Chapter 23: The Child With Cardiovascular Dysfunction
Evolve Resources for Wong’s Essentials of Pediatric Nursing, 11th Edition
MULTIPLE CHOICE
1. The nurse is caring for a school-age child who has had a cardiac catheterization, and upon
assessment of the leg finds the bandage and bed soaked with blood. Which is the priority
nursing action?
a. Notify physician
b. Apply new bandage with more pressure
c. Place the child in Trendelenburg position
d. Apply direct pressure above catheterization site
ANS: D
If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the
percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and
applying a new bandage can be done after pressure is applied. The nurse can have someone
else notify the physician while the pressure is being maintained. It is not a helpful intervention
to place the girl in the Trendelenburg position. It would increase the drainage from the lower
extremities.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
2. Which is the expected outcome from surgical closure of the ductus arteriosus?
a. Stops the loss of unoxygenated blood to the systemic circulation
b. Decreases the edema in legs and feet
c. Increases the oxygenation of blood
d. Prevents the return of oxygenated blood to the lungs
ANS: D
The ductus arteriosus allows blood to flow from the higher-pressure aorta to the
lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no
additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary
artery. The aorta carries oxygenated blood to the systemic circulation. Because of the higher
pressure in the aorta, blood is shunted into the pulmonary artery and the pulmonary
circulation. Edema in the legs and feet is usually a sign of heart failure. This repair would not
directly affect the edema. Increasing the oxygenation of blood would not interfere with the
return of oxygenated blood to the lungs.
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TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
3. Which defect results in increased pulmonary blood flow?
a. Pulmonic stenosis
b. Tricuspid atresia
c. Atrial septal defect
d. Transposition of the great arteries
ANS: C
Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left
atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the
pulmonary artery. Pulmonic stenosis is an obstruction to blood flowing from the ventricles.
Tricuspid atresia results in decreased pulmonary blood flow. Transposition of the great
arteries results in mixed blood flow.
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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
4. The nurse is conducting a staff in-service on congenital heart defects. Which structural defect
constitutes tetralogy of Fallot?
a. Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
c. Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy
d. Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular
hypertrophy
ANS: A
Tetralogy of Fallot has these four characteristics: pulmonic stenosis, ventricular septal defect,
overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not atrial
stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy,
is present in tetralogy of Fallot. Tetralogy of Fallot has right ventricular hypertrophy, not left
ventricular hypertrophy, and an atrial septal defect, not aortic hypertrophy.
DIF: Cognitive Level: Understand
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
5. The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure
(HF). Which is a beneficial effect of administering digoxin (Lanoxin)?
a. It decreases edema.
b. It decreases cardiac output.
c. It increases heart size.
d. It increases venous pressure.
ANS: A
Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous
pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size
and venous pressure are decreased by digoxin.
DIF: Cognitive Level: Understand
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
6. A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which
drug would the nurse administer?
a. Captopril (Capoten)
b. Furosemide (Lasix)
c. Spironolactone (Aldactone)
d. Chlorothiazide (Diuril)
ANS: A
Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Spironolactone blocks the action
of aldosterone. Chlorothiazide works on the distal tubules.
DIF: Cognitive Level: Remember
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
7. A 6-month-old infant is receiving digoxin (Lanoxin). The nurse would notify the practitioner
and withhold the medication if the apical pulse is less than _______ beats/min.
a. 60
b. 70
c. 90 to 110
d. 110 to 120
ANS: C
If a 1-minute apical pulse is less than 70 beats/min for an older child, the digoxin is withheld;
60 beats/min is the cut-off for holding the digoxin dose in an adult. A pulse below 90 to 110
beats/min is the determination for not giving a digoxin dose to infants and young children.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
8. The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common
sign of digoxin toxicity?
a. Seizures
b. Vomiting
c. Bradypnea
d. Tachycardia
ANS: B
Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin
toxicity. The child will have a slower heart rate, not respiratory rate. The heart rate will be
slower, not faster.
DIF: Cognitive Level: Understand
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
9. The nurse encourages the family to give a child who is prescribed furosemide (Lasix) foods
such as bananas, oranges, and leafy vegetables because they are high in which nutrient?
a. Chlorides
b. Potassium
c. Sodium
d. Vitamins
ANS: B
Diuretics that work on the proximal and distal renal tubules contribute to increased losses of
potassium. The child’s diet should be supplemented with this electrolyte. With this type of
diuretic, potassium must be monitored and supplemented as needed.
DIF: Cognitive Level: Understand
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
10. Which is important to decrease the risk of a cerebrovascular accident in a patient with
hypoxemia secondary to a cardiac defect?
a. Minimize seizures
b. Prevent dehydration
c. Promote cardiac output
d. Reduce energy expenditure
ANS: B
In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in
hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting
cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular
accidents.
DIF: Cognitive Level: Analyze
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
11. Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with
other children because of possible overexertion. The nurse’s reply would be based on which
statement?
a. The child needs opportunities to play with peers.
b. The child needs to understand that peers’ activities are too strenuous.
c. Parents can meet all of the child’s needs.
d. Constant parental supervision is needed to avoid overexertion.
ANS: A
The child needs opportunities for social development. Children usually limit their activities if
allowed to set their own pace. The child will limit activities as necessary. Parents must be
encouraged to seek appropriate social activities for the child, especially before kindergarten.
The child needs to have activities that foster independence. The child will be able to regulate
activities.
DIF: Cognitive Level: Understand
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Psychosocial Integrity
12. Which is an important nursing consideration when suctioning a child who is intubated after
cardiac surgery with cardiopulmonary bypass?
a. Perform suctioning at least every hour.
b. Suction for no longer than 30 seconds at a time.
c. Administer supplemental oxygen before and after suctioning.
d. Expect symptoms of respiratory distress when suctioning.
ANS: C
If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation
bag before and after the procedure to prevent hypoxia. Suctioning should be done only as
indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at
one time. Symptoms of respiratory distress are avoided by using appropriate technique.
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13. The nurse is caring for a child after heart surgery. Which would the nurse do if evidence of
cardiac tamponade is found?
a. Increase analgesia
b. Apply warming blankets
c. Immediately report this to physician
d. Encourage child to cough, turn, and breathe deeply
ANS: C
If evidence is noted of cardiac tamponade, which is blood or fluid in the pericardial space
constricting the heart, the physician is notified immediately of this life-threatening
complication. Increasing analgesia may be done before the physician drains the fluid, but the
physician must be notified. Warming blankets are not indicated at this time. Encouraging the
child to cough, turn, and breathe deeply should be deferred till after the evaluation by the
physician.
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TOP: Integrated Process: Nursing Process: Implementation
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14. Which is an important nursing consideration when chest tubes will be removed from a young
child?
a. Explain that it is not painful.
b. Prepare a Band-Aid for the dressing.
c. Administer analgesics before the procedure.
d. Expect bright red drainage for several hours after removal.
ANS: C
It is appropriate to prepare the child for the removal of chest tubes with analgesics.
Short-acting medications can be used that are administered through an existing IV line. A
sharp, momentary pain is felt. This should not be misrepresented to the child. A petroleum
gauze, air-tight dressing will be needed, but it is not a pain-free procedure. Little or no
drainage should be found on removal.
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TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
15. Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in
bacterial endocarditis?
a. Osler nodes
b. Janeway lesions
c. Subcutaneous nodules
d. Aschoff nodes
ANS: A
Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial
endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial
endocarditis. Subcutaneous nodules are nontender swellings, located over bony prominences,
commonly found in rheumatic fever. Aschoff nodules are small nodules composed of cells
and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.
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16. Which is a serious complication which occurs in more than half of the cases of rheumatic
fever?
a. Seizures
b. Cardiac arrhythmias
c. Pulmonary hypertension
d. Cardiac valve damage
ANS: D
Cardiac valve damage is the most significant complication of rheumatic fever. Seizures,
cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic
fever.
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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
17. The nurse is admitting a child with rheumatic fever. Which therapeutic management would
the nurse expect to implement?
a. Administering penicillin
b. Ambulation as tolerated
c. Imposing strict bed rest for 4 to 6 weeks
d. Administering corticosteroids if chorea develops
ANS: A
The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is
the drug of choice. Salicylates can be used to control the inflammatory process, especially in
the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile
stage, but it does not need to be strict. The chorea is transient and will resolve without
treatment.
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TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy
18. When caring for the child with Kawasaki disease, the nurse would know which information?
a. A child’s fever is usually responsive to antibiotics within 48 hours.
b. The principal area of involvement is the joints.
c. The child is very docile through the illness.
d. Therapeutic management includes administration of gamma globulin and
salicylates (aspirin).
ANS: D
High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of
coronary artery abnormalities when given within the first 10 days of the illness. The fever of
Kawasaki disease is unresponsive to antibiotics and antipyretics. Mucous membranes,
conjunctiva, changes in the extremities, and cardiac involvement are seen. Aspirin is part of
the therapy.
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19. Which occurs in early septic shock?
a. Hypothermia
b. Increased cardiac output
c. Vasoconstriction
d. Angioneurotic edema
ANS: B
Increased cardiac output, which results in warm, flushed skin, is one of the manifestations of
septic shock. Fever and chills are characteristic of septic shock. Vasodilation is more common
than vasoconstriction. Angioneurotic edema occurs as a manifestation in anaphylactic shock.
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TOP: Integrated Process: Nursing Process: Assessment
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MULTIPLE RESPONSE
1. Which are organisms are known to cause bacterial endocarditis? (Select all that apply.)
a. Staphylococcus aureus
b. Streptococcus hemolyticus
c. Staphylococcus albicans
d. Viridans streptococci
e. Candida albicans
ANS: A, D, E
Viridans streptococci and Staphylococcus aureus are the most common causative agent in
bacterial (infective) endocarditis. Other causative agents include gram-negative bacteria and
fungi such as Candida albicans, Streptococcus hemolyticus, and Staphylococcus albicans are
not common causative agents.
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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
2. Nursing interventions for the child following a venous cardiac catheterization would include
which actions? (Select all that apply.)
a. Allow ambulation as tolerated.
b. Monitor vital signs as frequently as every 15 minutes.
c. Assess the affected extremity for temperature and color.
d. Check pulses below the catheterization site for equality and symmetry.
e. Remove pressure dressing after 4 hours.
f. Keep affected extremity straight for 10 to 12 hours.
ANS: B, C, D
The extremity that was used for access for the cardiac catheterization must be checked for
temperature and color. Coolness and blanching may indicate arterial occlusion. The child
should have a patent peripheral intravenous line (PIV) to ensure adequate hydration. The child
should remain on bed rest with the leg extended for a minimum of 4 hours. Initially vital signs
are taken every 15 minutes, with emphasis on a heart rate counted for 1 minute. Pulses above
the catheterization site should not be affected by the catheterization. Pulses distal to the site
should be monitored. The pressure dressings should not be removed for 24 hours.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
3. Which clinical manifestation would the nurse expect to see as shock progresses in a child and
becomes decompensated shock? (Select all that apply.)
a. High blood pressure
b. Irritability
c. Cool extremities
d. Confusion
e. Narrowing pulse pressure
f. Tachypnea
ANS: C, D, E, F
Cool extremities, decreased skin turgor, confusion, somnolence, tachypnea, and poor capillary
refill time are beginning signs of decompensated shock. Thirst, diminished urinary output,
irritability, apprehension, normal blood pressure, and narrowing pulse pressure are signs of
compensated shock.
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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
4. The nurse is conducting discharge teaching about signs and symptoms of heart failure to
parents of an infant with cardiomyopathy. Which signs and symptoms would the nurse
include? (Select all that apply.)
a. Warm flushed extremities
b. Poor feeding
c. Rapid weight gain
d. Tachypnea
e. Abnormally slow pulse rate
ANS: B, C, D
Poor feeding, rapid weight gain, and tachypnea are all important signs of heart failure. Further
the extremities are cool due to ineffective peripheral circulation, and the pulse rate is high.
DIF: Cognitive Level: Analyze
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiological Integrity: Physiological Adaptation
OTHER
1. Which interventions would the nurse implement for an infant experiencing a hypercyanotic
spell? Place in order from the highest-priority intervention to the lowest-priority intervention.
Provide the answer using lowercase letters separated by commas (e.g., A, B, C, D).
a. Administer 100% oxygen by blow-by.
b. Place the infant in knee-chest position.
c. Begin volume expansion if needed.
d. Give morphine subcutaneously or by an existing intravenous line.
ANS:
B, A, D, C
Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in
infants with tetralogy of Fallot, may occur in any child whose heart defect includes
obstruction to pulmonary blood flow and communication between the ventricles. The infant
becomes acutely cyanotic and hyperpneic because sudden infundibular spasm decreases
pulmonary blood flow and increases right-to-left shunting. Because profound hypoxemia
causes cerebral hypoxia, hypercyanotic spells require prompt assessment and treatment to
prevent brain damage or possibly death. The infant would first be placed in the knee-chest
position to reduce blood returning to the heart. Next 100% oxygen is given to alleviate the
hypoxemia. Morphine is next administered to reduce infundibular spasms. Last, begin volume
expansion if needed.
Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in
infants with tetralogy of Fallot, may occur in any child whose heart defect includes
obstruction to pulmonary blood flow and communication between the ventricles. The infant
becomes acutely cyanotic and hyperpneic because sudden infundibular spasm decreases
pulmonary blood flow and increases right-to-left shunting. Because profound hypoxemia
causes cerebral hypoxia, hypercyanotic spells require prompt assessment and treatment to
prevent brain damage or possibly death. The infant should first be placed in the knee-chest
position to reduce blood returning to the heart. Next 100% oxygen is given to alleviate the
hypoxemia. Morphine is next administered to reduce infundibular spasms. Last, the nurse
should remain calm.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
2. An inpatient child with IV access is experiencing an anaphylactic reaction to a snack brought
by a friend containing peanut products. Prioritize the actions that follow: Place in correct
sequence. Provide the answer using lowercase letters separated by commas (e.g., A, B, C, D).
a. Administer IV epinephrine.
b. Administer fluids to restore blood volume.
c. Establish an airway.
d. Monitor child for biphasic reaction.
ANS:
C, A, B, D
The correct sequence of actions is to establish an airway, administer epinephrine, Administer
fluids to restore blood volume, and monitor child for biphasic reaction.
DIF: Cognitive Level: Apply
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation