Ch42-Cardiovascular-Dysfunction PDF

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Chapter 42: Cardiovascular Dysfunction 1. The nurse is assessing a child post–cardiac catheterization might the nurse anticipate? a. Cardiac arrhythmia

c.Congestive heart failure

b. Hypostatic pneumonia d.Rapidly increasing blood pressure ANS: A Because a catheter is introduced into the heart, a risk exists o occurring during the procedure. These are usually transient. H congestive heart failure, and rapidly increasing blood pressure associated with cardiac catheterization. 2. José is a 4-year-old child scheduled for a cardiac catheteriz teaching should be: a. Directed at his parents because he is too young to understa b. Detailed in regard to the actual procedures so he will know c. Done several days before the procedure so that he will be p d. Adapted to his level of development so that he can underst ANS: D Preoperative teaching should always be directed at the child’s caregivers also benefit from the same explanations. The paren which should be answered, but the child needs to receive the developmental level. This age group does not understand in-d Preschoolers should be prepared close to the time of the cardi 3. The nurse is caring for a school-age girl who has had a car

The child tells the nurse that her bandage is “too wet.” The nu soaked with blood. The most appropriate initial nursing action a.

Notify the physician.

b.

Apply a new bandage with more press

c.

Place the child in the Trendelenburg po

d. Apply direct pressure above the cathe ANS: D If bleeding occurs, direct continuous pressure is applied 2.5 cm skin site to localize pressure over the vessel puncture. Notifyin new bandage with more pressure can be done after pressure someone else notify the physician while the pressure is being position would not be helpful; it would increase the drainage f 4. Which defect results in increased pulmonary blood flow? a.

Pulmonic stenosis c.

Atrial septal defect

b. Tricuspid atresia d. Transposition of the great ANS: C Atrial septal defect results in increased pulmonary blood flow. (higher pressure) into the right atrium (lower pressure) and th artery. Pulmonic stenosis is an obstruction to blood flowing fro results in decreased pulmonary blood flow. Transposition of th blood flow. 5. Which structural defects constitute tetralogy of Fallot? a.

Pulmonic stenosis, ventricular septal d

b.

Aortic stenosis, ventricular septal defe

c.

Aortic stenosis, atrial septal defect, ov

d. Pulmonic stenosis, ventricular septal d ANS: A Tetralogy of Fallot has these four characteristics: pulmonary st overriding aorta, and right ventricular hypertrophy. There is pu in tetralogy of Fallot. Right ventricular hypertrophy, not left ve tetralogy of Fallot. There is a ventricular septal defect, not an aorta, not aortic hypertrophy, is present. 6. What is best described as the inability of the heart to pum to the systemic circulation at normal filling pressures? a.

Pulmonary congestion c. Congestive heart failure

b. Congenital heart d. defect Systemic venous congesti ANS: C The definition of congestive heart failure is the inability of the blood to the systemic circulation at normal filling pressures to body. Pulmonary congestion is an excessive accumulation of f defect is a malformation of the heart present at birth. Systemi accumulation of fluid in the systemic vasculature. 7. A clinical manifestation of the systemic venous congestion heart failure is: a.

Tachypnea. c.

Peripheral edema.

b. Tachycardia.d. Pale, cool extremities. ANS: C Peripheral edema, especially periorbital edema, is a clinical m congestion. Tachypnea is a manifestation of pulmonary conge

extremities are clinical manifestations of impaired myocardial 8. A beneficial effect of administering digoxin (Lanoxin) is tha a.

Decreases edema. c.

Increases heart size.

b. Decreases cardiac d. output. Increases venous pressure ANS: A Digoxin has a rapid onset and is useful in increasing cardiac o nous pressure, and as a result decreasing edema. Heart siz digoxin. 9. Which drug is an angiotensin-converting enzyme (ACE) inh a.

Captopril (Capoten) c.

Spironolactone (Aldactone

b. Furosemide d. (Lasix) Chlorothiazide (Diuril) ANS: A Capoten is an ACE inhibitor. Lasix is a loop diuretic. Aldactone dosterone. Diuril works on the distal tubules. 10. The nurse is evaluating a child who is taking digoxin for he nurse is cognizant that a common sign of digoxin toxicity i a.

Seizures.

c.

Bradypnea.

b. Vomiting. d. Tachycardia. ANS: B Vomiting is a common sign of digoxin toxicity. Seizures are not toxicity. The child will have a slower heart rate, not respira

11. The parents of a young child with congestive heart failure are “nervous” about giving digoxin. The nurse’s response s knowing that: a.

It is a safe, frequently used drug.

b.

It is difficult to either overmedicate or with digoxin.

c.

Parents lack the expertise necessary t digoxin.

d.

Parents must learn specific, important ministration of digoxin.

ANS: D Digoxin has a narrow therapeutic range. The margin of safety toxic, and lethal doses is very small. Specific guidelines are learn how to administer the drug safely and monitor for sid frequently used drug, but it has a narrow therapeutic rang the liquid are given to infants, which makes it easy to over cate. Parents may lack the necessary expertise to administ with discharge preparation they should be prepared to adm 12. As part of the treatment for congestive heart failure, the ch furosemide. As part of teaching home care, the nurse enco give the child foods such as bananas, oranges, and leafy v are recommended because they are high in: a.

Chlorides.

c.

Sodium.

b. Potassium. d. Vitamins. ANS: B Diuretics that work on the proximal and distal renal tubules co losses of potassium. The child’s diet should be supplement

13. An 8-month-old infant has a hypercyanotic spell while bloo nurse’s first action should be to: a.

Assess for neurologic defects.

b.

Place the child in the knee-chest posit

c.

Begin cardiopulmonary resuscitation.

d. Prepare the family for imminent death ANS: B The first action is to place the infant in the knee-chest position be indicated. Neurologic defects are unlikely. The child sho way, breathing, and circulation. Often calming the child an and morphine can alleviate the hypercyanotic spell; cardio is not necessary, and death is unlikely. 14. The nurse is caring for a child with persistent hypoxia seco fect. The nurse recognizes that a risk of cerebrovascular ac An important objective to decrease this risk is to: a.

Minimize seizures. c.

Promote cardiac output.

b. Prevent dehydration. d. Reduce energy expenditur ANS: B In children with persistent hypoxia, polycythemia develops. De vented in hypoxemic children because it potentiates the ri seizures, promoting cardiac output, and reducing energy e duce the risk of cerebrovascular accidents. 15. Parents of a 3-year-old child with congenital heart disease

child play with other children because of possible overexer should be based on knowing that: a.

The child needs opportunities to play w

b.

The child needs to understand that pe too strenuous.

c.

Parents can meet all the child’s needs

d.

Constant parental supervision is neede ertion.

ANS: A The child needs opportunities for social development. Children ities if allowed to set their own pace and regulate their act limit activities as necessary. Parents must be encouraged t cial activities for the child, especially before kindergarten. activities that foster independence. 16. When preparing a school-age child and the family for hear should consider: a.

Not showing unfamiliar equipment.

b.

Letting child hear the sounds of an ele monitor.

c.

Avoiding mentioning postoperative dis ventions.

d.

Explaining that an endotracheal tube w if the surgery goes well.

ANS: B The child and family should be exposed to the sights and soun unit. All positive, nonfrightening aspects of the environmen

child should be shown unfamiliar equipment, and its use s on a doll. Carefully prepare the child for the postoperative travenous lines, incision, and endotracheal tube. 17. Seventy-two hours after cardiac surgery, a young child has C (101 F). The nurse should: a.

Keep the child warm with blankets.

b.

Apply a hypothermia blanket.

c.

Record the temperature on nurses’ no

d. Report findings to physician. ANS: D In the first 24 to 48 hours after surgery, the body temperature (100 F) as part of the inflammatory response to tissue trau is higher or an elevated temperature continues after this p sign of an infection and immediate investigation is indicate removed from the child to keep the temperature from incre blanket is not indicated for this level of temperature. The t recorded, but the physician must be notified for evaluation 18. An important nursing consideration when suctionin surgery is to: a.

Perform suctioning at least every h

b.

Suction for no longer than 30 seco

c.

Administer supplemental oxygen b

d. ANS:

Expect symptoms of respiratory dis C

If suctioning is indicated, supplemental oxygen is administ before and after the procedure to prevent hypoxia. Suction not on a routine basis. The child should be suctioned for no Symptoms of respiratory distress are to be avoided by usin 19. The nurse is caring for a child after heart surgery. W is found of cardiac tamponade? a.

Increase analgesia.

b.

Apply warming blankets.

c.

Immediately report this to the phys

d. Encourage the child to cough, turn ANS: C If evidence is noted of cardiac tamponade (blood or fluid in heart), the physician is notified immediately of this life-thre analgesia may be done before the physician drains the flui Warming blankets are not indicated at this time. Encourag deeply should be deferred until after the evaluation by the 20. An important nursing consideration when chest tub from a child is to: a.

Explain that it is not painful.

b.

Explain that only a Band-Aid will be

c.

Administer analgesics before the p

d.

Expect bright red drainage for seve moval.

ANS:

C

It is appropriate to prepare the child for the removal of che gesics. Short-acting medications can be used that are adm isting intravenous line. It is not a pain-free procedure. A sh felt, and this should not be misrepresented to the child. A tight dressing is needed. Little or no drainage should be fo 21. The most common causative agent of bacterial end a.

Staphylococcus c. albus. Staphylococcus albican

b. Streptococcus d. hemolyticus. Streptococcus viridans ANS: D Staphylococcus viridans is the most common causative ag tive) endocarditis. Staphylococcus albus, Streptococcus he lococcus albicans are not common causative agents. 22. Which painful, tender, pea-sized nodules may appe fingers or toes in bacterial endocarditis? a.

Osler's nodes c.

Subcutaneous nodules

b. Janeway lesions d. Aschoff's nodules ANS: A Osler's nodes are red, painful, intradermal nodes found on in bacterial endocarditis. Janeway lesions are painless hem palms and soles in bacterial endocarditis. Subcutaneous no swellings located over bony prominences, commonly found Aschoff's nodules are small nodules composed of cells and interstitial tissues of the heart in rheumatic myocarditis.

23. The primary nursing intervention necessary to pre carditis is to: a.

Institute measures to prevent dent

b.

Counsel parents of high risk childre lactic antibiotics.

c.

Observe children for complications and heart failure.

d. Encourage restricted mobility in su ANS: B The objective of nursing care is to counsel the parents of h both the need for prophylactic antibiotics for dental proced of maintaining excellent oral health. The child’s dentist sho child’s cardiac condition. Dental procedures should be don level of oral health. Prophylactic antibiotics are necessary. tions and encouraging restricted mobility in susceptible ch but maintaining good oral health and using prophylactic an portant. 24. A common, serious complication of rheumatic feve a.

Seizures.

c.

Pulmonary hypertensio

b. Cardiac arrhythmias. d. Cardiac valve damage. ANS: D Cardiac valve damage is the most significant complication Seizures, cardiac arrhythmias, and pulmonary hypertensio plications of rheumatic fever. 25. A major clinical manifestation of rheumatic fever is

a.

Polyarthritis.

b.

Osler's nodes.

c.

Janeway spots.

d. Splinter hemorrhages of distal third ANS: A Polyarthritis is swollen, hot, red, and painful joints. The affe every 1 to 2 days. Primarily the large joints are affected. O spots, and splinter hemorrhages are characteristic of infec 26. When discussing hyperlipidemia with a group of ad should explain that high levels of what substance are thou cardiovascular disease? a. Cholesterol c. Low-density lipoprotein b. Triglyceridesd. High-density lipoprotei ANS: D HDLs contain very low concentrations of triglycerides, rela and high levels of proteins. It is thought that HDLs protect disease. Cholesterol, triglycerides, and LDLs do not protect disease. 27. The leading cause of death after heart transplanta a.

Infection.

c.

Cardiomyopathy.

b. Rejection. d. Congestive heart failur ANS: B The posttransplantation course is complex. The leading ca diac transplantation is rejection. Infection is a continued ris

munosuppression necessary to prevent rejection. Cardiom dications for cardiac transplant. Congestive heart failure is death. 28. When caring for the child with Kawasaki disease, t stand that: a.

The child’s fever is usually respons within 48 hours.

b.

The principal area of involvement i

c.

Aspirin is contraindicated.

d.

Therapeutic management includes gamma globulin and aspirin.

ANS: D High-dose intravenous gamma globulin and aspirin therap duce the incidence of coronary artery abnormalities when days of the illness. The fever of Kawasaki disease is unresp and antipyretics. Involvement of mucous membranes and the extremities, and cardiac involvement are seen. 29. One of the most frequent causes of hypovolemic s a.

Myocardial infarction. c.

Anaphylaxis.

b. Blood loss. d. Congenital heart disea ANS: B Blood loss and extracellular fluid loss are two of the most f volemic shock in children. Myocardial infarction is rare in a resulting shock would be cardiogenic, not hypovolemic. An tributive shock from extreme allergy or hypersensitivity to

Congenital heart disease tends to contribute to hypervolem 30. What type of shock is characterized by a hypersen massive vasodilation and capillary leaks, which may occur lergy? a.

Neurogenic shock c.

Hypovolemic shock

b. Cardiogenic d. shock Anaphylactic shock ANS: D Anaphylactic shock results from extreme allergy or hypers substance. Neurogenic shock results from loss of neuronal terruption of neuronal transmission that occurs from a spin genic shock is decreased cardiac output. Hypovolemic sho size of the vascular compartment, decreasing blood pressu nous pressure. 31. Which clinical changes occur as a result of septic s a.

Hypothermiac.

Vasoconstriction

b. Increased cardiac d. outputAngioneurotic edema ANS: B Increased cardiac output, which results in warm, flushed sk festations of septic shock. Fever and chills are characterist sodilation is more common in septic shock. Angioneurotic e ifestation in anaphylactic shock. 32. A child is brought to the emergency department ex lactic reaction to a bee sting. While an airway is being esta

tion should the nurse prepare for immediate administration a.

Diphenhydramine c. (Benadryl) Epinephrine

b. Dopamine d. Calcium chloride ANS: C After the first priority of establishing an airway, epinephrin Benadryl is not a strong enough antihistamine for this seve Dopamine and calcium chloride are not appropriate drugs 33. Which postoperative intervention should be questi cardiac catheterization? a.

Continue intravenous (IV) fluids un erating oral fluids.

b. c.

Check the dressing for bleeding. Assess peripheral circulation on th ity.

d. Keep the affected leg flexed and el ANS: D The child should be positioned with the affected leg straigh the procedure. IV fluid administration continues until the c ing adequate amounts of oral fluids. The insertion site dres served frequently for bleeding. The nurse should also look check for pooled blood. Peripheral perfusion is monitored a Distal pulses should be palpable, although they may be we tralateral extremity. 34. In which situation is there the greatest risk that a n a congenital heart defect (CHD)?

a.

Trisomy 21 detected on amniocent

b.

Family history of myocardial infarct

c.

Father has type 1 diabetes mellitus

d. Older sibling born with Turner's syn ANS: A The incidence of congenital heart disease is approximately trisomy 21 (Down syndrome). A family history of congenita quired heart disease, increases the risk of giving birth to a born to mothers who are insulin dependent have an increa identified as having certain genetic defects, such as Turner higher incidence of CHD. 35. Which intervention should be included in the plan the nursing diagnosis of Excess Fluid Volume related to con a.

Weigh the infant every day on the same time.

b.

Notify the physician when weight g than 20 g/day.

c.

Put the infant in a car seat to minim

d.

Administer digoxin (Lanoxin) as ord cian.

ANS: A Excess fluid volume may not be overtly visible. Weight cha retention. Weighing the infant on the same scale at the sam sures consistency. An excessive weight gain for an infant is than 50 g/day. With fluid volume excess, skin will be edem tion should be changed frequently to prevent undesirable

tain areas. Lanoxin is used in the treatment of congestive cardiac function. Diuretics will help the body get rid of exce 36. The nurse assessing a premature newborn infant a machinery-like murmur. This finding is associated with whi fect? a.

Pulmonary stenosis c.

Ventricular septal defe

b. Patent ductus d. arteriosusCoarctation of the aort ANS: B The classic murmur associated with patent ductus arterios one that can be heard throughout both systole and diastol murmur that may be accompanied by a palpable thrill is a monary stenosis. The characteristic murmur associated wi fect is a loud, harsh, holosystolic murmur. A systolic murm by an ejection click may be heard on auscultation when co present. 37. What is an expected assessment finding in a child aorta? a.