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NUR 101 CARE OF CHILDREN AND FAMILIES 38
CARDIOVASCULAR MANAGEMENT.EXAM QUESTIONS
AND ANSWERS LATEST UPDATE 2024 /Guaranteed
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Prior to administering digoxin to the 6-year-old child with HF, the nurse reviews the child’s serum laboratory report. Which value should concern the nurse and be reported to the HCP? A. Potassium 3.2 mEq/L B. Hemoglobin 10 g/dL C. Digoxin level 1.8 ng/mL D. Creatinine 0.3 mg/dL ANSWER: A A. The low serum potassium level should concern the nurse and be reported to the HCP. A low serum potassium level would increase the risk of digoxin toxicity. B. Although the Hgb level is a little low, this is not most concerning. C. The digoxin level is on the high side of normal. Thus, administering digoxin while the serum potassium level is low increases the risk further. D. The serum creatinine level is a measure of renal function. It is WNL and not conceming. Before administering oral digoxin to the pediatric client, the nurse assesses that the child has bradycardia and mild vomiting. Which is the nurse’s most appropriate action?
A. Explain to the parent that bradycardia is an expected effect of the digoxin. B. Give digoxin, document the observations, and reevaluate after the next dose. C. Withhold digoxin and notify the “CR as these signs indicate toxicity. D. Give both the oral beta blocker that is prescribed now and the digoxin. ANSWER: C A. Digoxin slows and strengthens the heart. Digoxin should not be given if the HR is too low. B. Digoxin should be held if the HR is slow. Continuing to administer the medication would be unsafe. C. The nurse should withhold digoxin (Lanoxin) and immediately notify the HCP because bradycardia and mild vomiting are signs of digoxin toxicity. D. A beta-blocking agent should not be administered because it may further slow the rate.
ANSWER: A
A. The nurse should instruct the client to contact the HCP if having muscle aches or dark urine when taking simvastatin (Zocor). These could be signs of a dangerous side effect of statins: rhabdomyolysis, the rapid breakdown of skeletal muscle tissue from the chemical effects of the medication. B. Simvastatin is an antilipidemic agent that lowers LDL and triglyceride levels; it will increase HDL cholesterol slightly (the good cholesterol). C. The effectiveness of Simvastatin is not affected by when it is taken; it can be taken in the morning or the evening. D. A common side effect is insomnia, not sleepiness.
The nurse is educating the parents of the pediatric client in preparation for their child’s home ECG monitoring. The nurse uses a picture to explain the different components of a normal ECG tracing. Place an X on the illustration where the nurse should be pointing when explaining repolarization of the ventricles. The T wave represents repolarization of the ventricles—the process whereby the cell is polarized again with positive charges on the outer surface and negative charges on the inner surface. The nurse is interpreting an ECG rhythm strip for the 2-year-old child with a congenital heart defect. The measurement for the PR interval is 0.26 seconds; the QRS is 0.08 seconds, and the QT is 0.28. The
B. In a bundle branch block, the QRS interval should be greater than or equal to 0.12 seconds. C. A normal HR for a 2-year-old is 80 to 130 bpm. A normal PR interval measures 0.12 to 0.20 seconds. Thus the PR interval is prolonged, indicating a first-degree AV block. The QRS is normal (0.6 to 0.10 seconds), and the QT is rate dependent. If the rate is fast, the QT will be shorter. The QT is within the normal range for the ventricular rate. D. In sinus tachycardia, the ventricular rate should be greater than 130 bpm for a 2-year—old; the rate is 126 bpm. The nurse is caring for multiple children with the rhythms illustrated- The nurse should activate the emergency response system when observing which ECG rhythm?
ANSWER: D
A. Option 1 is a ventricular paced rhythm with a pacemaker spike prior to the ventricular complex. This rhythm is expected with a pacemaker and would not require defibrillation. B. Option 2 is atrial fibrillation and is not a rhythm that requires defibrillation. C. This ECG shows a wandering atrial pacemaker with an irregular rhythm, variable PR interval, and multishaped P waves- Although abnormal, it would not require defibrillation. D. This ECG is a life-threatening torsades de pointes. The EMS should be activated. The pediatric client receives treatment to convert an SVT rhythm to a sinus rhythm. The nurse instructs the child’s parents on interventions to terminate the SVT rhythm should the rhythm recur. Which information stated by a parent indicates further teaching is needed? A. Wrap the child’s head with a cold, wet towel. B. Massage both of the child’s carotid arteries. C. Have the child perform the Valsalva maneuver. D. Insert a rectal thermometer for vagal stimulation. ANSWER: B A. Wrapping the child’s head with a cold, wet towel could potentially cause vagal stimulation. Vagal stimulation may convert the SVT rhythm to a sinus rhythm. B. Further teaching is needed when a parent states to massage both carotid
The 6-month-old infant being seen in the clinic has an HR of 167 bpm, RR of 65 bpm, and Spo2 of 98%. The mother states the infant gets very tired with feedings, eating approximately two ounces every four hours. Which action should be the nurse’s priority? A. Check peripheral capillary refill time B. Auscultate for bowel sormds C. Auscultate for a heart murmur D. Attempt to bottle-feed the infant ANSWER: C A. The Spo2 is 98%, already suggesting that oxygenation and perfusion status is adequate; checking peripheral CRT is not priority. B. Assessment of bowel sounds is not priority; fluid volume overload is of greater concern. C. Fatigue, tachycardia, and tachypnea suggest fluid volume overload. Assessing for a heart murmur is priority to help identify the pathology of the underlying fluid overload. D. There is no need to attempt to feed the infant. The infant may not be hungry, thus giving inaccurate assessment data. The nurse is using a picture to educate the parents of the child with a congenital murmur about the etiology of the condition. Which location should the nurse identify to the child’s parents for a murmur occurring at the tricuspid valve?
A. A
B. B
C. C
D. D
ANSWER: B
A. Line A shows where blood is entering the aorta after flowing through the aortic valve. B. Blood is pumped from the right atrium to the right ventricle through the tricuspid valve shown at line B. Backflow (regurgitation) or stenosis may result in a murmur. C. Line C is the pulmonic valve. D. Line D is the mitral valve. The nurse is caring for the child who has liver enlargement secondary to infective endocarditis. The nurse should assess the child for which associated complication? A. Pulmonary hypertension B. Right-sided heart failure C. Myocardial infarction
ANSWER: A
A. Palivizumab (Synagis), a prophylaxis medication against RSV, is administered monthly during the RSV season to infants with unrepaired heart defects to decrease the risk of hospitalization with RSV. B. Activity is generally not restricted. C. Infants with an unrepaired heart defect are often anorexic and require high- nutrient foods- D. Infants should receive scheduled childhood immunizations according to current guidelines. The nurse is teaching the parents of the child with a history of hypoxemia. The nurse should instruct the parents to immediately notify the I-ICP if the child is experiencing which manifestation(s)? A. Weight loss or gain B. Excessive fussiness and crying C. Dehydration and respiratory infection D. Not achieving developmental milestones ANSWER: C A. Weight change should be reported to the HCP but often is not an immediate concern. B. Excessive crying should be reported to the HCP but often is not an immediate concern. C. Dehydration can increase the risk of stroke in hypoxemic children, and respiratory infection may compromise pulmonary function and increase the
child’s hypoxemia. D. Concerns over developmental milestones should be reported to the HCP but often are not immediate concerns. The 18-month-old, hospitalized with uncorrected cyanotic heart disease, experiences a hypercyanotic spell. Which actions should be taken by the nurse? Select all that apply. A. Place the child in a knee-chest position. B. Administer 2 L of oxygen via nasal cannula. C. Administer intramuscular morphine sulfate. D. Use a calm and comforting approach. E. Administer oral propranolol if prescribed. ANSWER: A , C. D, E A. During a hypercyanotic episode, the child be- comes dyspneic and hypoxic. The knee-chest position reduces cardiac output by decreasing blood return from the lower extremities and increasing the SVR. B. The child should receive 100% oxygen via face mask when having a hypercyanotic spell. C. Morphine sulfate should be administered to decrease preload and afterload. D. A calm approach helps to settle the child and decrease oxygen demand. E. Propranolol may be given to aid pulmonary artery dilation.
ANSWER: B
A. Pulmonary hypertension, not hypotension, is a complication associated with congenital heart disease. B. The child with congenital heart disease is at risk for developing CHF and hypoxemia. Congenital heart disease lessens the effectiveness of the heart’s pumping action (HF), causing blood pooling in the heart or in the pulmonary circulation. Hypoxemia results when the blood is inadequately oxygenated. C. Hypoxemia and pulmonary hypertension, not hypotension, are complications of congenital heart disease. D. Cyanosis and hypertension, not hypotension, are complications of congenital heart disease. 1 0. The nurse is discussing the infant’s diagnosis of hypoplastic left heart syndrome (HLHS) with the parents. The father states, “Shouldn’t this get better when the heart grows in size with the baby?” How should the nurse respond to the father? A. “The growth of the heart does not repair the problem of the small left ventricle-” B. “Surgery is needed; we are doing everything we can to save your baby’s life.” C. “Your baby is very sick; many surgical procedures are needed for survival.” D. “The heart does not grow very much in early childhood, so it still needs to be fixed”
ANSWER: A
A. This is a therapeutic response that answers the father’s question. B. This is telling the father about the level of care but does not answer his question. C. This is explaining medical care and does not answer his question. D. This statement is incorrect; the heart continues to grow in early childhood. 1 1. The nurse is assessing the 3-month-old following the first surgery to repair hypoplastic left heart syndrome (HLHS). Which assessment findings require immediate intervention or notification of the HCP? Select all that apply. A. Heart rate of 120 bpm B. Grade 111 heart mumiur C. Severe intercostal retractions D. Oxygen saturation 80% E. Hematocrit level 69% ANSWER: C , E A. This HR of 120 bpm is WNL for a 3-month-old- B. Mumiurs are common following cardiac surgery. C. Severe intercostal retractions are a sign of severe respiratory distress. Without intervention, respiratory failure will occur. D. Decreased oxygen saturation levels are expected with HLHS. If oxygen saturations are normal, fetal ducts may close, thus worsening the problem. E. Extremely high Hct levels are associated with increased risk of stroke. The
13. The nurse assesses the pain level of the Native American pediatric client recovering from cardiac surgery. Knowing that Native American pediatric clients may not express pain, the nurse reviews the child’s pulse and BP readings following analgesic administration. Which finding indicates that the client’s pain is not well controlled? A. Decreased heart rate and decreased BP B. Increased heart rate and increased BP C. Increased heart rate and decreased BP D. Decreased heart rate and increased BP ANSWER: B A. Decreased HR and BP may indicate analgesics are effective for pain control. B. Increased HR and BP may indicate that the pediatric client’s pain is not well controlled. C. An increased HR and decreased BP could be signs of bleeding. D. Decreased HR and increased BP may be signs of a neurological complication associated with cardiac surgery. 1 4. The nurse is planning discharge teaching for parents of the child who had cardiac surgery. Which information should the nurse include in the discharge teaching? Select all that apply. A. Taking the child’s pulse before giving beta blocker medications B. Contacting the HCP for a temperature greater than lOO-3°F (379°C) C. Activity restrictions of not pulling the child up with the child’s arms D. Preparing an age-appropriate diet with vitamin C to promote wound healing E. Taking prophylactic antibiotics before dental care to prevent pericarditis
ANSWER: A , B, C, D
A. Beta blocker medications lower the HR, and the HR should be known before administration. B. A low-grade temperature could be a sign of an infection, and the HOP should be notified. C. Pulling the child up by the child’s arms can increase pain and cause sternal instability. D. A diet high in vitamin C will promote wound healing. E. Although discharge instructions should include the importance of prophylactic antibiotic therapy prior to dental procedures, the purpose is to prevent bacterial endocarditis (not pericarditis) 1 5. The nurse is suctioning the pediatric client who just had cardiac surgery. The nurse obsewes tachypnea, the use of accessory muscles to breathe, and restlessness. Which action should be taken by the nurse? A. Continue suctioning; these are expected findings during the procedure. B. Continue suctioning but monitor closely, as these could be signs of distress. C. Discontinue suctioning, carefully monitor the client, and notify the HCP. D. Discontinue suctioning, notify the HCP, and prepare for chest tube insertion. ANSWER: C
