unit 7

Question 1

The nurse is conducting a physical examination of a child with a ventricular septal

defect. Which finding would the nurse expect to assess?birb.com/test

A) Right ventricular heave

B) Holosystolic harsh murmur along the left sternalbborder

C) Fixed split-second heart sound
D) Systolic ejection murmur

Answer 1

b

Question 2

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next?

A) Contact the healthcare provider.

B) Offer a snack and administer another dose.

C) Immediately administer another dose.

D) Administer next dose as ordered in 12 hours.

Answer 2

d

Question 3

The nurse is caring for an infant with suspected patent ductus arteriosus. Which

assessment finding would the nurse identify as helping to confirm this suspicion?

A) Thrill at the base of the heart

B) Harsh, continuous, machine-like murmur under i the left clavicle

C) Faint pulses

D) Systolic murmur best heard along the left sternal border

Answer 3

B

Question 4

The nurse is conducting a physical examination of a child with a suspected

cardiovascular disorder. Which finding would the nurse most likely expect to assess if the child had transposition of the great vessels?

A) Significant cyanosis without presence of a murmur

B) Abrupt cessation of chest output with an increase in heart rate/filling

pressure

C) Soft systolic ejection

D) Holosystolic murmur

Answer 4

A

Question 5

The nurse is assessing a child with suspected infective endocarditis. Which

assessment finding would the nurse interpret as a sign of extracardiac emboli?

A) Pruritus

B) Roth spots

C) Delayed capillary refill

D) Erythema marginatum

Answer 5

B

Question 6

When conducting a physical examination of a child with suspected Kawasaki

disease, which finding would the nurse expect to assess?

A) Hirsutism or striae

B) Strawberry tongue

C) Malar rash

D) Café au lait spots

Answer 6

B

Question 7

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding?

A) Janeway lesions

B) Jerky movements of the face and upper extremities/test

C) Black lines

D) Osler nodes

Answer 7

B

Question 8

A nurse is reviewing the medical record of a child and finds that the child has a grade III murmur. After auscultating the child’s heart sounds,t how would the nurse document this murmur?

A) Loud without a thrill

B) Loud with a precordial thrill

C) Soft and easily heard

D) Loud, audible with a stethoscope

Answer 8

A

Question 9

The nurse is caring for a 2-month-old infant who has been diagnosed with acute

heart failure. The nurse is providing teaching about nutrition. Which statement by the
mother indicates a need for further teaching?

A) “The baby may need as much as 150 calories/kg/day.”

B) “Small, frequent feedings are best if tolerated.”

C) “I need to feed him every hour to make sure he eats enough.”

D) “Gavage feedings may be required for now.”

Answer 9

C

Question 10

The nurse is caring for an infant girl with a suspected cardiovascular disorder.

Which statement by the mother would warrant further investigation?
A) “My baby does not make any grunting noises.”

B) “The baby seems more comfortable over my shoulder.”

C) “The baby usually drinks all of her bottle.”

D) “I don’t notice any rapid breathing patterns.”

Answer 10

B

Question 11

.Auscultation of a child’s heart reveals a loud murmurb with a precordial thrill. The nurse documents this as which grade?

A) Grade II

B) Grade III

C) Grade IV

D) Grade V

Answer 11

C

A grade IVmurmur is loud with a precordial thrill. A grade IImurmur is soft and easily

heard. A grade III murmur is characterized as loud without a thrill. A grade V murmur
is characterized as loud, audible without a stethoscope.

Question 12

After assessing a child’s blood pressure, the nurse determines the pulse pressure and finds that it is narrowed. What would the nurse identify as associated with this
finding?

A) Aortic stenosis

B) Patent ductus arteriosus

C) Aortic insufficiency

D) Complete heart block

Answer 12

A

Question 13

A 9-year-old child has undergone a cardiac catheterization / and is being prepared for discharge. The nurse is instructing the parents and child about post procedure
care. Which statement by the parents indicates that the teaching was successful?

A) “This pressure dressing needs to stay on for 5 days from now.”

B) “He can’t eat but he can drink fluids for the next 24 hours.”

C) “He should avoid taking a bath for about 3 days, but he can shower.”

D) “It’s normal if he says he feels like his heart skipped t a t beat.”

Answer 13

C

After a cardiac catheterization, the child should avoid tub bathsefor about 3 days, but he can shower or use sponge baths. The pressure dressing should be removed the day after the procedure and a dry sterile dressing or adhesive bandage is applied for the next several days. After the procedure, the child can resume his usual diet. Any
reports of fluttering or the heart skipping a beat should be reported.

Question 14

A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that

the healthcare provider will most likely order which medication?

A) Alprostadil

B) Heparin

C) Indomethacin

D) Spironolactone

Answer 14

Ans: C

Indomethacin is the drug typically ordered to close a patent ductus arteriosus. Alprostadil would beindicated to maintain the ductus arteriosus temporarily in infants
with ductal-dependent congenital heart defects. Heparin would be used for

prophylaxis and treatment of thromboembolic disorders, especially after surgery.

Spironolactone would be used to manage edema due to heart failure and to treat hypertension.

Question 15

The nurse is preparing a teaching plan for the parents of a child who has been
diagnosed with a congenital heart defect. What would the nurse be least likely to

include?

A) Daily weight assessment

B) Maintenance of strict bed rest

C) Prevention of infection

D) Signs of complications

Answer 15

b

A child with congenital heart disease should be allowed tobengage in activity as tolerated, with rest periods frequently throughout the day to prevent overexertion. Daily weights, infection prevention measures, and signs of. complications are all appropriate to includewhen teaching parents of a child with a congenital heart defect.

Question 16

After teaching a class about the hemodynamic characteristics of congenital heart

disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorderb involving increased
pulmonary blood flow?

A) Tetralogy of Fallot

B) Atrial septal defect

C) Hypoplastic left heart syndrome

D) Transposition of the great vessels

Answer 16

Ans: B

Feedback:

Atrial septal defect is an example of a disorder involving increased pulmonary blood flow. Tetralogy of Fallot is a defect involving decreased pulmonary blood flow. Transposition of the great vessels and hypoplastic left heart syndrome are examples of mixed disorders

Question 17

A 7-year-old child with a family history of cardiovascular .disease is being screened for hyperlipidemia. When reviewing the child’s laboratory test results, which total

cholesterol level would be of significant concern?

A) 120 mg/dL (3.11 mmol/L)

B) 150 mg/dL (3.88 mmol/L)

C) 180 mg/dL (4.66 mmol/L)

D) 210 mg/dL (5.44 mmol/L)

Answer 17

d

Question 18

A child with a suspected cardiovascular disorder is to undergo diagnostic testing
and is scheduled for an echocardiogram. When explaining this test to the child, what
would the nurse most likely include?

A) “This test will check the pattern of how your heart is beating.”

B) “They’ll take a picture of your chest to look at the heart’s size.”

C) “A special wand that picks up sound is used to check your heart.”

D) “Small patches are attached to your chest to check the heart rhythm.”

Answer 18

c

Question 19

The nurse is reviewing the medical record of a child with infective endocarditis.
What would the nurse expect to find? Select all that apply.

A) White blood cell count revealing leukopenia

B) Microscopic hematuria with urinalysis

C) Electrocardiogram with prolonged PR interval

D) Lungs clear on auscultation

E) Petechiae on palpebral conjunctiva

Answer 19

Ans: B, C, E

Feedback:

With infective endocarditis, leukocytosis, microscopic hematuria, prolonged PR

interval, adventitious lung sounds, and petechiae on the palpebral conjunctiva are noted.

Question 20

A child with heart failure is receiving supplemental oxygen. The nurse
understands that in addition to improving oxygen saturation, this intervention also
has what effect?

A) Cause vasodilation

B) Increase pulmonary vascular resistance

C) Promote diuresis

D) Mobilize secretions

Answer 20

Ans: A

Oxygen improves oxygen saturation and also functions as a vasodilator and decreases pulmonary vascular resistance.

Question 21

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin .and notify the healthcare provider if the infant’s apical pulse rate was:

A) 140 beats per minute

B) 120 beats per minute

C) 100 beats per minute

D) 80 beats per minute

Answer 21

d

Question 22

A nurse is working with an adolescent who is slightly overweight and was recently diagnosed with hypertension. They are discussing nutritional management. Which statement by the adolescent demonstrates understandingbof the information?

A) “I have to make sure that I don’t eat a lot of salty foods.”

B) “I can eat any amount at a meal as long as I don’t eat t between meals.”

C) “I should eat plenty of fresh fruits and vegetables.”
D) “If I skip breakfast, I can eat a much bigger lunch.”

Answer 22

c

Question 23

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the healthcare provider to prescribe? Select all

that apply.

A) Intravenous immunoglobulin

B) Ibuprofen
C) Acetaminophen

D) Aspirin

E) Alprostadil

Answer 23

a d

In the acute phase, high-dose aspirin in four divided dosesbdaily and a single infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever.
Nonsteroidal anti-inflammatory agents such as ibuprofen iare avoided while the child is receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus
arteriosus patent in infants with ductal-dependent congenital heart defects.

Question 24

An infant with congenital heart disease isto undergo surgery tocorrect the defect.

The mother states, “I guess I’m going to have to stop breastfeeding her.” Which
response by the nurse would be most appropriate?

A) “That’s true, but we’ll make sure she gets the best intravenous nutrition.”

B) “Unfortunately, your baby needs more nutrients than what breast milk can

provide.”

C) “Breast milk may help to boost her immune system, so you can continue to

use it.”

D) “She won’t be able to suck, so we have to give her fortified formula through

a tube.”

Answer 24

Ans: C

Feedback:

Breastfeeding a child before and after cardiac surgery may boost the infant’s immune

system, which can help fight postoperative infection. If breastfeeding is not possible, mothers can pump milk and the breast milk may be given via / bottle, dropper, or
gavage feeding. In addition, breastfeeding is associated with decreased energy

expenditure during the act of feeding.

Question 25

During a follow-up visit, the parents of a 5-month-old infant diagnosed with congenital heart disease tell the nurse, “We’re just so tired and t emotionally spent. All these tests and examinations are overwhelming. We just want to have a normal life. We’re so focused on the baby that it seems like our 3-year-old is lost in the shuffle.” Which nursing diagnosis would the nurse identify as most appropriate?

A) Risk for delayed growth and development related to/ necessary treatments

B) Deficient knowledge related to the care of a child with congenital heart

disease

C) Interrupted family processes related to demands of caring for the ill child

D) Fear related to infant’s cardiac condition and needo for songoing care

Answer 25

c

The statements by the parents indicate that there is disruption in the family resulting from the demands of caring for the ill infant and they verbalized concern about their older child. The child may be at risk for delayed growth and development, but this is not indicated by the parents’ statements. The parents may lack knowledge about their infant’s condition and they may be experiencing fear about the infant’s condition, but the statements reflect issues related to the family functioning.

Question 26

A child with suspected dyslipidemia undergoes laboratory testing. The nurse is reviewing the results. Which finding would the nurse interpret as supporting the
diagnosis? Select all that apply.

A) Total cholesterol level of 150 mg/dL (3.88 mmol/L)

B) Total cholesterol level of 180 mg/dL (4.66 mmol/L) /test

C) Total cholesterol level of 220 mg/dL (5.70 mmol/L)

D) LDL level of 90 mg/dL (2.33 mmol/L)

E) LDL level of 120 mg/dL (3.11 mmol/L)

F) LDL level of 140 mg/dL (3.63 mmol/L)

Answer 26

Ans: C, F

A total cholesterol level over 200 mg/dL (5.18 mmol/L)aando LDL level above 130 mg/dL (3.37 mmol/L) are considered high and would support the diagnosis of dyslipidemia. Total cholesterol levels between 170 to 199 mg/dL (4.40 to 5.15 mmol/L) and LDL levels between 110 to 129 mg/dL (2.85 to 3.34 mmol/L) are
considered borderline. Total cholesterol levels less than 170 mg/dL (4.40 mmol/L)

and LDL levels less than 110 mg/dL (2.85 mmol/L) are acceptable in children.

Question 27

The mother of a 4-week-old infant is tearful. She reports thet healthcare provider has told her that her son has a small atrial septal defect. She reports she is worried
and asks the nurse more about the condition. Which statement by the parents best indicates an understanding of the nurse’s teaching?

A) “This greatly places my son at risk for cardiac failure.”
B)“If this does not resolve by the time my child is 1 yearold,he will likely need

surgery.”

C) “Most of the time this condition spontaneously resolves.”

D) “Since the surgery to correct this condition can be risky my son will need to

be at least 40 pounds.”

Answer 27

Ans: C

Atrial septal defects in children most likely resolve without treatment. Those that are not corrected by the age of 18 months will likely require surgical intervention. When planned, surgery is not usually performed until the childbis. at least 3 years of age. There is no indication other problems are present, so the child is not at an increased risk for cardiac failure.

Question 28

The nurse is caring for a child that just returned fromi a coronary arteriogram in which the catheter was placed through the left femoral artery. Which nursing actions
demonstrate knowledge of the procedure? Select all that apply.
A) The nurse allows the client up to the bathroom only.

B) The nurse assesses the dorsalis pedis pulse inathe left sfoot.

C) The nurse assesses the puncture site frequently.

D) The nurse tells the parents that the healthcareb provider will discuss the

results of the procedure with them.

E) The nurse assesses the client’s vital signs everyr 8 hours.

Answer 28

Ans: B, C, D
Feedback:

The nurse must assess the pulse distal to the puncture site tot determine that circulation remains adequate to the extremity. Assessing the puncture site ensures
early recognition of bleeding from the site. The healthcare.provider will be able to inform the parents regarding the results of the procedure after completion. The child should be kept on bed rest for a specified period of time, soctheyt cannot be up to the bathroom. Vital signs will need to be taken more frequently than every 8 hours for early detection of complications.

Question 29

The nurse is caring for a newborn diagnosed with an atrial septal defect (ASD). The parents voice concern and state, “I can’t believe this is happening. Will our child be okay?” What is the nurse’s best response?

A) “If the defect isn’t treated it can cause problemsb such sas pulmonary hypertension, heart failure, atrial arrhythmias, or stroke.”

B) “While each case is different, the majority of these defects correct on their

own. Let’s see what the tests show, then speak with the healthcare provider.”

C) “Since there are no symptoms being exhibited right now, your child will

likely not require surgery until the age of 3 years.”

D) “Most children have no symptoms of this defect.”com/

Answer 29

Ans: B

Feedback:

While all responses supply correct information about the disorder, the best response is, “While each case is different, the majority of these defects/ correct on their own.
Let’s see what the tests show, then speak with the healthcaret provider.” This individualizes the response to this child, offers realistic hope, and verifies that the healthcare provider will need to be consulted to answera questions regarding prognosis.