Health And care- Pediatric Cardiac Disease Test

1. Child's chest should be assessed for thrills or abnormal pulsations during the physical exam.

True

False

A thrill is a continual rhythmic vibration.

Explanation

A thrill is a continual rhythmic vibration.

2. Decreased urinary output may be a sign of worsening heart failure.

True

False

Decreased urinary output can be a sign of worsening heart failure because when the heart is not functioning properly, it may not be able to pump blood effectively, leading to a decrease in blood flow to the kidneys. This can result in reduced urine production. Therefore, a decrease in urinary output, such as fewer wet diapers or less frequent toileting, can indicate that the heart failure is worsening.

Explanation

Decreased urinary output can be a sign of worsening heart failure because when the heart is not functioning properly, it may not be able to pump blood effectively, leading to a decrease in blood flow to the kidneys. This can result in reduced urine production. Therefore, a decrease in urinary output, such as fewer wet diapers or less frequent toileting, can indicate that the heart failure is worsening.

3. In the fetal heart, the Foramen Ovale allows blood to enter the Left _____ from the Right Atrium.

The foramen ovale is a normal cardiac structure found in all newborns and can be best described as a "door" between the right and left atria.

Explanation

The foramen ovale is a normal cardiac structure found in all newborns and can be best described as a "door" between the right and left atria.

Submit

4. Digoxin should not be administered to an adult with a heart rate less than 60 bpm.

True

False

Digoxin is a medication commonly used to treat heart conditions such as congestive heart failure and atrial fibrillation. It works by slowing down the heart rate and increasing the strength of each heartbeat. However, if an adult already has a heart rate less than 60 beats per minute, giving them digoxin can further slow down the heart rate to dangerously low levels. This can lead to symptoms such as dizziness, fainting, and even heart block. Therefore, it is important to avoid administering digoxin to adults with a heart rate less than 60 bpm.

Explanation

Digoxin is a medication commonly used to treat heart conditions such as congestive heart failure and atrial fibrillation. It works by slowing down the heart rate and increasing the strength of each heartbeat. However, if an adult already has a heart rate less than 60 beats per minute, giving them digoxin can further slow down the heart rate to dangerously low levels. This can lead to symptoms such as dizziness, fainting, and even heart block. Therefore, it is important to avoid administering digoxin to adults with a heart rate less than 60 bpm.

5. In the developing fetus, the ductus arteriosus (DA), is a shunt connecting the pulmonary artery to the aortic arch.

True

False

It allows most of the blood from the right ventricle to bypass the fetus' fluid-filled lungs, protecting the lungs from being overworked and allowing the right ventricle to strengthen.

Explanation

It allows most of the blood from the right ventricle to bypass the fetus' fluid-filled lungs, protecting the lungs from being overworked and allowing the right ventricle to strengthen.

6. An infant with tetralogy of Fallot becomes cyanotic and dyspneic after a crying episode. To relieve the cyanosis and dyspnea, the nurse should place the infant in the:

Orthopneic position

Knee-chest position

Lateral Sims' position

Semi-Fowler's position

Flexing the hips and knees decreases venous return to the heart from the legs; when venous return to the heart is decreased, the cardiac workload is decreased.

Explanation

Flexing the hips and knees decreases venous return to the heart from the legs; when venous return to the heart is decreased, the cardiac workload is decreased.

7. Marfan syndrome is a congenital defect sometimes associated with CHD. Affected persons have valvular problems, increased dilitation of the Aorta, are tall and lean in stature with a "wingspan" that exceeds their height. Abe Lincoln was thought to have Marfan syndrome.

True

False

Marfan syndrome is a genetic disorder that can be associated with congenital heart defects (CHD). People with Marfan syndrome often have issues with their heart valves and an enlarged aorta. They also tend to be tall and lean, with a wingspan that is longer than their height. It is believed that Abraham Lincoln may have had Marfan syndrome. Therefore, the statement "Marfan syndrome is a congenital defect sometimes associated with CHD" is true.

Explanation

Marfan syndrome is a genetic disorder that can be associated with congenital heart defects (CHD). People with Marfan syndrome often have issues with their heart valves and an enlarged aorta. They also tend to be tall and lean, with a wingspan that is longer than their height. It is believed that Abraham Lincoln may have had Marfan syndrome. Therefore, the statement "Marfan syndrome is a congenital defect sometimes associated with CHD" is true.

8. An 8 year old is admitted with myocarditis and associated tachycardia, and is prescribed fuosemide (Lasix). Which lab value does the nurse need to closely monitor for this child?

Calcium

Glucose

Potassium

Sodium

Everybody needs a "gimme" now and then

Explanation

Everybody needs a "gimme" now and then

9. The nurse is aware that a common physiologic adaptation of children with tetralogy of Fallot is:

Clubbing of fingers

Slow, irregular respirations

Subcutaneous hemorrhages

Decreased red blood cell count

Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips.

Explanation

Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips.

10. Per our notes: Breathing stimulates the closure of the Ductus arteriosis.

True

False

I'm not trying to explain this shit. I have to read it some more.

Explanation

I'm not trying to explain this shit. I have to read it some more.

11. A nurse is caring for a nine year old experiencing tachycardia due to myocarditis. Digoxin (lanoxin) is prescribed. Before giving digoxin to this child, the nurse should assess:

Apical pulse

Urine output

Radial pulse

Blood pressure

digoxin slows the heart rate and strengthens contractions; it shouldn't be given if the heart rate is abnormally low with regard to the child's age. The most accurate measure of the child's heart rate is the apical (not radial) pulse. Urine output and blood pressure don't need to be assessed before digoxin administration.

Explanation

digoxin slows the heart rate and strengthens contractions; it shouldn't be given if the heart rate is abnormally low with regard to the child's age. The most accurate measure of the child's heart rate is the apical (not radial) pulse. Urine output and blood pressure don't need to be assessed before digoxin administration.

12. Which nursing intervention best helps decrease anxiety for the parents of a child scheduled for cardiac surgery?

Tell the parents not to worry, because the physician performs this procedure all the time.

Obtain an order for anti-anxiety medication for the parents, if requested.

Teach the parents and the child about the surgery 1 month before the procedure

Explain the steps that will occur before and after surgery. The parents need something tangible to focus on.

Telling the parents about the sequence of events before and after surgery will decrease their anxiety and increase cooperation. The nurse should listen to the parents' concerns, rather than dismissing them by telling them not to worry. It isn't appropriate to obtain an order for anti-anxiety medication for the parents. Children do best with preoperative teaching 3 to 7 days before a procedure rather than 1 month before.

Explanation

Telling the parents about the sequence of events before and after surgery will decrease their anxiety and increase cooperation. The nurse should listen to the parents' concerns, rather than dismissing them by telling them not to worry. It isn't appropriate to obtain an order for anti-anxiety medication for the parents. Children do best with preoperative teaching 3 to 7 days before a procedure rather than 1 month before.

13. Digoxin should not be administered to a child (1 year and older) with a heart rate of less than 70.

True

False

Digoxin is a medication commonly used to treat heart conditions, such as congestive heart failure and certain arrhythmias. It works by increasing the strength of the heart's contractions and slowing down the heart rate. However, in children (1 year and older) with a heart rate of less than 70, administering digoxin can further slow down the heart rate, potentially leading to serious complications. Therefore, it is true that digoxin should not be given to a child with a heart rate below 70.

Explanation

Digoxin is a medication commonly used to treat heart conditions, such as congestive heart failure and certain arrhythmias. It works by increasing the strength of the heart's contractions and slowing down the heart rate. However, in children (1 year and older) with a heart rate of less than 70, administering digoxin can further slow down the heart rate, potentially leading to serious complications. Therefore, it is true that digoxin should not be given to a child with a heart rate below 70.

14. When caring for a 3 year old with tetralogy of Fallot, he nurse expects to see fatigue and poor activity tolerance. This is caused by:

Poor muscle tone

Inadequate oxygenation of tissues.

Restricted blood flow leaving the heart

Inadequate intake of food.

The child's fatigue results from left to right shunting that occurs with tetralogy of Fallot. This shunting causes poorly oxygenated blood to circulate through the body. Poor muscle tone and inadequate food intake can result from this condition, but these are effects, not causes. Restricted blood flow leaving the heart is associated with aortic stenosis.

Explanation

The child's fatigue results from left to right shunting that occurs with tetralogy of Fallot. This shunting causes poorly oxygenated blood to circulate through the body. Poor muscle tone and inadequate food intake can result from this condition, but these are effects, not causes. Restricted blood flow leaving the heart is associated with aortic stenosis.

15. Mrs. Reklau's notes state: DO NOT give more than ____ mL (0.05 mg) in one dose to an infant

The correct answer to the question is 1, One, ONE, one. This indicates that the maximum amount of medication that should be given in a single dose to an infant is 1 mL (0.05 mg). The repetition of the word "one" and the use of both numerical and written forms emphasize the importance of not exceeding this dosage.

Explanation

The correct answer to the question is 1, One, ONE, one. This indicates that the maximum amount of medication that should be given in a single dose to an infant is 1 mL (0.05 mg). The repetition of the word "one" and the use of both numerical and written forms emphasize the importance of not exceeding this dosage.

Submit

16. A 1-year-old with postductal coarctation of the aorta is admitted to the acute care unit for treatment. When performing an assessment, the nurse finds that the lower extremities are cool. Which finding should the nurse anticipate as the assessment continues?

Lethargy

Low blood pressure in the arms

Low blood pressure in the legs

Bilateral pedal edema

Postductal coarctation of the aorta causes several changes in the lower extremities: diminished peripheral pulses, hypotension, and resulting cool temp. A child under age 3 can't describe his symptoms, but may exhibit exceptional irritability (rather than lethargy). High blood pressure in the upper portions of the body produces headache and vertigo. Pedal edema isn't related to diminished perfusion of the lower extremities.

Explanation

Postductal coarctation of the aorta causes several changes in the lower extremities: diminished peripheral pulses, hypotension, and resulting cool temp. A child under age 3 can't describe his symptoms, but may exhibit exceptional irritability (rather than lethargy). High blood pressure in the upper portions of the body produces headache and vertigo. Pedal edema isn't related to diminished perfusion of the lower extremities.

17. A newborn is diagnosed with coarctation of the aorta. The infant is discharged with a prescription for digoxin (lanoxin) 0.05 mg PO every 12 hours. The bottle of digoxin is labeled 0.15 mg in 1/2 teaspoon, the nurse should teach the mother to administer the medication using a:

Nipple

Calibrated syringe

Plastic measuring spoon

Bottle with an ounce of water

A calibrated syringe or dropper provides the most accurate measurement of the medication.

Explanation

A calibrated syringe or dropper provides the most accurate measurement of the medication.

18. A nine year old received digoxin (Lanoxin) daily for the past 5 days of his hospitalization. Before giving him his dose this morning, the nurse performs a routine assessment. Which assessment finding indicates the need to hold the child's morning dose of digoxin?

Vomiting

Palpitations

Increased heart rate

Serum digoxin level of 1.2 ng/mL

Vomiting is a sign of digoxin toxicity. Palpitations and increased heart rate indicate that digoxin is needed. The serum level is within the normal range.

Explanation

Vomiting is a sign of digoxin toxicity. Palpitations and increased heart rate indicate that digoxin is needed. The serum level is within the normal range.

19. An appropriate nursing action to include in the care of an infant with congenital heart disease who has been admitted with heart failure is:

Positioning flat on the back

Encouraging nutritional fluids

Offering small frequent feedings

Measuring the head circumference

Because these infants become extremely fatigued while sucking, small frequent feedings with adequate rest periods can improve their total intake.

Explanation

Because these infants become extremely fatigued while sucking, small frequent feedings with adequate rest periods can improve their total intake.

20. At about 21 days of gestation the fetal heart begins beating and circulating blood.

True

False

At about 21 days of gestation, the fetal heart begins beating and circulating blood. This is a crucial milestone in the development of the fetus, as it marks the beginning of the cardiovascular system. The fetal heart starts to pump blood, which allows nutrients and oxygen to be delivered to the developing organs and tissues. The circulation of blood is essential for the proper growth and development of the fetus. Therefore, the statement is true.

Explanation

At about 21 days of gestation, the fetal heart begins beating and circulating blood. This is a crucial milestone in the development of the fetus, as it marks the beginning of the cardiovascular system. The fetal heart starts to pump blood, which allows nutrients and oxygen to be delivered to the developing organs and tissues. The circulation of blood is essential for the proper growth and development of the fetus. Therefore, the statement is true.

21. When palpating the brachial, radial, and femoral pulses of a neonate, the nurse notes a difference in pulse amplitude between the femoral and radial pulses bilaterally. This difference suggests:

Patent ductus arteriosus

Coarctation of the aorta

Diminished cardiac output

Left to right shunting in the heart.

A difference in pulse amplitude between the upper and lower extremities or between the femoral and radial pulses suggests a coarctation of the aorta (narrowing of the aorta below the left subclavian artery). A patent ductus arteriousus is associated with a bounding pulse due to left-to-right shunting of blood in the heart. A weak or thinner pulse indicates diminished cardiac output.

Explanation

A difference in pulse amplitude between the upper and lower extremities or between the femoral and radial pulses suggests a coarctation of the aorta (narrowing of the aorta below the left subclavian artery). A patent ductus arteriousus is associated with a bounding pulse due to left-to-right shunting of blood in the heart. A weak or thinner pulse indicates diminished cardiac output.

22. A 4-month old infant who has a congenital heart defect develops heart failure and is exhibiting marked dyspnea at rest . The nurse is aware this finding can be attributed to:

Anemia

Hypovolemia

Pulmonary edema

Metabolic acidosis

The increased blood volume and pressure in the lungs resulting from left ventricular failure causes pulmonary edema; dyspnea, and early sign of failure, is probably caused by the decreased distensibility of the lungs.

Explanation

The increased blood volume and pressure in the lungs resulting from left ventricular failure causes pulmonary edema; dyspnea, and early sign of failure, is probably caused by the decreased distensibility of the lungs.

23. The mother of a child with a congenital cardiac defect asks the nurse why her child squats after exertion. The nurse should reply that this position:

Reduces muscle aches

Increases cardiac efficiency

Enhances the pull of gravity

Decreases blood volume in the extremities

When the child squats, blood pools in the lower extremities because of flexion of the hips and knees; less blood returns to the hear, enabling the heart to beat more effectively.

Explanation

When the child squats, blood pools in the lower extremities because of flexion of the hips and knees; less blood returns to the hear, enabling the heart to beat more effectively.

24. Do not administer Digoxin (lanoxin) if heart rate is less than ____ in an infant (numeric response only)

Digoxin is a medication used to treat heart failure and certain heart rhythm disorders. It works by slowing down the heart rate and making the heart beat stronger. However, if the heart rate is already too slow, administering Digoxin can further decrease the heart rate and lead to serious complications. Therefore, it is contraindicated to administer Digoxin if the heart rate is less than 100 in an infant.

Explanation

Digoxin is a medication used to treat heart failure and certain heart rhythm disorders. It works by slowing down the heart rate and making the heart beat stronger. However, if the heart rate is already too slow, administering Digoxin can further decrease the heart rate and lead to serious complications. Therefore, it is contraindicated to administer Digoxin if the heart rate is less than 100 in an infant.

Submit

25. A child is in the pediatric intensive care unit immediately after cardiac surgery. Which nursing action is most important?

Assess the airway.

Administer sedation

Maintain semi-Fowler's position.

Monitor oxygen saturation readings.

Surprise!!!! Child will return from surgery with ET tube and nurse should check for bilateral breath sounds to evaluate tube placement. Just a thought. What would we do if two of the choices were 1.) assess airway & 2.) perform hand hygiene? My head would explode.

Explanation

Surprise!!!! Child will return from surgery with ET tube and nurse should check for bilateral breath sounds to evaluate tube placement. Just a thought. What would we do if two of the choices were 1.) assess airway & 2.) perform hand hygiene? My head would explode.

26. A 3 month old infant is admitted with a diagnosis of tetralogy of Fallot. Assessment reveals that the infant's weight is in the 5th percentile. The nurse is aware that the reason for this inadequate weight gain is:

Cyanosis leading to cerebral changes

Decreased arterial Po2 resulting in polycythemia

Activity intolerance resulting in deficient caloric intake

Pulmonary hypertension resulting in recurrent respiratory infections.

Because the infant tires so easily, sufficient calories cannot be infested to meet nutritional needs.

Explanation

Because the infant tires so easily, sufficient calories cannot be infested to meet nutritional needs.

27. A one month old infant is admitted for confirmation of the diagnosis of ventricular septal defect. During the initial admission assessment, the nurse would expect to find:

Bradycardia at rest

Bounding peripheral pulses

An activity related cyanosis

A murmur at the left sternal border.

This murmur is the most characteristic finding in children with VSD

Explanation

This murmur is the most characteristic finding in children with VSD

28. A child is suspected of having Kawasaki disease. Which finding is significant?

Extreme lethargy

Increased appetite

Respiratory congestion

Fever for at least 5 days

Kawasaki disease is a type of vasculitis affecting small to medium sized vessels. It primarily affects the lymph nodes but may progress to the coronary arteries. A child with Kawasaki disease has afever for at least five days along with an erythematous rash, red tongue, and red, cracked dry lips. Irritability, not lethargy is seen in Kawasaki disease, along with decreased appetite and edema of the hands and feet. Respiratory congestion isn't a common symptom.

Explanation

Kawasaki disease is a type of vasculitis affecting small to medium sized vessels. It primarily affects the lymph nodes but may progress to the coronary arteries. A child with Kawasaki disease has afever for at least five days along with an erythematous rash, red tongue, and red, cracked dry lips. Irritability, not lethargy is seen in Kawasaki disease, along with decreased appetite and edema of the hands and feet. Respiratory congestion isn't a common symptom.

29. The nurse explains to the parents of a 5 year old with a VSD that a cardiac cath has been scheduled to:

Identify the specific location of the defect

Determine the degree of cardiomegaly present

Confirm the presence of a pansystolic murmur

Establish the presence of ventricular hypertrophy

A cardiac catheterization will identify the exact location of the VSD as well as assess pulmonary pressures.

Explanation

A cardiac catheterization will identify the exact location of the VSD as well as assess pulmonary pressures.

30. A 1 year old child is diagnosed with a congenital heart defect after cardiac catheterization. His parents express concern about activities at home. Which is the nurse's best response?

"You'll have to establish strict discipline so that he learns what he can't do".

"Allow him to play and be active as long as he doesn't get fatigued".

"He'll only be able to play by himself."

"Discipline and limit-setting need to be relaxed to reduce his stress and crying."

Parents should encourage normalcy within the limits of the child's condition. The child needs to have appropriate limits and discipline, but being too strict or overindulging the child makes it hard for him to learn acceptable behavior. A 1 year old child is beginning to explore his world and needs to have activities with other children.

Explanation

Parents should encourage normalcy within the limits of the child's condition. The child needs to have appropriate limits and discipline, but being too strict or overindulging the child makes it hard for him to learn acceptable behavior. A 1 year old child is beginning to explore his world and needs to have activities with other children.

31. A nurse is assessing a 5 year old with a history of heart failure. Which finding indicates that the child has adequate cardiac output?

Urine output of 30 mL/h

Heart rate of 120 beats/min

Cap refill time of 10 to 15 sec

Bilateral crackles heard on auscultation.

The minimal hourly urine output should be at least 30 mL/hr for an adult or a child. The normal heart rate for a 5 yr old is 70 to 90 bts minute. Adequate cap refill time is 3 to 5 seconds. Crackles are an abnormal finding and may indicate hypervolemia, or excess circulating fluid volume, and heart failure.

Explanation

The minimal hourly urine output should be at least 30 mL/hr for an adult or a child. The normal heart rate for a 5 yr old is 70 to 90 bts minute. Adequate cap refill time is 3 to 5 seconds. Crackles are an abnormal finding and may indicate hypervolemia, or excess circulating fluid volume, and heart failure.

32. Which medication is usually given to children diagnosed with Kawasaki disease?

Acetaminophen (Tylenol) every 4 hours

Amoxicillin (Amoxil) divided into three daily doses

Aspirin daily

Ibuprofen (Motrin) every 6 to 8 hours

For kawasaki disease, aspirin is given initially in an anti-inflammatory dose to control fever and symptoms of inflammation. When fever has subsided, aspirin is continued at an antiplatelet dose. If the child develops coronary abnormalities, salicylate therapy is continued indefinitely. Acetaminophen and ibuprofen aren't used because they don't thin the blood. Amoxicillin is an antibiotic, and antibiotics aren't effective in treating kawasaki disease.

Explanation

For kawasaki disease, aspirin is given initially in an anti-inflammatory dose to control fever and symptoms of inflammation. When fever has subsided, aspirin is continued at an antiplatelet dose. If the child develops coronary abnormalities, salicylate therapy is continued indefinitely. Acetaminophen and ibuprofen aren't used because they don't thin the blood. Amoxicillin is an antibiotic, and antibiotics aren't effective in treating kawasaki disease.

33. A nurse is carting for a child who recently underwent a cardiac catheterization to diagnose a congenital heart defect. Which finding indicates the need for immediate action?

Increased Pulse

Decreased urine output

Increased temperature

Bleeding from the catheter site.

Bleeding from the catheter site may become life threatening and demands immediate action. Immediately apply pressure to the site. An increased pulse indicates pain and the need for medication, which the nurse should give if other signs of pain are present, but it isn't an emergency intervention. Because a child must remain flat after a cardiac cath, a decrease in urine output may occur, but it doesn't require immediate action unless urine output is absent. An increased body temperature after cardiac catheterization is not abnormal.

Explanation

Bleeding from the catheter site may become life threatening and demands immediate action. Immediately apply pressure to the site. An increased pulse indicates pain and the need for medication, which the nurse should give if other signs of pain are present, but it isn't an emergency intervention. Because a child must remain flat after a cardiac cath, a decrease in urine output may occur, but it doesn't require immediate action unless urine output is absent. An increased body temperature after cardiac catheterization is not abnormal.

34. What congenital heart defect causes cyanosis in children?

Atrial septal defect

Coarctation of the aorta

Ventricular septal defect

Trasposition of the great vessels

With transposition of the great vessels, the pulmonary artery is attached to the left ventricle and the aorta is attached to the right ventricle. The child is cyanotic because blood reaches the tissues from the right ventricle before being oxygenated by the lungs. In atrial septal defect and ventricular septal defect, blood is shunted from the left side of the heart to the right side through patent openings. Because the blood travels from left to right, it's oxygenated and doesn't produce cyanosis. Coarctation of the aorta is a narrowing of the aorta that decreases the circulation of oxygenated blood to the body. With this condition, the child won't be cyanotic unless cardiac output drops.

Explanation

With transposition of the great vessels, the pulmonary artery is attached to the left ventricle and the aorta is attached to the right ventricle. The child is cyanotic because blood reaches the tissues from the right ventricle before being oxygenated by the lungs. In atrial septal defect and ventricular septal defect, blood is shunted from the left side of the heart to the right side through patent openings. Because the blood travels from left to right, it's oxygenated and doesn't produce cyanosis. Coarctation of the aorta is a narrowing of the aorta that decreases the circulation of oxygenated blood to the body. With this condition, the child won't be cyanotic unless cardiac output drops.

35. A complete blood workup is ordered for a 5 month old with tetralogy of Fallot. Because of the infant's heart disease, the nurse would expect the report to show:

Anemia

Polycythemia

Agranulocytosis

Thrombocytopenia

Mrs. Reklau emphasized this. The body responds to the chronic hypoxia caused by the heart defect by increasing the production of red blood cells in an attempt to increase the oxygen-carrying capacity of the blood.

Explanation

Mrs. Reklau emphasized this. The body responds to the chronic hypoxia caused by the heart defect by increasing the production of red blood cells in an attempt to increase the oxygen-carrying capacity of the blood.

36. A nurse is teaching the mother of an infant who will take digoxin (Lanoxin) at home to treat a chronic tachyarrhythmia. Which signs of digoxin toxicity should the mother be taught?

Blurred vision

Heart rate of 180 beats/minute

Vomiting two or more feedings

Bulging of the anterior fontanel

signs of digoxin toxicity include nausea, vomiting, blurred vision, and yellow-green visual spots, but the mother will only be able to assess objective symptoms such as vomiting. Digoxin causes a decreased heart rate, which can progress to complete heart block if toxicity occurs (digoxin toxicity doesn't lead to tachycardia). Bulging of the anterior fontanel is a sign of increased intracranial pressure.

Explanation

signs of digoxin toxicity include nausea, vomiting, blurred vision, and yellow-green visual spots, but the mother will only be able to assess objective symptoms such as vomiting. Digoxin causes a decreased heart rate, which can progress to complete heart block if toxicity occurs (digoxin toxicity doesn't lead to tachycardia). Bulging of the anterior fontanel is a sign of increased intracranial pressure.

37. A nurse is teaching the parents of a child with tetralogy of Fallot about hypercyanotic spells ("tet spells"). When a spell occurs, the parents should:

Call the physician immediatelycall the physician immediately

Use a calm, comforting approach

Lay the child in the supine position

Take the child to the nearest emergency dept.

Hypercyanotic spells ("tet spells"), in which a child has an extreme bluish discoloration of the skin and mucous membranes, are commonly seen in children with tetralogy of Fallot (a condition with four cardiac anomalies: VSD, pulmonic stenosis, an overriding aorta, and right ventricular hypertrophy). The parents should maintain a calm, comforting approach and place the child in the knee-chest position. It isn't necessary to call the physician, and the spells aren't considered a medical emergency unless profound hypoxia occurs.

Explanation

Hypercyanotic spells ("tet spells"), in which a child has an extreme bluish discoloration of the skin and mucous membranes, are commonly seen in children with tetralogy of Fallot (a condition with four cardiac anomalies: VSD, pulmonic stenosis, an overriding aorta, and right ventricular hypertrophy). The parents should maintain a calm, comforting approach and place the child in the knee-chest position. It isn't necessary to call the physician, and the spells aren't considered a medical emergency unless profound hypoxia occurs.

38. Normal K+ levels are the same for newborns and older children/adults

True

False

Newborn K+ 3-6 mEq/L Older: 3.5-5.0 mEq/L

Explanation

Newborn K+ 3-6 mEq/L Older: 3.5-5.0 mEq/L

39. A 12 year old is diagnosed with hypertension. The nurse understands that hypertension may lead to heart failure. Which assessment finding indicates that the child may have developed heart failure?

Weight loss

Bradycardia

Sudden weight gain

Bounding peripheral pulses

Early signs of heart failure include tachycardia, sudden weight gain, scalp sweating, and weak peripheral pulses. Weight gain can indicate venous congestion. Tachycardia occurs with heart failure as the heart's workload increases. Weak peripheral pulses are a sign of heart failure.

Explanation

Early signs of heart failure include tachycardia, sudden weight gain, scalp sweating, and weak peripheral pulses. Weight gain can indicate venous congestion. Tachycardia occurs with heart failure as the heart's workload increases. Weak peripheral pulses are a sign of heart failure.

40. Per our notes: The clamping of the umbilical cord closes the Foramen Ovale.

True

False

The clamping of the umbilical cord refers to the process of cutting and sealing the cord after birth. The Foramen Ovale is a small opening between the left and right atria of the heart in a fetus. During fetal development, this opening allows blood to bypass the lungs since the fetus receives oxygen from the placenta. However, when the umbilical cord is clamped, it causes changes in the circulatory system, leading to the closure of the Foramen Ovale. Therefore, the statement that clamping the umbilical cord closes the Foramen Ovale is true.

Explanation

The clamping of the umbilical cord refers to the process of cutting and sealing the cord after birth. The Foramen Ovale is a small opening between the left and right atria of the heart in a fetus. During fetal development, this opening allows blood to bypass the lungs since the fetus receives oxygen from the placenta. However, when the umbilical cord is clamped, it causes changes in the circulatory system, leading to the closure of the Foramen Ovale. Therefore, the statement that clamping the umbilical cord closes the Foramen Ovale is true.

41. Serum Digoxin levels are 0.8-2.9 ug/L

True

False

Nursing responsibility includes but not limited to knowing serum digoxin levels.

Explanation

Nursing responsibility includes but not limited to knowing serum digoxin levels.

42. A child underwent cardiac surgery and the nurse must prepare his parents for discharge. Which discharge instruction is correct?

"Call your doctor before your child has dental care."

"Keep your child away from other children for 6 months."

"if your child vomits his digoxin, he may need a second dose".

"Encourage the child to participate in activities so he can develop normally."

Upon discharge, parents should be taught to call the physician before the child has dental care. The child may be at risk for bacterial endocarditis after surgery, and dental procedures are a common portal of entry for bacteria. The physician may order antibiotics before a dental procedure.

Explanation

Upon discharge, parents should be taught to call the physician before the child has dental care. The child may be at risk for bacterial endocarditis after surgery, and dental procedures are a common portal of entry for bacteria. The physician may order antibiotics before a dental procedure.

43. Which of the following are correct statements regarding Digoxin (Lanoxin)? Check all that apply.

Digoxin is the drug of choice to improve myocardial contractility

Often prescribed to increase contractility and decrease afterload

ALWAYS check dose with another Registered Nurse before administration

Administration is normally IV for infants

Administration:Direct to the side of the mouth and rinse with water.

Explanation

Administration:Direct to the side of the mouth and rinse with water.

Submit

44. ECHO can be used to detect the pressure in the chambers of the heart and it's surrounding vessels.

True

False

Cardiac Catheterization is used for pressure readings inside the heart.

Explanation

Cardiac Catheterization is used for pressure readings inside the heart.

45. A 16 year old is admitted to the emergency department with complaints of sudden, severe chest pain. He says that he didn't experience any recent trauma to the chest. What should the nurse next ask about?

Exercise and weight lifting

Cocaine use

Smoking

Family history of myocardial infarction (MI)

The nurse should next ask about cocaine use. Cocaine use can cause tachycardia, hypertension, coronary artery spasm with infarction, and pneumothorax resulting in severe, acute chest pain. Exercise, smoking, and family hx of MI can be addressed after the danger of cocaine-related complications has been eliminated.

Explanation

The nurse should next ask about cocaine use. Cocaine use can cause tachycardia, hypertension, coronary artery spasm with infarction, and pneumothorax resulting in severe, acute chest pain. Exercise, smoking, and family hx of MI can be addressed after the danger of cocaine-related complications has been eliminated.