Health And care- Pediatric Cardiac Disease Test

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

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

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

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 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

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.

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 immediately call the physician immediately

• Use a calm, comforting approach

• Lay the child in the supine position

• Take the child to the nearest emergency dept.

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.

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."

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

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.

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

What congenital heart defect causes cyanosis in children?

• Atrial septal defect

• Coarctation of the aorta

• Ventricular septal defect

• Trasposition of the great vessels

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

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.

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.

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

• Extreme lethargy

• Increased appetite

• Respiratory congestion

• Fever for at least 5 days

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 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 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.

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

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

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

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

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.

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

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

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

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

• True

• False

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

• True

• False

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

• True

• False

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

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

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

• True

• False

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

• True

• False

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

• True

• False

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

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

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

• True

• False

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

• True

• False

Serum Digoxin levels are 0.8-2.9 ug/L

• True

• False

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

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

• True

• False

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

• True

• False