Peds week 9/Perfusion NCLEX

Peds week 9/Perfusion NCLEX Leave the first rating Students also studied Terms in this set (37) Science MedicinePaediatrics Save Congenital Heart Defect Practice Q...43 terms LeMoyneFreeman Preview Pediatric Perfusion (PERFUSION EX...22 terms claudinefranxo Preview

Pediatric Perfusion: Cardiac

47 terms morgan_elizabeth471 Preview Practic 28 terms daw A chest radiograph film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" What knowledge about the x-ray should the nurse include in the response to the parents?

• Bones of chest but not the heart
• Measurement of electrical potential generated from

heart muscle

• Permanent record of heart size and configuration
• Computerized image of heart vessels and tissues
• Permanent record of heart size and configuration

rationale:

A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated from heart muscle. Echocardiography will produce a computerized image of the heart vessels and tissues by using sound waves.The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for?

• Cardiac arrhythmia
• Hypostatic pneumonia
• Heart failure
• Rapidly increasing blood pressure
• Cardiac arrhythmia

rationale:

Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient.Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

José is a 4-year-old child scheduled for a cardiac catheterization. What should be included in preoperative teaching?

• Directed at his parents because he is too young to

understand

• Detailed in regard to the actual procedures so he will

know what to expect

• Done several days before the procedure so that he will

be prepared

• Adapted to his level of development so that he can

understand

• Adapted to his level of development so that he can understand

rationale:

Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.Which explanation regarding cardiac catheterization is appropriate for a preschool child?

• Postural drainage will be performed every 4 to 6 hours

after the test.

• It is necessary to be completely "asleep" during the

test.

• The test is short, usually taking less than 1 hour.
• When the procedure is done, you will have to keep

your leg straight for at least 4 hours.

• When the procedure is done, you will have to keep your leg straight for at least
• hours.

rationale:

The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. What is the priority nursing action?

• Notify physician
• Apply new bandage with more pressure
• Place the child in Trendelenburg position
• Apply direct pressure above catheterization site
• Apply direct pressure above catheterization site

rationale:

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.The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?

• "I should avoid tub baths but may shower."
• "I have to stay on strict bed rest for 3 days."
• "I should remove the pressure dressing the day after

the procedure."

• "I may attend school but should avoid exercise for

several days."

• "I have to stay on strict bed rest for 3 days."

rationale:

The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.

What does the surgical closure of the ductus arteriosus do?

• Stop the loss of unoxygenated blood to the systemic

circulation

• Decrease the edema in legs and feet
• Increase the oxygenation of blood
• Prevent the return of oxygenated blood to the lungs
• Prevent the return of oxygenated blood to the lungs

rationale:

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.Which defect results in increased pulmonary blood flow?

• Pulmonic stenosis
• Tricuspid atresia
• Atrial septal defect
• Transposition of the great arteries
• Atrial septal defect

rationale:

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.The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot?

• Pulmonic stenosis, ventricular septal defect, overriding

aorta, right ventricular hypertrophy

• Aortic stenosis, ventricular septal defect, overriding

aorta, right ventricular hypertrophy

• Aortic stenosis, atrial septal defect, overriding aorta,

left ventricular hypertrophy

• Pulmonic stenosis, ventricular septal defect, aortic

hypertrophy, left ventricular hypertrophy

• Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular

hypertrophy

rationale:

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.A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?

• Atrial septal defect
• Tetralogy of Fallot
• Ventricular septal defect
• Patent ductus arteriosus
• Tetralogy of Fallot

rationale:

Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

• Pulmonary congestion
• Congenital heart defect
• Heart Failure

d.Systemic venous congestion

• Heart Failure

rationale:

The definition of heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the body's metabolic demands. Pulmonary congestion is an excessive accumulation of fluid in the lungs. Congenital heart defect is a malformation of the heart present at birth. Systemic venous congestion is an excessive accumulation of fluid in the systemic vasculature.

Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure?

• Tachypnea
• Tachycardia
• Peripheral edema
• Pale, cool extremities
• Peripheral edema

rationale:

Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool extremities are clinical manifestations of impaired myocardial function 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)?

• It decreases edema.
• It decreases cardiac output.
• It increases heart size.
• It increases venous pressure.
• It decreases edema.

rationale:

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.A nurse is preparing to administer an angiotensin- converting enzyme (ACE) inhibitor. Which drug should the nurse administer?

• Captopril (Capoten)
• Furosemide (Lasix)
• Spironolactone (Aldactone)
• Chlorothiazide (Diuril)
• Captopril (Capoten)

rationale:

Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Spironolactone blocks the action of aldosterone. Chlorothiazide works on the distal tubules.An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min.

• 60
• 70
• 90
• 100
• 70

rationale:

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.A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _______ beats/min.

• 60
• 70
• 90 to 110
• 110 to 120
• 90 to 110

rationale:

If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a 6-month-old. Sixty beats/min is the cut-off for holding the digoxin dose in an adult; 70 beats/min is the determining heart rate to hold a dose of digoxin for an older child; 110 to 120 beats/min is an acceptable heart rate to administer digoxin to a 6-month-old.The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity?

• Seizures
• Vomiting
• Bradypnea
• Tachycardia
• Vomiting

rationale:

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.