Exam #3 Peds - Cardiac Flashcards
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
d. Cardiac output
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.
A chest radiography examination is ordered for a child with suspected cardiac problems. The child’s parent asks the nurse, “What will the x-ray show about the heart?” The nurse’s response should be based on knowledge that the radiograph provides which information?
a. Shows bones of the chest but not the heart
b. Evaluates the vascular anatomy outside of the heart
c. Shows a graphic measure of electrical activity of the heart
d. Supplies information on heart size and pulmonary blood flow patterns
d. Supplies information on heart size and pulmonary blood flow patterns
Chest radiographs provide information on the size of the heart and pulmonary blood flow patterns. The bones of the chest are visible on chest radiographs, but the heart and blood vessels are also seen. Magnetic resonance imaging is a noninvasive technique that allows for evaluation of vascular anatomy outside of the heart. A graphic measure of electrical activity of the heart is provided by electrocardiography.
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.
b. Preoperative teaching should be adapted to his level of development so that he can understand.
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.
After returning from cardiac catheterization, the nurse monitors the child’s vital signs. The heart rate should be counted for how many seconds?
a. 15
b. 30
c. 60
d. 120
c. 60
The heart rate is counted for a full minute to determine whether arrhythmias or bradycardia is present. Fifteen to 30 seconds are too short for accurate assessment. Sixty seconds is sufficient to assess heart rate and rhythm.
After returning from cardiac catheterization, the nurse determines that the pulse distal to the catheter insertion site is weaker. How should the nurse respond?
a. Elevate the affected extremity.
b. Notify the practitioner of the observation.
c. Record data on the assessment flow record.
d. Apply warm compresses to the insertion site.
c. Record data on the assessment flow record.
The pulse distal to the catheterization site may be weaker for the first few hours after catheterization but should gradually increase in strength. Documentation of the finding provides a baseline. The extremity is maintained straight for 4 to 6 hours. This is an expected change. The pulse is monitored. If there are neurovascular changes in the extremity, the practitioner is notified. The site is kept dry. Warm compresses are not indicated.
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.
d. Apply direct pressure above the catheterization site.
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 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
b. Consequence of an underlying cardiac defect
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.
The nurse finds that a 6-month-old infant has an apical pulse of 166 beats/min during sleep. What nursing intervention is most appropriate at this time?
a. Administer oxygen.
b. Record data on the nurses’ notes.
c. Report data to the practitioner.
d. Place the child in the high Fowler position.
c. Report data to the practitioner.
One of the earliest signs of HF is tachycardia (sleeping heart rate >160 beats/min) as a direct result of sympathetic stimulation. The practitioner needs to be notified for evaluation of possible HF. Although oxygen or a semiupright position may be indicated, the first action is to report the data to the practitioner.
What drug is an angiotensin-converting enzyme (ACE) inhibitor?
a. Furosemide (Lasix)
b. Captopril (Capoten)
c. Chlorothiazide (Diuril)
d. Spironolactone (Aldactone)
b. Captopril (Capoten)
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.
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
b. 90 beats/min
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 clinical manifestation is a common sign of digoxin toxicity?
a. Seizures
b. Vomiting
c. Bradypnea
d. Tachycardia
b. Vomiting
Vomiting is a common sign of digoxin toxicity and is often unrelated to feedings. Seizures are not associated with digoxin toxicity. The child will have a slower (not faster) heart rate but not a slower respiratory rate.
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.
d. Parents need to learn specific, important guidelines for administration of digoxin.
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.
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
d. Increase in calories
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.
Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infant’s status, which finding is indicative of achieving this goal?
a. Irritability when awake
b. Capillary refill of more than 5 seconds
c. Appropriate weight gain for age
d. Positioned in high Fowler position to maintain oxygen saturation at 90%
c. Appropriate weight gain for age
Appropriate weight gain for an infant is indicative of successful feeding and a reduction in caloric loss secondary to the HF. Irritability is a symptom of HF. The child also uses additional energy when irritable. Capillary refill should be brisk and within 2 to 3 seconds. The child needs to be positioned upright to maintain oxygen saturation at 90%. Positioning is helping to decrease respiratory effort, but the infant is still having difficulty with oxygenation.
The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. What strategy is an important objective to decrease this risk?
a. Minimize seizures.
b. Prevent dehydration.
c. Promote cardiac output.
d. Reduce energy expenditure.
b. Prevent dehydration.
In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.
A 3-month-old infant has a hypercyanotic spell. What should be the nurse’s first action?
a. Assess for neurologic defects.
b. Prepare the family for imminent death.
c. Begin cardiopulmonary resuscitation.
d. Place the child in the knee–chest position.
d. Place the child in the knee–chest position.
The first action is to place the infant in the knee–chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. Preparing the family for imminent death or beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.
A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition?
a. Cyanosis
b. Heart failure
c. Decreased pulmonary blood flow
d. Bounding pulses in upper extremities
b. Heart failure
As blood is shunted into the right side of the heart, there is increased pulmonary blood flow and the child is at high risk for heart failure. Cyanosis usually occurs in defects with decreased pulmonary blood flow. Bounding upper extremity pulses are a manifestation of coarctation of the aorta.
What blood flow pattern occurs in a ventricular septal defect?
a. Mixed blood flow
b. Increased pulmonary blood flow
c. Decreased pulmonary blood flow
d. Obstruction to blood flow from ventricles
b. Increased pulmonary blood flow
The opening in the septal wall allows for blood to flow from the higher pressure left ventricle into the lower pressure right ventricle. This left-to-right shunt creates increased pulmonary blood flow. The shunt is one way, from high pressure to lower pressure; oxygenated and unoxygenated blood do not mix. The outflow of blood from the ventricles is not affected by the septal defect.
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
d. Pulmonary vascular congestion
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.
What cardiovascular defect results in obstruction to blood flow?
a. Aortic stenosis
b. Tricuspid atresia
c. Atrial septal defect
d. Transposition of the great arteries
a. Aortic stenosis
Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Tricuspid atresia results in decreased pulmonary blood flow. The atrial septal defect results in increased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.
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
a. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.
The parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. How should the nurse reply to this concern?
a. The parents should meet all the child’s needs.
b. The child needs opportunities to play with peers.
c. Constant parental supervision is needed to avoid overexertion.
d. The child needs to understand that peers’ activities are too strenuous.
b. The child needs opportunities to play with peers.
The child needs opportunities for social development. Children are able to regulate and limit their activities based on their energy level. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence.
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.
b. Let the child hear the sounds of a cardiac monitor, including alarms.
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.
Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4° C (101.1° F). What action should the nurse perform?
a. Report findings to the practitioner.
b. Apply a hypothermia blanket.
c. Keep the child warm with blankets.
d. Record the temperature on the assessment flow sheet.
a. Report findings to the practitioner.
In the first 24 to 48 hours after surgery, the body temperature may increase to 37.8° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or fever continues after this period, it is most likely a sign of an infection, and immediate investigation is indicated. A hypothermia blanket is not indicated for this level of temperature. Blankets should be removed from the child to keep the temperature from increasing. The temperature should be recorded, but the practitioner must be notified for evaluation.
What nursing consideration is important when suctioning a young child who has had heart surgery?
a. Perform suctioning at least every hour.
b. Suction for no longer than 30 seconds at a time.
c. Expect symptoms of respiratory distress when suctioning.
d. Administer supplemental oxygen before and after suctioning.
d. Administer supplemental oxygen before and after suctioning.
When suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated and very carefully to avoid vagal stimulation. The child should be suctioned for no more than 5 seconds at a time. Symptoms of respiratory distress are avoided by using appropriate technique.
The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be the nurse’s initial intervention?
a. Apply warming blankets.
b. Notify the practitioner of these findings.
c. Give additional pain medication per protocol.
d. Encourage child to cough, turn, and deep breathe.
b. Notify the practitioner of these findings.
The practitioner is notified immediately. Increases of chest tube drainage to more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and tachycardia may indicate cardiac tamponade—blood or fluid in the pericardial space constricting the heart—which is a life-threatening complication. Warming blankets are not indicated at this time. Additional pain medication can be given before the practitioner drains the fluid, but the notification is the first action. Encouraging the child to cough, turn, and deep breathe should be deferred until after evaluation by the practitioner.
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.
a. Immediately bring the child to the clinic for evaluation.
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.
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.
a. Counsel parents of high-risk children.
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.
