KEYWORDS
Bacterial endocarditis Cardiac demand
Defects with decreased pulmonary flow
Defects with increased pulmonary flow Obstructive defects
ABBREVIATIONS
Angiotensin receptor blockers (ARB) Aortic stenosis (AS)
Atrial septal defect (ASD) Atrioventricular canal (AVC) Bacterial endocarditis (BE) Blood pressure (BP) Cardiac output (CO)
Cardiovascular accident (CVA) Coarctation of the aorta (COA) Congenital heart defect (CHD) Congestive heart failure (CHF)
Heart rate (HR) Kawasaki disease (KD) Left sternal border (LSB) Patent ductus arteriosus (PDA) Pulmonic stenosis (PS) Rheumatic fever (RF)
Supraventricular tachycardia (SVT) Systemic vascular resistance (SVR) Tetralogy of Fallot (TOF)
Ventricular septal defect (VBD)
QUESTIONS
1. A child with a history of cardiac surgery requires an annual electrocardiogram. What can the electrocardiogram detect? Select all that apply.
1. Ischemia.
2. Injury.
3. CO.
4. Dysrhythmias.
5. SVR.
6. Occlusion pressure.
7. Conduction delay.
2. A newborn is diagnosed with a CHD. The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as _____________________.
3. The parent of an infant newly diagnosed with TOF is asking the nurse which defects are involved. Select all that apply.
1. VSD.
2. Right ventricular hypertrophy.
3. Left ventricular hypertrophy.
4. PS.
5. Pulmonic atresia.
6. Overriding aorta.
7. PDA.
4. A 10-year-old child is recovering from a severe sore throat. The caregiver now states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause of this syndrome is _________________________.
5. An infant with CHF is receiving digoxin to enhance myocardial function. What should the nurse assess prior to administering the medication?
1. Yellow sclera.
2. Apical pulse rate.
3. Cough.
4. Liver function test.
6. Which statement by the mother of an infant boy with CHF who is being sent home on digoxin indicates she needs further education on the care of her child?
1. “I will give him the medication at regular 12-hour intervals.”
2. “If he vomits, I will not give him a make-up dose.”
3. “If I miss a dose, I will not give an extra dose, but keep him on his same schedule.”
4. “I will mix the digoxin in some of his formula to make it taste better for him.”
7. A 1-year-old child is being prepared for a cardiac catheterization procedure. Which of the following findings about the child might delay the procedure?
1. 30th percentile for weight.
2. Severe diaper rash.
3. Allergy to soy.
4. Oxygen saturation of 91% on room air.
8. The nurse is caring for a child who has undergone cardiac catheterization. During the recovery phase, the nurse notices the dressing is saturated with bright red blood and a 6-inch circle of blood on the crib sheet. The nurse’s first action is to:
1. Call the interventional cardiologist.
2. Notify the cardiac catheterization laboratory that the child will be returning.
3. Apply a bulky pressure dressing over the present dressing.
4. Apply direct pressure 1 inch above the puncture site.
9. The nurse is caring for an infant with CHF. The following are interventions to de-crease cardiac demands on the infant. Select all that apply.
1. Allow parents to hold and rock their child.
2. Feed only when the infant is crying.
3. Keep the child uncovered to promote low body temperature.
4. Make frequent position changes.
5. Feed the child when sucking the fists.
6. Change bed linens only when necessary.
7. Organize nursing activities.
10. Indomethacin may be given to close what CHD in newborns? _________________
11. For the child with hypoplastic left heart syndrome, what drug may be given to allow the PDA to remain open until surgery? _________________
12. The nurse is examining a 5-year-old boy who has diarrhea and fever. The caregiver states that the boy is normally active and healthy. On examination, the nurse hears a murmur at the LSB. The caregiver asks why the pediatrician has never said anything about it. The nurse explains:
1. “The pediatrician is not a cardiologist.”
2. “Murmurs are difficult to detect, especially in children.”
3. “The fever increased the intensity of the murmur.”
4. “We need to refer the child to an interventional cardiologist.”
13. While assessing a newborn with respiratory distress, the nurse auscultates a machine-like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2. The nurse suspects that the newborn has:
1. Pulmonary hypertension.
2. A PDA.
3. A VSD.
4. Bronchopulmonary dysplasia.
14. A child has been diagnosed with KD. The parents are asking questions about the child’s outcome. The nurse explains the most serious complications. Select all that apply.
1. Coronary thrombosis.
2. Coronary stenosis.
3. Coronary artery aneurysm.
4. Hypocoagulability.
5. Decreased sedimentation rate.
6. Hypoplastic left heart syndrome.
15. The nurse is caring for a 3-year-old boy whose caregiver noticed that his eyes are red-dened with no discharge, and his palms and soles of the feet are red, swollen, and peel-ing. Upon examination, the nurse’s assessment includes dry, cracked lips and a “straw-berry tongue.” The nurse most likely suspects ______________________________.
16. The nurse is caring for a school-aged boy with KD. A student nurse who is on the unit asks if there are medications to treat this disease. The nurse’s response to the student nurse is:
1. Immunoglobulin G and aspirin.
2. Immunoglobulin G and ACE inhibitors.
3. Immunoglobulin E and heparin.
4. Immunoglobulin E and ibuprofen.
17. CHDs are classified by which of the following? Select all that apply.
1. Cyanotic defect.
2. Acyanotic defect.
3. Defects with increased pulmonary blood flow.
4. Defects with decreased pulmonary blood flow.
5. Mixed defects.
6. Obstructive defects.
7. Pansystolic murmurs.
18. A 2-month-old with TOF is seen in your clinic for a check-up. During the examina-tion, the child develops severe respiratory distress and becomes cyanotic. The nurse’s first action should be to:
1. Lay the child flat to promote hemostasis.
2. Lay the child flat with legs elevated to increase blood flow to the heart.
3. Sit the child on the parent’s lap, with legs dangling, to promote venous pooling.
4. Hold the child in knee-chest position to decrease venous blood return.
19. Hypoxic spells in the infant with CHD can cause which of the following? Select all that apply.
1. Polycythemia.
2. Blood clots.
3. CVA.
4. Developmental delays.
5. Viral pericarditis.
6. Brain damage.
7. Alkalosis.
20. The 6-month-old who has a “tet spell” could have the CHD defect of decreased pulmonary blood flow called ___________________________.
21. The nurse is caring for a toddler who has been hospitalized for 2 days with vomiting due to gastroenteritis. During morning assessment, she is sleeping and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute, res-piratory rate of 30 per minute, BP of 84/52, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child?
1. Rapid pulmonary flutter.
2. Sinus bradycardia.
3. Rapid atrial fibrillation.
4. Supraventricular tachycardia.
22. BP screenings to detect end-organ damage should be done routinely beginning at what age?
1. Birth.
2. 3 years.
3. 8 years.
4. 13 years.
23. A 4-year-old is diagnosed with Wilm tumor. What associated manifestation does the nurse expect?
1. Atrial fibrillation.
2. Hypertension.
3. Endocarditis.
4. Hyperlipidemia.
24. A 15-year-old female who is sexually active is diagnosed with secondary hypertension.
She admits to intermittent use of birth control. Which of the following drugs should not be used to control her BP?
1. Beta blockers.
2. Calcium channel blockers.
3. ACE inhibitors.
4. Diuretics.
25. A 16-year-old male is diagnosed with hypertension. His laboratory values are hemo-globin B 16 g/dL, hematocrit level 43%, sodium 139 mEq/L, potassium 4.4 mEq/L, and total cholesterol of 220 mg/dL. Which of the following drugs would increase his total cholesterol?
1. Beta blockers.
2. Calcium channel blockers.
3. ACE inhibitors.
4. Diuretics.
26. The ______________ serves as the septal opening between the atria of the fetal heart.
27. While looking through the chart of an infant with a CHD of decreased pulmonary blood flow, the nurse would expect what laboratory finding?
1. Decreased platelet count.
2. Polycythemia.
3. Decreased ferritin level.
4. Shift to the left.
28. The nurse is caring for a 9-month-old who was born with a CHD. Assessment reveals an HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of ___________________.
29. The following are examples of acquired heart disease. Select all that apply.
1. Infective endocarditis
2. Hypoplastic left heart syndrome.
3. RF.
4. Cardiomyopathy.
5. KD.
6. Transposition of the great vessels.
30. The nurse is caring for a preschool female diagnosed with CHF. She is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse suspects which laboratory finding?
1. Hypokalemia.
2. Hypomagnesemia.
3. Hypocalcemia.
4. Hypophosphatemia.
31. A 2-month-old is being treated with furosemide for CHF. Which of the following plans would also be appropriate in helping to control the CHF?
1. Promoting fluid restriction.
2. Feeding a low-salt formula.
3. Feeding in semi-Fowler position.
4. Encouraging breast milk.
32. In which of the following CHDs would the nurse need to take upper and lower extremity BPs?
1. Transposition of the great vessels.
2. AS.
3. COA.
4. TOF.
33. A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess:
1. Pain.
2. Pulses.
3. Hemoglobin and hematocrit levels.
4. Catheterization report.
34. Which statement by the mother of a male toddler with RF shows she has good understanding of the care of her child?
1. “I will apply heat to his swollen joints to promote circulation.”
2. “I will have him do gentle stretching exercises to prevent contractures.”
3. “I will give him the aspirin that is ordered for pain and inflammation.”
4. “I will apply cold packs to his swollen joints to reduce pain.”
35. The school-aged female for whom you are caring has been diagnosed with valvular disease following RF. During patient teaching, you discuss the child’s long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth.
The parents indicate they understand when they say:
1. “She will need to take the antibiotics until she is 18 years old.”
2. “She will need to take the antibiotics for 5 years after the last attack.”
3. “She will need to take the antibiotics for 10 years after the last attack.”
4. “She will need to take the antibiotics for the rest of her life.”
36. A child born with Down syndrome should be evaluated for what associated cardiac manifestation?
1. CHD.
2. Systemic hypertension.
3. Hyperlipidemia.
4. Cardiomyopathy.
37. A child with a CHD undergoes the Norwood procedure. This procedure is used to correct:
1. Transposition of the great vessels.
2. Hypoplastic left heart syndrome.
3. TOF.
4. PDA.
38. The nurse is caring for a 4-year-old female with a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about accidental ingestion of what drug?
1. Calcium channel blocker.
2. Beta blocker.
3. ACE inhibiter.
4. ARB.
39. A 6-year-old is receiving aspirin therapy for KD. Exposure to what illnesses should be a cause to discontinue therapy and substitute dipyridamole (Persantine)?
1. Chickenpox or flu.
2. E. coli or staphylococcus.
3. Mumps or streptococcus A.
4. Streptococcus A or staphylococcus.
40. The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech distur-bances. They state it seems worse when she is anxious and does not occur when she is sleeping. The nurse questions the parents about what recent illness?
1. KD.
2. RF.
3. Malignant hypertension.
4. Atrial fibrillation.
41. The nurse in the pediatric telemetry unit has been reviewing heart rhythms in chil-dren. The most common dysrhythmia in pediatrics is:
1. Ventricular tachycardia.
2. Sinus bradycardia.
3. Supraventricular tachycardia.
4. First-degree heart block.
42. A nursing action that promotes ideal nutrition in an infant with CHF is:
1. Feeding formula that is supplemented with additional calories.
2. Allowing the infant to nurse at each breast for 20 minutes.
3. Providing large feedings every 5 hours.
4. Using firm nipples with small openings to slow feedings.
43. An 18-month-old with a myelomeningocele is going to undergo a cardiac catheteri-zation. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies listed on the medical record. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff?
1. Soy.
2. Latex.
3. Penicillin.
4. Dairy.
44. The nurse is caring for a 1-year-old who has been diagnosed with CHF. Treatment began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear and equal bilaterally, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child’s urine output is:
1. 0.5 cc/kg/hr 2. 1 cc/kg/hr 3. 30 cc/hr 4. 1 oz/hr
45. A 3-month-old has been diagnosed with a VSD. The flow of blood through the heart with this type of defect is:
1. Right to left.
2. Equal between the two chambers.
3. Left to right.
4. Bypassing the defect.
46. The nurse is caring for a 3-month-old with a VSD. The physicians have decided not to repair it surgically. The parents express concern that this is not best for their child and ask why their daughter will not have an operation. The nurse’s best response to the parents is:
1. “It is always helpful to get a second opinion about any serious condition like this.”
2. “Your daughter’s defect is small and will likely close on its own by the time she is 2 years old.”
3. “It is common for the physicians to wait until an infant develops respiratory distress before they do the surgery because of the danger.”
4. “With a small defect like this, we will wait until the child is 10 years old to do the surgery.”
47. A 5-month-old has been diagnosed with an ASD. The flow of blood through the heart with this type of defect is:
1. Right to left.
2. Equal between the two chambers.
3. Left to right.
4. Bypassing the defect.
48. An infant has been diagnosed with an ASD, or AVC defect. The flow of blood through the heart with this type of defect is:
1. Right to left.
2. Equal between the two chambers.
3. Bypassing the defect.
4. In either direction.
49. Parents report that their 6-year-old has been seen by the school nurse for dizziness that occurred when standing in line for recess and homeroom since the start of the school term. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks the child if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has:
1. VSD.
2. AS.
3. Mitral valve prolapse.
4. Tricuspid atresia.
50. The school nurse has been following an 8-year-old female who comes to the office frequently. She has come mainly for vague complaints of dizziness and headache.
Today, she is brought after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. Calling for the ambulance, the nurse suspect she has:
1. Transposition of the great vessels.
2. COA.
3. AS.
4. PS.
51. Which medication should the nurse give to a patient who is diagnosed with transpo-sition of the great vessels?
1. Ibuprofen.
2. Betamethasone.
3. Prostaglandin E.
4. Indocin.
52. Which statement by the mother of a patient with RF shows she has an understanding of prevention in her other children?
1. “Whenever one of them gets a sore throat, I will give that child an antibiotic.”
2. “There is no treatment. It must run its course.”
3. “If their culture is positive for group A streptococcus, I will give them their antibiotic.”
4. “If their culture is positive for staphylococcus A, I will give them their antibiotic.”
53. Which patient could require feeding by gavage?
1. A patient with KD in the acute phase.
2. A toddler with repair of transposition of the great vessels.
3. An infant with CHF.
4. A school-ager with RF and chorea.
54. What two physiological changes occur as a result of hypoxemia in CHF?
1. Polycythemia and clubbing.
2. Anemia and barrel chest.
3. Increased white blood cells and low platelets.
4. Elevated erythrocyte sedimentation rate and peripheral edema.
55. Aspirin has been ordered for the child with RF in order to:
1. Keep the PDA open.
2. Reduce joint inflammation.
3. Decrease swelling of strawberry tongue.
4. Treat ventricular hypertrophy of endocarditis.
56. Gamma globulin is being given to a 1-year-old being treated for KD. Which of the following vaccines must be delayed for 11 months after the administration of gamma globulin?
1. Diphtheria, tetanus, and pertussis.
2. Hepatitis B.
3. Inactivated polio virus.
4. Measles, mumps, and rubella.
57. The mother of a toddler reports that the baby’s father has just had a myocardial infarction. Because of this information, the nurse recommends the child have a(n):
1. Electrocardiogram.
2. Lipid profile.
3. Echocardiogram.
4. Cardiac catheterization.
58. During play, a toddler with a history of TOF might assume which of the following positions?
1. Sitting.
2. Supine.
3. Squatting.
4. Left lateral recumbent.
59. Heart transplant may be indicated for a child with which of the following symptoms?
1. Severe heart failure and PDA.
2. Severe heart failure and VSD.
3. Severe heart failure and hypoplastic left heart syndrome.
4. Severe heart failure and PS.
60. Family discharge teaching has been effective when the parents of a female toddler diagnosed with KD states:
1. “The arthritis in her knees is permanent. She will need knee replacements.”
2. “I will give her a pain reliever for her peeling palms and soles of her feet.”
3. “I know she will be irritable for 2 months after her symptoms started.”
4. “I will continue with high doses of Tylenol for her inflammation.”
61. Which of the following assessments indicate that the parents of a 7-year-old are following the prescribed treatment for CHF?
1. HR of 56 beats per minute.
2. Elevated red blood cell count.
3. 50th percentile height and weight for age.
4. Urine output of 0.5 cc/kg/hr.
ANSWERS AND RATIONALES
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4. To make the diagnosis of RF, major and minor criteria are used. Major criteria in-clude carditis, subcutaneous nodules, ery-thema marginatum, chorea, and arthritis.
Minor criteria include fever and previous history of RF.
TEST-TAKING HINT:It is an inflammatory disease caused by group A beta-hemolytic streptococcus.
5. 1. Yellow sclera has nothing to do with CHF.
It is seen in patients with liver disease.
2. The apical pulse rate is ordered because digoxin decreases the HR, and if the HR is <60 digoxin should not be administered.
3. Cough would not be assessed before admin-istration. It is more commonly seen in patients who have been prescribed ACE inhibitors.
4. Liver function tests are not assessed before digoxin is administered. Digoxin can lower HR and cause dysrhythmias.
TEST-TAKING HINT:The test taker should know that yellow sclera and liver function tests have nothing to do with digoxin.
Cough could be associated with ACE inhibitors.
6. 1. This is appropriate for digoxin administration.
2. This is appropriate for digoxin administration.
3. This is appropriate for digoxin administration.
4. If the medication is mixed in his formula, and he refuses to drink the entire amount, the digoxin dose will be inadequate.
TEST-TAKING HINT:What if the child does not drink all the formula?
7. 1. This may be a reason the child needs the catheterization.
2. A child with severe diaper rash has potential for infection if the interventionist makes the standard groin approach.
3. Shellfish, not soy, is an allergy concern.
4. This may be a reason the child needs the
4. This may be a reason the child needs the