ch23 adaptive quiz Flashcards
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
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.
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
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.
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.
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.
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
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.
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
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.
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
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.
What condition is defined as sepsis with organ dysfunction and hypotension? 1 Anaphylaxis Correct2 Septic shock 3 Massive vasodilation 4 Toxic shock syndrome
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.
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
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.
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
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.
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
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.
What should the nurse recognize as an early clinical sign of compensated shock in a child? Incorrect1 Confusion 2 Sleepiness 3 Hypotension Correct4 Apprehensiveness
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.
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
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.
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
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.
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
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.
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
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.
