Applying ice to the face Administration of adenosine (Adenocor) Having the child perform a Valsalva maneuver The treatment of SVT depends on the degree of compromise imposed by the dysrhythmia. In some instances, vagal maneuvers, such as applying ice to the face, massaging the carotid artery (on one side of the neck only), or having an older child perform a Valsalva maneuver (e.g., exhaling against a closed glottis, blowing on the thumb as if it were a trumpet for 30 to 60 seconds), can reverse the SVT. When vagal maneuvers fail, adenosine may be used to end the episode of SVT by impairing AV node conduction. IV adenosine is the first-line pharmacologic measure for termination of SVT in infants and children in the emergency setting. Administration of atropine or bed rest will not resolve SVT. Institute prophylactic antibiotic therapy. The parents must take adequate measures to prevent infection. The child must be administered prophylactic antibiotic therapy 1 hour before certain procedures, such as dental work. Treatment of IE requires long-term parenteral drug therapy. Intravenous antibiotics may be administered at home with nursing supervision. Any unexplained fever, weight loss, lethargy, malaise, or anorexia must be reported to the health care provider. Such symptoms should not be self-diagnosed as a cold or flu, nor should they be treated with over-the-counter drugs. Early diagnosis and treatment are important in preventing further cardiac damage, embolic complications, and growth of resistant organisms. Blood cultures must be taken periodically to evaluate the response to antibiotic therapy. In which procedure for cardiac diagnosis are radiopaque catheters placed in a peripheral blood vessel and advanced into the heart to measure pressures and oxygen levels in heart chambers? 4 In cardiac catheterization, radiopaque catheters are placed in a peripheral blood vessel and advanced into the heart as a means of measuring pressures and oxygen levels in heart chambers. The electrocardiogram (ECG) is a graphic measure of the electrical activity of the heart. Cardiac magnetic resonance imaging (MRI) is a noninvasive imaging technique used to evaluate the vascular anatomy outside the heart. The exercise stress test is used to assess heart function at rest and during progressively more demanding exercise on a treadmill or bicycle. The nurse should explain to the parents that
their child is receiving furosemide for severe congestive heart failure because of which effect? 1 Furosemide is a diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated with congestive heart failure. Furosemide is not a β-blocker. Furosemide is not a form of digitalis. Furosemide is not an angiotensin-converting enzyme (ACE) inhibitor. What is a priority patient outcome for a child with congestive heart failure? 3 A lack of distended neck veins is an appropriate patient outcome for a child with congestive heart failure. The child should have a heart rate that is acceptable for the child's age rather than rapid. The skin should be warm to the touch rather than cool. The child should sleep with the head elevated rather than with the head down and the feet elevated. What position does the nurse caring for a young child with tetralogy of Fallot see the child assuming in an attempt to compensate for the congenital heart
defect? 3 The squatting or knee-chest position decreases the amount of blood returning to the heart and allows the child time to compensate. The prone and supine positions do not offer any advantages to the child with cardiac compromise. The low Fowler position would assist with respiratory issues but not with cardiac compensation. A child
presents to the emergency department with an urticarial rash and laryngeal edema. What do these clinical symptoms suggest? 2 An urticarial rash and laryngeal edema suggest anaphylaxis. Shock is circulatory failure that results in hypotension, tissue hypoxia, and metabolic acidosis. Septic shock results in vasodilation and increased capillary permeability. Toxic shock syndrome resembles septic shock and can cause acute multisystem organ failure. In what procedure are high-frequency sound waves directed through a transducer to produce an image of cardiac structures? 2 Echocardiography involves the use of high-frequency sound waves. The child undergoing this procedure must lie completely still. With improvements in technology a diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is an electrical tracing of the depolarization of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart, a contrast medium is injected, and the heart and its vessels are visualized. Electrophysiology is an invasive procedure in which catheters with electrodes record the impulses of the heart directly from the conduction system. Which heart defect causes narrowing of the aortic valve? 1 Aortic stenosis causes narrowing of the aortic valve, which in turn results in resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Atrial septal defect is an abnormal opening between the atria that allows blood from the higher-pressure left atrium to flow into the lower-pressure right atrium. Coarctation of the aorta is an obstructive defect in which there is narrowing near the insertion of the ductus arteriosus. Patent ductus arteriosus is the failure of the fetal ductus arteriosus to close during the first few weeks of life. Which term
describes the thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia? 1 Clubbing is a thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia and polycythemia. Polycythemia is an increased number of red blood cells. Hypercyanotic, or "blue," spells are often seen in infants with tetralogy of Fallot; the affected infant becomes acutely cyanotic and hyperpneic. Raynaud phenomenon is an autoimmune disease. What is an important nursing responsibility when a dysrhythmia is suspected? 4 Counting the apical pulse is the nurse's first action. If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate. Ordering an electrocardiogram may be indicated after the nurse has conferred with the practitioner. The radial pulse rate needs to be compared with the apical pulse rate but does not need to be counted for 1 minute five times. Only one nurse is needed to carry out the action of taking the radial pulse simultaneously with the apical pulse. What is an early sign of congestive heart failure that the nurse should recognize? 1 Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child with congestive heart failure may be diaphoretic and exhibit decreased urine output. What nursing intervention is the most important in preventing complications of digoxin administration? 3 The child's apical pulse should be assessed for 60 seconds before the medication is administered; the medication should be held if the apical pulse is below 90 to 110 beats/min in infants and young children or below 70 beats/min in older children. Assessing the blood pressure or the carotid pulse before giving digoxin is not necessary. What care should the nurse take when obtaining a blood pressure measurement for a child with systemic hypertension? 1 The nurse must quiet the child to obtain an accurate blood pressure reading and to avoid false readings caused by excitement. Initial evaluation of the child should include pressure at the four extremities, with the child in the supine position, to rule out coarctation of the aorta. Falsely elevated blood pressure readings can be avoided by using properly fitted cuffs. Blood pressure should be measured with the arm at the level of the heart for accuracy. What is considered a mixed cardiac defect? 4 Transposition of the great arteries permits mixing of oxygenated and unoxygenated blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow. What clinical manifestation should the nurse expect to find during the assessment of an infant with coarctation of the aorta? 4 An infant with coarctation of the aorta, an obstructive defect of the heart, has cooler lower extremities due to localized narrowing near the insertion of the ductus arteriosus. This leads to decreased pressure in the lower extremities and weak or absent femoral pulses. The narrowing also causes increased pressure in the head and upper extremities and bounding pulses in the arms. Which congenital heart defect is
described as the incomplete fusion of the endocardial cushions? 4 Atrioventricular canal defect is the incomplete fusion of the endocardial cushions. Atrial septal defect is abnormal opening between the atria. Ventricular septal defect is an abnormal opening between right and left ventricles. Patent ductus arteriosus is the failure of the fetal ductus arteriosus to close within the first weeks of life. Which medications are diuretics that are used in the management of heart failure? Select all that apply. 2, 3, 5 Diuretics used in the management of heart failure include furosemide (Lasix), chlorothiazide (Diuril), and spironolactone (Aldactone). Digoxin (Lanoxin) is not a diuretic. Potassium supplements are not diuretics; instead, they replace potassium lost as a result of taking potassium-depleting diuretics. Congenital heart defects have traditionally been divided into acyanotic and cyanotic defects. The nurse knows which information about this system in clinical practice? 4 This classification is problematic. Children with traditionally named acyanotic defects may become cyanotic, and children with traditionally classified cyanotic defects may be pink at times. The classification does not reflect the blood flow within the heart. Cardiac defects are best described by their actual pathophysiologic processes and mechanisms. Children with cyanosis may be easily identified, but that does not aid diagnosis. Cyanosis is present when children have defects in which there is mixing of oxygenated and unoxygenated blood. What does the nurse recognize as an early clinical sign of compensated shock in a
child? 4 Apprehension is a clinical manifestation of compensated shock in children. Confusion is a sign of decompensated shock in children. Sleepiness is not an indication of shock. Hypotension is a sign of irreversible shock in children. A child with a severe peanut allergy accidentally ate a candy bar that contained peanuts.
The child is now experiencing progressively worsening respiratory distress. What is the priority nursing intervention for this child? 1 Successful outcome of anaphylactic reactions depends on rapid recognition and institution of treatment. Establishing an airway is always the first concern for a moderate to severe reaction. Asking the child about past reactions and leaving the child to locate a physician are not priority nursing interventions for this child. For a mild reaction diphenhydramine (Benadryl) may be administered. What should nurses stress when counseling parents regarding the home care of the child with a cardiac defect before corrective surgery? 4 The child needs social interactions, discipline, and appropriate limit-setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child requires increased caloric intake after cardiac surgery. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to identify and manage them appropriately; this will ease their anxiety and concern. The patient has had a persistent fever for the last 5 days, inflammation of lips and conjunctiva, and reddening of the tongue. The patient also has cervical lymphadenopathy and erythema in the palms and soles. What diagnosis does the nurse expect
to find in the medical record? 3 The patient's symptoms suggest Kawasaki disease. A patient with Kawasaki disease may have cardiomyopathy; however, a persistent fever for 5 days, inflammation of the lips and conjunctiva, and a strawberry tongue are not symptoms of cardiomyopathy. Rheumatic fever is not associated with lymphadenopathy and erythema in the palms and soles. Bacterial endocarditis is associated with weight loss, anorexia, and splinter hemorrhages, none of which are symptoms in this patient. The nurse is assessing a patient with polycythemia and notices finger clubbing and cyanosis. Which medication would be beneficial to the patient in this situation? 2 The patient has polycythemia, clubbed fingers, and cyanosis, indicating that the patient has hypoxemia. The patient with hypoxemia will have spasms in the infundibulum, which are reduced by morphine. Digoxin is an inotropic antidysrhythmic which is useful for the treatment of cardiac dysrhythmias. Midazolam is a central nervous system depressant which helps relieve anxiety. Furosemide is a diuretic that does not reduce hypoxic symptoms in the patient. The
nurse is caring for a child with Kawasaki disease (KD). To which intervention performed at the time of diagnosis does the nurse refer for evaluating long-term complications? 1 Echocardiograms are used to monitor myocardial and coronary artery status. A baseline echocardiogram should be obtained at the time of diagnosis for comparison with future studies. Long-term complications of KD include the development of coronary artery aneurysms and disrupting blood flow. In the convalescent phase, intake, output, and daily weight all return to normal. The convalescent phase is complete when all blood values such as complete blood count and erythrocyte sedimentation rate are normal. This is 6 to 8 weeks after the onset of the disease. The nurse is assessing a child with septic shock.
Which assessment finding does the nurse recognize as the first stage of septic shock? 1 In early septic shock, the child has chills, fever, and vasodilation with increased cardiac output. This results in warm, flushed skin that reflects vascular tone abnormalities. The blood pressure, pulses, and urinary output are normal. As the condition progresses, in the third and hypodynamic stage, the child has low blood pressure with weak pulses and anuria. Surgical repair for patent ductus arteriosus (PDA) is performed to prevent the complication of what? 4 A patent ductus arteriosus (PDA) allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary vascular congestion may occur. Increased pulmonary vascular congestion is the primary complication; pulmonary infection may occur, but it is not the priority complication. A PDA involves left-to-right shunting of blood. The decreased workload on the left side of the heart is not a priority complication of a PDA. The nurse, preparing to give digoxin to a 9-month-old infant, checks the dosage and sees that 4 mL of the drug is to be drawn up. What is the most appropriate action by the nurse, drawing on knowledge of this medication and safe pediatric dosages? 2 Digoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. As a potentially dangerous drug, digoxin has precise administration guidelines. Some institutions require that digoxin dosages be checked with another professional before administration. The nurse has drawn up too much medication and should not give it to the child. Administering the dose through a nipple is the correct procedure, but too much medication has been prepared, so it should not be given to the child. Administering the dose by placing it at the back and side of the mouth is the correct procedure, but too much medication has been prepared, so it should not be given to the child. What preprocedural interventions should the nurse implement for a child who is prescribed a
cardiac catheterization? Select all that apply. 2, 3, 4 The nurse must assess the child for signs and symptoms of infection. The procedure may be cancelled in case of severe diaper rash if femoral access is required. A history of allergies is important to obtain, because some of the contrast agents are iodine-based. The nurse must obtain an accurate height of the child to ensure correct catheter selection. Assessment of pedal pulses is important after catheterization. The nurse should therefore assess the presence and quality of pedal pulses before the procedure. The nurse must ensure that the child is NPO for 4 to 6 hours or more before the procedure. The
nurse is caring for a child with an atrial septal defect. What clinical manifestation should the nurse expect to find in this child? 1 A child with atrial septal defect has systolic murmur with a fixed split second heart sound. A loud holosystolic murmur is heard best at the left sternal border and is found in a child with ventricular septal defect. A child with an atrioventricular canal defect has a loud systolic murmur. There may be mild cyanosis that increases with crying. A child with patent ductus arteriosus has a characteristic machinery-like murmur. A widened pulse pressure and bounding pulses, which result from runoff of blood from the aorta to the pulmonary artery, are also found. What nursing interventions should the nurse perform when caring for an infant with hypoxemia? Select all that apply. 1, 2, 5 Morphine is administered subcutaneously or through an existing intravenous line to help reduce infundibular spasm. When an infant is hypoxic, the child can suddenly develop hypercyanotic spells, so prompt recognition and treatment are essential. The nurse uses a calm and comforting approach when caring for the infant. The infant is placed in a knee-chest position. Any compromise in pulmonary function will increase the infant's hypoxemia. Good hand washing and protection from individuals with a respiratory tract infection are important. An infant with hypoxemia may have polycythemia, a condition in which there is an increased number of red blood cells. However, anemia may result if iron is not available for hemoglobin. Therefore, the infant must receive iron supplements, not potassium supplements. The infant must be monitored for signs of anemia, not hypertension. The nurse is caring for a child with heart failure. What teaching should the nurse give to the parents of the child about
reducing the workload on the child's heart? 2 The nurse should teach the parents to minimize the metabolic needs of the child and lessen the workload on the heart. An irritable or crying child has a greater demand for oxygen, which increases cardiac demands. Parents should therefore use medication to sedate the child. Parents should not play with the child too often, as this increases cardiac demands. The child should be allowed to rest as much as possible, without any external or environmental stimuli. The child should be placed in a semi-Fowler position to reduce the effort of breathing. The child should have a neutral thermal environment to prevent cold stress. The nurse is
preparing to administer a potassium supplement as prescribed to a patient with congestive heart failure. Which medication in the patient's medication profile would make the nurse hold the dose and contact the primary health care provider for further guidance? 4 Spironolactone blocks the action of aldosterone and helps in treatment of heart failure. It is a potassium-sparing diuretic, so the patient should be instructed to avoid potassium supplements to prevent hyperkalemia, an increase in serum potassium. Digoxin is an inotropic antidysrhythmic, which affects the contractility of the cardiac muscle. Furosemide and chlorothiazide are long-acting diuretics that cause hypokalemia or low serum potassium. On those medications, the patient will have hypokalemia and should be instructed to take potassium supplements. What
clinical manifestation should the nurse expect to find in a child with infective endocarditis? 2 Splinter hemorrhages, or thick black lines, under the nails are a manifestation of infective endocarditis caused by extracardiac emboli formation. Swollen, red, hot, and painful joints are observed in a child with polyarthritis. Sudden aimless movement of the extremities and involuntary facial grimaces and tics are clinical manifestations of chorea during the initial attack of rheumatic fever. These may occur in children who have not been diagnosed with rheumatic fever. A nurse is caring for a child who has just undergone cardiac catheterization. What interventions should the nurse implement with this
child? Select all that apply. 1, 3, 4, 5 Post-cardiac catheterization nursing care includes removing the pressure dressing the day after catheterization and covering the site with adhesive bandage. It is also important to keep the site clean and dry. Administering acetaminophen or ibuprofen for pain is important. Assessing the pulses, temperature, and color of extremities are some of the most important nursing responsibilities in decreasing the risk of complications. Strenuous exercise the day after the procedure is not recommended. What clinical
manifestations result from pulmonary congestion in children with congestive heart failure? 4 Tachypnea, exercise intolerance, and cyanosis, along with orthopnea, wheezing, and cough, are clinical manifestations of pulmonary congestion in children with congestive heart failure. Fatigue and restlessness are the result of impaired myocardial function, and weight gain is caused by systemic venous congestion. |
Surgical repair for patent ductus arteriosus is performed to prevent which complication Quizlet
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