Chapter 29 - Cardiovascular dysfunction Flashcards
The parents of a young child with heart failure (HF) tell the nurse that they are nervous about giving digoxin. The nurse’s response should be based on which knowledge?
a.
It is a safe, frequently used drug.
b.
Parents lack the expertise necessary to administer digoxin.
c.
It is difficult to either overmedicate or undermedicate with digoxin.
d.
Parents need to learn specific, important guidelines for administration of digoxin.
ANS: D
Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects. Parents may lack the expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.
A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38° C (100.4° F), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother?
a.
Immediately bring the child to the clinic for evaluation.
b.
Come to the clinic next week on a scheduled appointment.
c.
Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness.
d.
Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.
ANS: A
These are the insidious symptoms of bacterial endocarditis. Because the child is in a high-risk group for this disorder (VSD repair), immediate evaluation and treatment are indicated to prevent cardiac damage. With appropriate antibiotic therapy, bacterial endocarditis is successfully treated in approximately 80% of the cases. The child’s complaints should not be dismissed. The low-grade fever is not a symptom that the child can fabricate.
The nurse is giving discharge instructions to the parent of a 6-year-old child who had a cardiac catheterization 4 hours ago. What statement by the parent indicates a correct understanding of the teaching?
a.
“My child should not attend school for the next 5 days.”
b.
“I should change the bandage every day for the next 2 days.”
c.
“My child can take a tub bath but should avoid taking a shower for the next 4 days.”
d.
“I should expect the site to be red and swollen for the next 3 days.”
ANS: B
Discharge instructions for a parent of a child who recently had a cardiac catheterization should include changing the bandage every day for the next 2 days. The child should avoid strenuous exercise but can go back to school. The child should avoid a tub bath, but an older child could take a shower the first day after the catheterization. The site should not have swelling or redness; if there is, it should be reported to the health care practitioner.
The test that provides the most reliable evidence of recent streptococcal infection is which?
a.
Throat culture
b.
Mantoux test
c.
Antistreptolysin O test
d.
Elevation of liver enzymes
ANS: C
Antistreptolysin O (ASLO) titers measure the concentration of antibodies formed in the blood against this product. Normally, the titers begin to rise about 7 days after onset of the infection and reach maximum levels in 4 to 6 weeks. Therefore, a rising titer demonstrated by at least two ASLO tests is the most reliable evidence of recent streptococcal infection.
An adolescent is being placed on a calcium channel blocker. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.)
a.
The medication may cause fatigue.
b.
The medication may increase heart rate.
c.
The medication may cause constipation.
d.
The medication may cause cold extremities.
e.
The medication may cause peripheral edema.
ANS: B, C, E
Calcium channel blockers may cause an increase in heart rate, constipation, and peripheral edema. Beta-blockers can cause fatigue and cold extremities, but calcium channel blockers do not cause these potential side effects.
What nutritional component should be altered in the infant with heart failure (HF)?
a.
Decrease in fats
b.
Increase in fluids
c.
Decrease in protein
d.
Increase in calories
ANS: D
Infants with HF have a greater metabolic rate because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of average infants, yet their ability to take in calories is diminished by their fatigue. The diet should include increased protein and increased fat to facilitate the child’s intake of sufficient calories. Fluids must be carefully monitored because of the HF.
The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication?
a.
Hypoxemia
b.
Right-to-left shunt of blood
c.
Decreased workload on the left side of the heart
d.
Pulmonary vascular congestion
ANS: D
In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular congestion. Hypoxemia usually results from defects with mixed blood flow and decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure would stop this. There is increased workload on the left side of the heart with a PDA.
The nurse is caring for a child after cardiac surgery. What interventions should the nurse implement with regard to chest tubes placed to a water-seal drainage system? (Select all that apply.)
a.
Maintain sterility.
b.
Check for tube patency.
c.
Do not interrupt the water-seal drainage system.
d.
Clamp the chest tube when ambulating the child.
e.
Measure the drainage by emptying the collection chamber every shift.
ANS: A, B, C
Nursing considerations with regard to chest tubes attached to a water-seal drainage system include (1) do not interrupt water-seal drainage unless the chest tube is clamped, (2) check for tube patency (fluctuation in the water-seal chamber), and (3) maintain sterility. The chest tube should not be clamped when ambulating the child and the drainage is measured in the collection chamber, not emptied.
A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate?
a.
60 beats/min
b.
90 beats/min
c.
100 beats/min
d.
120 beats/min
ANS: B
If a 1-minute apical pulse is less than 90 beats/min for an infant or young child, the digoxin is withheld. Sixty beats/min is the cut-off for holding the digoxin dose in an adult. One hundred to 120 beats/min is an acceptable pulse rate for the administration of digoxin.
What primary nursing intervention should be implemented to prevent bacterial endocarditis?
a.
Counsel parents of high-risk children.
b.
Institute measures to prevent dental procedures.
c.
Encourage restricted mobility in susceptible children.
d.
Observe children for complications, such as embolism and heart failure.
ANS: A
The objective of nursing care is to counsel the parents of high-risk children about the need for both prophylactic antibiotics for dental procedures and maintaining excellent oral health. The child’s dentist should be aware of the child’s cardiac condition. Dental procedures should be done to maintain a high level of oral health. Restricted mobility in susceptible children is not indicated. Parents are taught to observe for unexplained fever, weight loss, or change in behavior.
What statement best identifies the cause of heart failure (HF)?
a.
Disease related to cardiac defects
b.
Consequence of an underlying cardiac defect
c.
Inherited disorder associated with a variety of defects
d.
Result of diminished workload imposed on an abnormal myocardium
ANS: B
HF is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the body’s metabolic demands. HF is not a disease but rather a result of the inability of the heart to pump efficiently. HF is not inherited. HF occurs most frequently secondary to congenital heart defects in which structural abnormalities result in increased volume load or increased pressures on the ventricles.
What condition is the leading cause of death after heart transplantation?
a.
Infection
b.
Rejection
c.
Cardiomyopathy
d.
Heart failure
ANS: B
The posttransplant course is complex. The leading cause of death after cardiac transplant is rejection. Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection. Cardiomyopathy is one of the indications for cardiac transplant. Heart failure is not a leading cause of death.
What structural defects constitute tetralogy of Fallot?
a.
Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
b.
Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
c.
Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy
d.
Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy
ANS: A
Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.
What term is defined as the volume of blood ejected by the heart in 1 minute?
a.
Afterload
b.
Cardiac cycle
c.
Stroke volume
d.
Cardiac output
ANS: D
Cardiac output is defined as the volume of blood ejected by the heart in 1 minute. Cardiac output = Heart rate x Stroke volume. Afterload is the resistance against which the ventricles must pump when ejecting blood (ventricular ejection). A cardiac cycle is the sequential contraction and relaxation of both the atria and ventricles. Stroke volume is the amount of blood ejected by the heart in any one contraction.
Selective cholesterol screening is recommended for children older than the age of 2 years with which risk factor?
a.
Body mass index (BMI) = 95th percentile
b.
Blood pressure = 50th percentile
c.
Parent with a blood cholesterol level of 200 mg/dl
d.
Recently diagnosed cardiovascular disease in a 75-year-old grandparent
ANS: A
Obesity is an indication for cholesterol screening in children. A BMI in the 95th percentile or higher is considered obese. Children who are hypertensive meet the criteria for screening, but blood pressure in the 50th percentile is within the normal range. A parent or grandparent with a cholesterol level of 240 mg/dl or higher places the child at risk. Early cardiovascular disease in a first- or second-degree relative is a risk factor. Age 75 years is not considered early.
The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is “too wet.” The nurse finds the bandage and bed soaked with blood. What nursing action is most appropriate to institute initially?
a.
Notify the physician.
b.
Place the child in Trendelenburg position.
c.
Apply a new bandage with more pressure.
d.
Apply direct pressure above the catheterization site.
ANS: D
When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified, and a new bandage with more pressure can be applied after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. Trendelenburg positioning would not be a helpful intervention. It would increase the drainage from the lower extremities.
What drug is an angiotensin-converting enzyme (ACE) inhibitor?
a.
Furosemide (Lasix)
b.
Captopril (Capoten)
c.
Chlorothiazide (Diuril)
d.
Spironolactone (Aldactone)
ANS: B
Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Chlorothiazide works on the distal tubules. Spironolactone blocks the action of aldosterone and is a potassium-sparing diuretic.
The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication?
a.
Pulmonary hypertension
b.
Right-to-left shunt of blood
c.
Pulmonary embolism
d.
Left ventricular hypertrophy
ANS: A
Congenital heart defects with a large left-to-right shunt (e.g., in ventricular septal defect, patent ductus arteriosus, or complete AV canal), which cause increased pulmonary blood flow, may result in pulmonary hypertension. If these defects are not repaired early, the high pulmonary flow will cause changes in the pulmonary artery vessels, and the vessels will lose their elasticity. The blood does not shunt right to left, a pulmonary embolism is not a complication of ventricular septal defect, and the left ventricle does not hypertrophy.
The nurse is teaching an adolescent with hypertension foods recommended on the DASH diet. What foods should the nurse include in the teaching session? (Select all that apply.)
a.
Green beans
b.
Energy drinks
c.
Low-fat yogurt
d.
Chocolate milk
e.
Whole grain bread
ANS: A, C, E
The DASH diet provides a lower salt diet that has been associated with improvement in BP and is believed to be beneficial for all patients with hypertension. DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet is plentiful in vegetables, fruits, whole grains, and low-fat dairy products and low in sugar and salt. Energy drinks are high in sugar, and chocolate milk is high in fat.
A 6-year-old child is scheduled for a cardiac catheterization. What consideration is most important in planning preoperative teaching?
a.
Preoperative teaching should be directed at his parents because he is too young to understand.
b.
Preoperative teaching should be adapted to his level of development so that he can understand.
c.
Preoperative teaching should be done several days before the procedure so he will be prepared.
d.
Preoperative teaching should provide details about the actual procedures so he will know what to expect.
ANS: B
Preoperative teaching should always be directed to the child’s stage of development. The caregivers also benefit from these explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. This age group will not understand in-depth descriptions. School-age children should be prepared close to the time of the cardiac catheterization.
A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what?
a.
Tetralogy of Fallot
b.
Coarctation of the aorta
c.
Pulmonary stenosis
d.
Ventricular septal defect
ANS: D
Heart failure is common with ventricular septal defect that causes failure to thrive, respiratory infections, and an increase in exhaustion during feedings. There is a characteristic murmur. The other defects do not have left-to-right shunting.
What preparation should the nurse consider when educating a school-age child and the family for heart surgery?
a.
Unfamiliar equipment should not be shown.
b.
Let the child hear the sounds of a cardiac monitor, including alarms.
c.
Explain that an endotracheal tube will not be needed if the surgery goes well.
d.
Discussion of postoperative discomfort and interventions is not necessary before the procedure.
ANS: B
The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The family and child should make the decision about a tour of the unit if it is an option. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous lines, incision, endotracheal tube, expected discomfort, and management strategies.
The nurse is teaching parents about administering digoxin (Lanoxin). What instructions should the nurse tell the parents?
a.
If the child vomits, give another dose.
b.
Give the medication at regular intervals.
c.
If a dose is missed, give a give an extra dose.
d.
Give the medication mixed with the child’s formula.
ANS: B
The family should be taught to administer digoxin at regular intervals. If a dose is missed, an extra dose should not be given; the same schedule should be maintained. If the child vomits, do not give a second dose. The drug should not be mixed with foods or other fluids because refusal to consume these would result in inaccurate intake of the drug.
An adolescent is being placed on an ACE inhibitor. What should the nurse inform the adolescent with regard to this medication? (Select all that apply.)
a.
Stay well hydrated.
b.
Increase intake of potassium.
c.
Avoid rapid position changes.
d.
Take the medication with meals.
e.
Side effects may include a cough.
ANS: A, C, E
The adolescent should be instructed to stay well hydrated and avoid rapid position changes and that side effects may include a cough when on ACE inhibitors. ACE inhibitors do not deplete potassium, and they should be taken 1 hour before meals to increase absorption.
