Pediatric Cardiovascular Disorders Exam | Answered with Rationales

Pediatric Cardiovascular Disorders Exam | Answered with Rationales The nurse is providing information to the parents of a toddler who is scheduled for surgery for the replacement of the pulmonic valve. The parents hav ...

Pediatric Cardiovascular Disorders Exam | Answered with Rationales The nurse is providing information to the parents of a toddler who is scheduled for surgery for the replacement of the pulmonic valve. The parents have many questions about the function of the valve. Which information from the nurse is correct? 1. The valve must work correctly to get oxygen from the lungs to the body. 2. If the valve does not work correctly, blood is kept from entering the heart. 3. When the valve is defective, the blood leaving the heart is decreased. 4. A defect in the valve causes less blood to get to the lungs for oxygenation. When there is a defect in the right pulmonic valve, the blood has difficulty leaving the right ventricle and getting to the lungs for reoxygenation. This explanation by the nurse correctly describes the function of the valve and the purpose of the surgery. 1 This is incorrect. The aortic valve must work correctly for oxygenated blood to be carried from the left side of the heart to the rest of the body. 2 This is incorrect. Blood must enter the right side of the heart from the body in order to be reoxygenated. The unoxygenated blood enters the right atrium through the tricuspid valve into the right ventricle. 3 This is incorrect. A defect in the aortic valve would cause problems with oxygenated blood leaving the left ventricle. The nurse is teaching a pediatric electrocardiogram (EKG) class to nurses in a pediatric cardiac unit. Which anatomical structure does the nurse use to describe the initiation of cardiac electrical conduction? 1. The Purkinje fibers in the ventricles 2. The bundle branch in the left atrium 3. The sinoatrial node in the right atrium 4. The bundle of His in the ventricle walls From the SA, the electrical impulse is conducted to the fibers called the bundle of His located in the walls of the ventricles. The process of electrical conduction does not start here. 1 This is incorrect. The Purkinje fibers are located in the ventricles; however, the process of electrical conduction does not start here. The fibers initiate contractions of the ventricles. 2 This is incorrect. The bundle branches are divided into either left or right bundles; however, the process of electrical conduction does not start here. 3 This is correct. When teaching the electrical conduction of the heart, the nurse starts with the sinoatrial (SA) node in the right ventricle, which is known as the pacemaker of the heart. 0:13 The nurse is aware the neonate's blood circulation is different before birth than after birth. Which circulation pattern does the nurse recognize as occurring prior to birth? 1. Oxygenated blood flows from the right atrium to the left atrium through the foramen ovale. 2. Oxygenated blood flows from the right ventricle to the lungs and then to the left ventricle. 3. For a short time after birth, the neonate continues to depend on the mother for oxygen supply. 4. Once the neonate takes a first breath, the ductus venosus closes and blood goes to the lungs. Feedback 1 This is correct. Prior to birth, oxygenated blood crosses from the right atrium to the left atrium via the patent foramen ovale (PFO) and is pumped by the left ventricle. 2 This is incorrect. Prior to birth, oxygenated blood does not flow from the right ventricle to the lungs and then to the left ventricle. 3 This is incorrect. Before birth, 90% of blood bypasses the lungs; the placenta is the organ of respiration. After the cord is cut and the placenta is delivered, the infant is expected to independently breathe. 4 This is incorrect. Upon birth and first breath, the foramen ovale and ductus arteriosus close. The nurse is providing care for a neonate diagnosed with a cardiovascular disorder immediately after birth. When gathering assessment information from the mother, which comment will the nurse recognize as the most likely contributing factor for the defect? 1. "We live in the country, and we get all our water from a well." 2. "I quit my preschool job when a child was diagnosed with measles." 3. "The baby was born a week early; I hope that is not the cause." 4. "We were in a European country before pregnancy was confirmed." The nurse is most likely to contribute exposure to a child with measles as a causative factor for the neonate's heart defect. The nurse will assess further for timelines and manifestations. 1 This is incorrect. Using a well as a water source does not necessarily place a neonate at risk for developing a heart defect. 3 This is incorrect. The mother's concern about the neonate being born a week early is not recognized as a contributing factor to the neonate's heart defect. 4 This is incorrect. Traveling to a foreign country during the first trimester may or may not effect fetal development. The nurse needs additional information before making a connection between the travel and heart defect. The nurse is assisting with high school sports physicals. The nurse performs a physical assessment on a male student who is tall and thin, with disproportionately long arms. Which additional finding will prompt the nurse to recommend a cardiac evaluation? 1. Notable laxity of joints 2. Sparsity of body hair 3. Deep tone to the voice 4. Slow, rhythmic gait Tall and thin with arms disproportionately long and with laxity of joints are physical manifestations of Marfan syndrome. The nurse may also notice dislocation of lenses, spinal problems, stretch marks, hernia, pectus abnormalities, and/or restrictive lung disease. Marfan syndrome is also associated with aortic aneurism as well as aortic and/or mitral regurgitation. 2 This is incorrect. A sparsity of body hair is not an indication of cardiac issues; male high school students may not exhibit heavy body hair. 3 This is incorrect. A male high school student is expected to have a deep tone to his voice. 4 This is incorrect. A slow, rhythmic gait may be unique to this student; however, it does not support the presence of Marfan syndrome. The nurse is providing care for a 12-year-old patient who is hospitalized with generalized weakness and muscle wasting, which began in the hips, pelvic area, thighs, and shoulders. The physician suspects Duchenne muscular dystrophy. Which action by the physician does the nurse expect? 1. Prescribe physical therapy to improve muscle strength. 2. Suggest homeschooling until the acute stage ends. 3. Perform an echocardiogram to evaluate cardiac functioning. 4. Perform muscle biopsies to identify the stage of the disease. The physician is likely to order cardiac testing, especially to rule out cardiomyopathy, a condition frequently associated with Duchenne muscular dystrophy. 1 This is incorrect. Duchenne muscular dystrophy is a progressive genetic disease. Physical therapy is not prescribed to improve muscle strength; it is used to maintain body function for as long as possible. 2 This is incorrect. Duchenne muscular dystrophy is a progressive genetic disease. The physician may recommend homeschooling when the patient is no longer able to attend classes. There is no acute stage to this disease that will improve. 4 This is incorrect. The physician is more likely to prescribe neuromuscular tests to determine the extent of the disease. The nurse is performing a physical assessment on a 7-year-old child as a requirement for playing a sport at school. The nurse reports which assessment finding as abnormal and requests a follow-up from a primary care physician? 1. Systolic blood pressure is 84 mm Hg. 2. Systolic blood pressure is 90 mm Hg and diastolic is 20 mm Hg. 3. Pulse oximeter reading is 95% on room air. 4. PMI is at 4th or 5th intercostal space at the midclavicular line. Wide pulse pressures—diastolic pressures are low, with a wide gap between diastolic and systolic pressures—are indicative of such processes as patent ductus arteriosus. 1 This is incorrect. Average systolic blood pressures are considered 70+ (2´ age in years). This would be 84. 3 This is incorrect. Pulse oximeter readings of 95% of room air are considered normal. 4 This is incorrect. The point of maximum impulse (PMI) is heard at the fourth or fifth intercostal space at the midclavicular line (MCL). The nurse is preparing an 8-year-old patient for a cardiac catheterization. Which intervention will the nurse initiate immediately postprocedure? 1. Observe for signs and symptoms of infection. 2. Hold food and fluids until gag reflex returns. 3. Keep the involved extremity straight for 4 to 6 hours. 4. Notify physician if green or yellow drainage is noted. 1 This is incorrect. It is not likely for the patient to develop an infection immediately following a cardiac catheterization. 2 This is incorrect. The patient will receive a sedative before the procedure to reduce anxiety; a local anesthetic is used at the puncture site. Neither intervention is likely to cause an absent or depressed gag reflex. 3 This is correct. Immediately after the procedure the nurse will assure that the limb used for cardiac catheterization is kept straight with no movement for 4 to 6 hours. The child should be positioned flat on the back; a sandbag may be used on the extremity. All precautions are to prevent bleeding from the puncture site. 4 This is incorrect. Immediately after a cardiac catheterization, the nurse will not expect to see yellow or green drainage, which is indicative of an infection. The nurse will include this intervention in parent teaching. A 3-month-old infant is diagnosed with pulmonary stenosis. Which parent teaching does the nurse provide? 1. Options for treatment include a repair of the artery or the valve. 2. Balloon angioplasty is performed as an outpatient procedure. 3. Pulmonary stenosis repair can be delayed until 1 year of age. 4. After repair, the child is no longer at risk for cardiac problems. 1 This is correct. Options are to repair the pulmonary artery and/or pulmonic valve as soon as possible to avoid worsening side effects of the condition. 2 This is incorrect. Side effects of pulmonary stenosis include increased workload of the right ventricle, CHF, hepatomegaly, development of murmurs, shortness of breath, and cyanosis. Delaying corrective surgery will worsen effects of the condition. 3 This is incorrect. The infant with pulmonary stenosis will be hospitalized for assessment and treatment. 4 This is incorrect. The child must return to the cardiologist frequently for follow-up, and caregivers should be provided information on the recurrence of symptoms that may occur due to restenosis. The parents are preparing to take their newborn, who was diagnosed with tetralogy of Fallot with pulmonary atresia, home. The nurse is developing a teaching sheet regarding care of the newborn for the parents. Which information does the nurse need to include in the teaching plan? 1. There is no need to limit activities. 2. It is important to maintain caloric intake. 3. No secondary complications are expected. 4. The neonate has natural immunity to infections. 1 This is incorrect. The parents will be taught to calm the infant by holding the infant over the caregiver's shoulders with the infant's knees drawn up toward the chest. This will increase the blood flow to the lungs. The parents will limit cardiac stress by keeping the infant calm. 2 This is correct. Due to a clinical finding of failure to gain weight, the parents are instructed on the importance of maintaining caloric intake. Frequent small feedings are necessary to meet this need and not increase cardiac stress. 3 This is incorrect. Parents need to monitor for signs and symptoms of heart failure. 4 This is incorrect. Educate parents on the increased risk of bacterial endocarditis and the prescribed medication regimen. The nurse is reviewing medications for the treatment of a heart rhythm disorder in a patient who is 8 years of age. The parent of the patient states that the physician recently prescribed medication to treat the patient's attention deficit-hyperactivity disorder. Using knowledge of recent professional recommendations, which statement by the nurse is correct? 1. "We need to remind the physician there is a heart condition." 2. "Do not start the medication until I can check for safety warnings." 3. "Children with heart disorders have a higher incidence of ADHD." 4. "Giving the medication can cause death if there is a cardiac issue." 1 This is incorrect. A black box warning about giving medications for ADHD to children with heart problems was issued in 2006. The AAP and the AHA state that medications used to treat ADHD have not been shown in most cases to cause heart disease or result in sudden cardiac death (CDC, 2016; Magellan Health, 2016a). There is no reason to contact the prescribing physician. 2 This is incorrect. If the nurse is knowledgeable about current medication recommendations, the nurse does not tell the parent to hold the medication until the safety can be checked by the nurse. 3 This is correct. Joint statements by the AAP and the AHA show that children with heart conditions have a higher incidence of ADHD, but that medications used to treat ADHD have not been shown in most cases to cause heart disease or result in sudden cardiac death. 4 This is incorrect. It is inaccurate and inappropriate for the nurse to tell the parent that the prescribed medication can cause death in children with cardiac issues. The nurse is providing care for a neonate diagnosed with tetralogy of Fallot. Prostaglandin E1 therapy is prescribed to keep the foramen ovale and the ductus arteriosus open. Which is the most important intervention for the nurse to include in the neonate's plan of care? 1. Maintain a separate IV access for continuous administration of the medication. 2. Watch for respiratory distress or apnea after adding medication to the breathing tube. 3. Monitor for and document evidence of flushing, bradycardia, and irritability as expected. 4. Monitor weight and adjust the dosage using a scale of 0.05 to 0.1 mcg/kg/min IV infusion. 1 This is correct. During the administration of prostaglandin E1, the nurse starts and maintains a separate IV access for continuous administration of the medication. 2 This is incorrect. During the administration of prostaglandin E1, the nurse monitors for respiratory distress or apnea. However, the medication is not administered via the neonate's breathing tube. 3 This is incorrect. During the administration of prostaglandin E1, the nurse will watch the neonate for flushing, bradycardia, irritability, and diarrhea, and monitor for bleeding. The nurse always documents assessment findings; however, the manifestations need to be reported to the primary health-care provider. 4 This is incorrect. The dosage for prostaglandin is usually 0.05 to 0.1 mcg/kg/min IV infusion, as ordered by the primary health-care provider. The nurse does not adjust the dose using any parameter. The nurse in a pediatric office is aware that certain factors may be indicators of heart disease in children. Which children does the nurse recognize with manifestations related to heart disease? Select all that apply. 1. The newborn with dysmorphic facial features 2. The school-age patient with slow capillary refill 3. Identification of scoliosis in a new adolescent patient 4. An infant who is unable to meet developmental milestones 5. A toddler with clubbing and erythema of the fingers and toes 1. This is correct. Dysmorphic facial features can be identified at any age and can be indicative of heart disease. 2. This is incorrect. Slow capillary refill can be from multiple causes, such as poor circulation, low oxygenation, anemia, exposure to cold, and/or stress. The finding alone does not cause the nurse to recognize a manifestation of heart disease. 3. This is correct. When assessing a new patient, the nurse recognizes that scoliosis is common in adolescents with congenital heart disease. The nurse will perform additional assessment. 4. This is correct. When an infant is unable to meet developmental milestones, the nurse recognizes that children with congenital heart defects are more likely to have developmental disabilities. 5. This is correct. Clubbing and erythema in fingers and toes may result from longstanding cyanosis due to increased formation and enlargement of the capillaries in the periphery to improve circulation. This is a manifestation of heart disease in a toddler. A new mother brings her 2-week-old neonate to the pediatrician's office, stating, "I think something is wrong with my baby." When the infant is undressed, the nurse notices signs of possible cardiac problems. Which assessment findings support the nurse's suspicions? Select all that apply. 1. Prolonged capillary refill time 2. Bluish tinge to oral structures 3. Peripheral cyanosis of left leg 4. Amount of urinary output 5. Mottled appearance of skin 1. This is correct. Prolonged capillary refill time is a sign of poor perfusion; it can be indicative of possible cardiac or lung issues. The assessment is made by pressing on the sternum or forehead. 2. This is correct. Central cyanosis is the presence of bluish discoloration of mucous membranes, tongue, circumoral, or core body and is due to problems with the heart or lungs. 3. This is incorrect. Peripheral cyanosis (acrocyanosis) is often due to interruption in blood flow to the extremity. 4. This is incorrect. Urine output is indicative of perfusion to the kidneys; however, the nurse is unable to determine the amount of urinary output through observation. 5. This is correct. Skin that is pale, mottled, or gray in appearance indicates poor perfusion. A neonate became dusky and developed respiratory distress at the age of 4 days and is diagnosed with a hypoplastic left heart. The surgeon obtains an informed consent from the parents to perform emergency surgery. Which information will the nurse provide to promote parental understanding? Select all that apply. 1. The left side of the neonate's heart did not develop correctly. 2. The function of left side of the heart is to pump blood to the body. 3. Provide reassurance to the parents that surgery will fix the problem. 4. Share that medical management of the condition is needed for one year. 5. A normally existing hole in the wall of the heart at birth will be enlarged. 1. This is correct. The hypoplastic left heart is the second most common congenital heart defect, caused by underdevelopment of the left side of the heart, aorta, aortic valve, left ventricle, and mitral valve. 2. This is correct. The nurse is correct in providing information about the normal functioning of the left side of the heart to clarify the existing condition. 3. This is incorrect. The nurse needs to provide the parents with information about the severity of the condition. The nurse anticipates possible transport out of the facility for heart transplant. 4. This is incorrect. The neonate will require clinical and medication management for life. 5. This is correct. Symptoms appear when the PDA closes; the condition is usually fatal within the first days or months of life unless treated. It is appropriate for the nurse to describe the surgery in terms the parents can understand. The nurse is providing care for a 9-year-old patient who was recently diagnosed with cardiomyopathy after a viral infection. Which teaching does the nurse provide to the patient's parents about the diagnosed condition? Select all that apply. 1. Need for intensive care of the patient 2. Preparation for anticipatory grieving 3. The necessity for physical activity 4. Allowing patient to discuss feelings 5. Reasons for frequent medical visits 1. This is correct. The nurse will provide teaching about the intensive care necessary for a child with this life-threatening condition. 2. This is correct. The patient with cardiomyopathy has a possible terminal status. The nurse will prepare the parents for expected anticipatory grieving, which is expected with this life-threatening condition. 3. This is incorrect. The nurse will provide teaching about the activity restrictions to prevent overstimulation of the heart. 4. This is correct. The nurse will instruct the parents to allow the child to discuss feelings concerning the restriction of activity in the previously active child. 5. This is correct. The parents need to understand that frequent echocardiograms will be required to monitor the size and function of the heart. The nurse on a pediatric unit is providing care for a 5-year-old child diagnosed with congestive heart failure. The physician prescribes digoxin therapy. Which medication-focused interventions does the nurse include when creating a plan of care for the patient? Select all that apply. 1. Hold medication if an antibiotic is prescribed. 2. Evaluate parent's ability to obtain radial pulse. 3. Administer medication at the same time every day. 4. Administer 1 hour before or 2 hours after meals. 5. Replace medication if a dose is vomited within 1 hour. 1. This is incorrect. The child on digoxin therapy needs to be closely monitored for digoxin toxicity with antibiotic therapy, which is caused by changes in intestinal flora. The nurse will not include any interventions for holding digoxin on the plan of care. 2. This is incorrect. Educating parents on how to assess an infant's apical pulse rate and to notify the health-care practitioner if the heart rate is out of the range set by the health-care provider is included in the plan of care. However, the nurse will not include teaching parents how to take radial pulses. 3. This is correct. The nurse will include interventions on the plan of care regarding medication administration. The medication is administered at the same time every day and at the correct frequency. 4. This is correct. In order to promote absorption of digoxin, the nurse will administer the medication 1 hour before or 2 hours after meals. This intervention can be included on the plan of care. 5. This is incorrect. The nurse will not include an intervention on the plan of care addressing when to replace vomited or missed doses; the medication is not to be replaced. There is no way to determine how medication was already absorbed. The pediatric nurse is providing care for a school-age patient diagnosed with rheumatic heart disease. When developing a plan of care for the patient's hospital stay, which interventions does the nurse include? Select all that apply. 1. Administer inflammatory and antibiotic medications as prescribed. 2. Assess for the presence of strep throat or other throat infections. 3. Include chest pain and heart palpation assessment with vital signs. 4. Begin patient/family teaching about the possibility of surgery. 5. Organize daily care and treatments to provide for joint pain relief. 1. This is correct. The nurse will address interventions for the administration of inflammatory and antibiotic medications as prescribed. 2.This is incorrect. The nurse does not need to add assessment interventions for strep throat or other throat infections in a patient diagnosed with rheumatic heart disease. 3. This is correct. The nurse will include the intervention of including assessment for chest pain or heart palpitations with vital signs, because rheumatic heart disease causes heart valve damage. 4. This is incorrect. The scenario does not specify the reason for the patient's hospitalization. Patient/family teaching is not initiated until surgery is planned. 5. This is correct. Rheumatic heart disease can cause polyarthritis; it is necessary for the nurse to include interventions that will promote rest and relieve joint pain. The nurse works in a pediatric clinic with patients who have heart disease or who have undergone treatment for heart disease. The nurse is frequently asked about the need for prophylactic antibiotics for these patients during invasive dental care. Which patients does the nurse identify as being at risk for endocarditis and being in need of antibiotic therapy? Select all that apply. 1. A child with a prosthetic heart valve 2. A child with a congenital defect scheduled for surgical repair 3. A child who was previously diagnosed with endocarditis 4. A child with a confirmed diagnosis of rheumatic heart disease 5. A child who had a congenital heart defect repaired 9 months ago 1. This is correct. The American Heart Association recommends prophylactic antibiotics for the child with a valve replacement. 2. This is correct. The American Heart Association recommends prophylactic antibiotics for the child with a congenital defect who is scheduled for surgical repair. 3. This is correct. The American Heart Association recommends prophylactic antibiotics for the child who was previously diagnosed with endocarditis. 4. This is correct. The American Heart Association recommends prophylactic antibiotics for the child who is diagnosed with rheumatic heart disease, which affects the heart valves. 5. This is incorrect. Prophylactic antibiotics are recommended for the child with a congenital heart defect that has been corrected for the first 6 months after the repair. The child who is 9 months past the repair does not need prophylactic antibiotics. A parent brings a 2-year-old child with a fever and a rash to the pediatric clinic. The health-care provider suggests the child may have one of several conditions that present with similar symptoms, but wants to rule out Kawasaki disease. Which tests does the nurse expect to be performed? Select all that apply. 1. Chest x-ray 2. White blood cell count 3. Allergy testing 4. Baseline echocardiograms 5. MRI of the chest 1. This is incorrect. A chest x-ray will not reveal Kawasaki's, as it is a blood infection. 2 This is correct. The WBC will reveal lymphocytosis and thrombosis, which are present with Kawasaki disease. 3. This is incorrect. Kawasaki is not an allergy reaction, and allergy testing is inappropriate. 4. This is correct. A life-threatening complication of Kawasaki disease is the development of coronary artery aneurysms. Baseline echocardiogram 6 to 8 weeks after the onset of symptoms is used to rule out this complication. 5. This is incorrect. Magnetic resonance imaging will not reveal Kawasaki disease. The right ventricle is responsible for: 1. Pumping blood to the left atrium. 2. Pumping deoxygenated blood to the lungs. 3. Pumping oxygenated blood to the body. 4. Returning oxygenated blood from the lungs. Feedback 1. The ventricle pumps blood to the lungs via the pulmonary artery.