximal to the defect and decreased pressure distal to the defect leading to bounding pulses and higher blood pressures in the upper extremities. Patent ductus arteriosus (PDA) leads to increased pulmonary blood flow as blood shunts back to the right ventricle. Truncus arteriosus is a cyanotic defect where a single vessel overrides both ventricles leading to mixing of the blood.

Question 33

Children with congenital heart conditions are extremely susceptible to:

a. Gastrointestinal disorders
b. Skin infections
c. Allergic conditons
d. Upper respiratory infections

Answer 33

d

Children with congenital heart disease are more susceptible to upper respiratory infections because of the increased likelihood of CHF.

Question 34

The nurse is caring for a child who is at risk for CHF secondary to a congenital heart defect that increases pulmonary blood flow. Which of the following is an example of a heart defect that increases pulmonary blood flow?

a. Coartation of the aorta
b. Atrial septal defect
c. Tetralogy of Fallot
d. Pulmonary stenosis

Answer 34

b

Since the pressure is higher on the left side of the heart, an atrial septal defect results in a left to right shunt, increasing pulmonary blood flow.
Coarctation of the aorta results in decreased circulation to the lower extremities but does not increase pulmonary blood flow.
In Tetralogy of Fallot, as well as pulmonary stenosis, there is a narrowing in the pulmonary artery or valve causing decreased pulmonary blood flow.

Question 35

The nurse is caring for Ben, a 4-year-old with an unrepaired VSD. Which of the following woul dthe nurse expect to find in Ben’s history?

a. Tachypnea with a congested cough
b. History of tet spells
c. Weight for age at 95th percentile
d. Baseline oxygen saturations of 85%

Answer 35

a

The increased blood flow to the lungs can cause tachypnea with a congested cough. Children with congenital heart defects are often small as they require increased energy for breathing.
Tet spells are associated with Tetralogy of Fallot, not a VSD.
The child with a VSD should have oxygen saturation that are within normal limits.

Question 36

Three-week-old Autumn is admitted with CHF secondary to an atrial septal defect (ASD). Her plan of care should include:

a. Monitor strict I&O, weigh all diapers, and weigh Autumn weekly.
b. Cluster care so that oxygen demands are decreased.
c. Provide high calorie formula and allow Autumn to feed slowly over an hour.
d. Allow Autumn to cry to encourage expansion and clearing of lung fields.

Answer 36

b

Care should be clustered so that oxygen demands are decreased. The child should be weighed daily, not weekly. Although high calorie formula may be used, the feeding should not last one hour as this increases energy expenditure and oxygen demands. Crying increases the oxygen demands and should therefore be prevented as much as possible.

Question 37

The nurse is reviewing information regarding Kawasaki’s disease. Which of the following is correct?

a. Without treatment, 50% of all children diagnosed with Kawasaki’s disease will have permanent cardiac sequelae.
b. It is second only to rheumatic fever as the leading cause of acquired pediatric heart disease.
c. It generally affects children over 10 years old.
d. It is treated with salicylate (aspirin) therapy.

Answer 37

d

Kawasaki’s disease is treated with salicylate (aspirin) therapy. Without treatment, 25% of all children diagnosed with Kawasaki’s disease will have permanent cardiac sequelae. It is the leading cause of acquired pediatric heart disease, generally affecting children under the age of 5 years.

Question 38

The nurse us caring for 3-year-old Noah, diagnosed with Kawasaki’s disease. Which of the following is correct?

a. Swelling of the conjunctiva with purulent drainage
b. A very distinctive rash to extremities
c. Inflammation of the mouth, lips, and tongue
d. Lab reults showing a positive ASO titer

Answer 38

c

In Kawasaki’s disease there is an inflammation of the mouth, lips, and tongue, which is also known as strawberry tongue. In Kawasaki’s disease, swelling of the conjunctiva occurs without drainage. The rash in Kawasaki’s disease is non-specific and varies from child to child. The etiology of the condition is unknown and is not related to a streptococcal infeciton.

Question 39

Which of the following is true concerning the subacute phase of Kawasaki’s disease?

a. Children in this phase experience a high persistent fever that does not respond to antipyretics.
b. Cervical lymphadenopathy is most prominent during this phase.
c. Peeling of the hands and feet occurs during this phase.
d. This phase begins with the resolution of all clinical signs and the normalization of lab values.

Answer 39

c

The subacute phase of Kawasaki’s disease begins with the resolution of the fever and is characterized by peeling hands and feet. A nonresponsive high persistent fever and cervical lymphadenopathy occur during the acute phase. The convalescent phase begins with the resolution of all clinical signs and the normalization of lab values.