Chapter 025

Hockenberry, et al.
: Wong's Essential of Pediatric Nursing, 8

th
Edition
Chapter 25: The Child with Cardiovascular Dysfunction
MU!"PE #H$"#E
1. A chest radiograph film is ordered for a child with suspected cardiac problems. The childs
parent as!s the nurse" #$hat will the radiograph show about the heart%& The nurses response
should be based on !nowledge that the '(ray film will do which of the following%
1. )how bones of chest but not the heart
2. *easure electrical potential generated from heart muscle
+. ,rovide permanent record of heart si-e and configuration
.. ,rovide computeri-ed image of heart vessels and tissues
A/): +
+. A chest radiograph will provide information on the heart si-e and pulmonary blood(flow
patterns. 0t will be provide a baseline for future comparisons.
1. The heart will be visible" as well as the sternum and ribs.
2. 1lectrocardiography 21C34 measures the electrical potential generated from heart muscle.
.. 1chocardiography will produce a computeri-ed image of the heart vessels and tissues by
using sound waves.
D05: Cognitive 6evel: Comprehension T7,: 0ntegrated ,rocess: Teaching86earning
*)C: Area of Client /eeds: 9ealth ,romotion and *aintenance: ,revention and 1arly
Detection of Disease
2. $hich of the following is a complication that may occur after a cardiac catheteri-ation%
1. Cardiac arrhythmia
2. 9ypostatic pneumonia
+. Congestive heart failure
.. :apidly increasing blood pressure
A/): 1
1. ;ecause a catheter is introduced into the heart" a ris! e'ists of catheter(induced dysrhythmias
occurring during the procedure. These are usually transient.
2" +" and .. These are not ris!s usually associated with cardiac catheteri-ation.
D05: Cognitive 6evel: Comprehension T7,: 0ntegrated ,rocess: /ursing ,rocess:
,roblem 0dentification
*)C: Area of Client /eeds: ,hysiological 0ntegrity: :eduction of :is! ,otential
*osby items and derived items < 2==>" 2==5" 2==1 by *osby 0nc.
Test ;an!
+. ?os@ is a .(year(old child scheduled for a cardiac catheteri-ation. ,reoperative teaching
should be:
1. Directed at his parents" because he is too young to understand.
2. Detailed in regard to the actual procedures so he will !now what to e'pect.
+. Done several days before the procedure so that he will be prepared.
.. Adapted to his level of development so that he can understand.
A/): .
.. ,reoperative teaching should always be directed at the childs stage of development. The
caregivers also benefit from the same e'planations.
1 and 2. The parents may as! additional Auestions" which should be answered" but the child
needs to receive the information based on developmental level. This age group will not
understand in(depth descriptions.
+. ,reschoolers should be prepared close to the time of the cardiac catheteri-ation.
D05: Cognitive 6evel: Application T7,: 0ntegrated ,rocess: Teaching86earning
.. $hich of the following e'planations regarding cardiac catheteri-ation is appropriate for a
preschool child%
1. ,ostural drainage will be performed every . to B hours after the test.
2. 0t is necessary to be completely #asleep& during the test.
+. The test is very short" usually ta!ing less than 1 hour.
.. $hen the procedure is done" you will have to !eep your leg straight for at least .
hours.
A/): .
.. The childs leg will have to be maintained in a straight position for appro'imately . hours.
Counger children can be held in the parents lap with the leg maintained in the correct
position.
1. This is not done unless the child has corresponding pulmonary problems.
2. 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.
5. /ursing interventions for the child after a cardiac catheteri-ation would include which of the
following%
1. Allow ambulation as tolerated.
2
Test ;an!
2. *onitor vital signs every 2 hours.
+. Assess the affected e'tremity for temperature and color.
.. Chec! pulses above the catheteri-ation site for eAuality and symmetry.
A/): +
+. The e'tremity that was used for access for the cardiac catheteri-ation must be chec!ed for
temperature and color. Coolness and blanching may indicate arterial occlusion.
1. The child should remain on bed rest with the leg e'tended for a minimum of . hours.
2. 0nitially vital signs are ta!en every 15 minutes" with emphasis on a heart rate counted for 1
minute.
.. ,ulses above the catheteri-ation site should be not affected by the catheteri-ation. ,ulses
distal to the site should be monitored.
0mplementation
B. After the child returns from cardiac catheteri-ation" the nurse monitors the childs vital signs.
The heart rate should be counted for how many seconds%
1. 1=
2. 15
+. +=
.. B=
A/): .
.. After cardiac catheteri-ation" the heart rate should be counted for a full minute to detect
evidence of dysrhythmias or bradycardia.
1" 2" and +. These are not sufficient length of times to detect a dysrhythmia after a cardiac
catheteri-ation.
Assessment
D. The nurse is caring for a school(age girl who has had a cardiac catheteri-ation. The child tells
the nurse that her bandage is #too wet.& The nurse finds the bandage and bed soa!ed with
blood. The most appropriate initial nursing action is which of the following%
1. /otify physician.
2. Apply new bandage with more pressure.
+. ,lace in Trendelenburg position.
+
Test ;an!
.. Apply direct pressure above catheteri-ation site.
A/): .
.. 0f bleeding occurs" direct continuous pressure is applied 2.5 cm 21 inch4 above the
percutaneous s!in site to locali-e pressure over the vessel puncture.
1 and 2. These can be done after pressure is applied. The nurse can have someone else notify the
physician while the pressure is being maintained.
+. This would not be a helpful intervention. 0t would increase the drainage from the lower
e'tremities.
D05: Cognitive 6evel: Analysis T7,: 0ntegrated ,rocess: /ursing ,rocess:
0mplementation
>. $hich of the following should be included in the instructions to an active adolescent who is
going home after a cardiac catheteri-ation%
1. Avoid tub baths but may shower.
2. *aintain strict bed rest for + days.
+. 6eave pressure dressing on for D days.
.. )tay home from school until ;and(Aid is removed.
A/): 1
1. The catheteri-ation site should be !ept relatively dry with a adhesive bandage. )howers are
recommended.
2 and .. )trenuous activity must be avoided for several days" but the child can return to school.
+. The pressure dressing is removed the day after the catheteri-ation and replaced by an
adhesive bandage to !eep the area clean.
E. )urgical closure of the ductus arteriosus would do which of the following%
1. )top the loss of uno'ygenated blood to the systemic circulation
2. Decrease the edema in legs and feet
+. 0ncrease the o'ygenation of blood
.. ,revent the return of o'ygenated blood to the lungs
A/): .
.. The ductus arteriosus allows blood to flow from the higher(pressure aorta to the lower(
pressure pulmonary artery" causing a right(to(left shunt. 0f this is surgically closed" no
additional o'ygenated blood 2from the aorta4 will return to the lungs through the pulmonary
artery.
1. The aorta carries o'ygenated blood to the systemic circulation. ;ecause of the higher
pressure in the aorta" blood is shunted into the pulmonary artery and the pulmonary
circulation.
.
Test ;an!
2. 1dema in the legs and feet is usually a sign of congestive heart failure. This repair would not
directly affect the edema.
+. This would not interfere with the return of o'ygenated blood to the lungs.
,lanning
*)C: Area of Client /eeds: ,hysiological 0ntegrity: ,hysiological Adaptation
1=. $hich of the following defects results in increased pulmonary blood flow%
1. ,ulmonic stenosis
2. Tricuspid atresia
+. Atrial septal defect
.. Transposition of the great arteries
A/): +
+. The atrial septal defect results in increased pulmonary blood flow. ;lood flows from the left
atrium 2higher pressure4 into the right atrium 2lower pressure4 and then to the lungs via the
pulmonary artery.
1. ,ulmonic stenosis is an obstruction to blood flowing from the ventricles.
2. Tricuspid atresia results in decreased pulmonary blood flow.
.. Transposition of the great arteries results in mi'ed blood flow.
Assessment
11. $hich of the following structural defects constitute tetralogy of 5allot%
1. ,ulmonary stenosis" ventricular septal defect" overriding aorta" right ventricular
hypertrophy
2. Aortic stenosis" ventricular septal defect" overriding aorta" right ventricular
hypertrophy
+. Aortic stenosis" atrial septal defect" overriding aorta" left ventricular hypertrophy
.. ,ulmonary stenosis" ventricular septal defect" aortic hypertrophy" left ventricular
hypertrophy
A/): 1
1. Tetralogy of 5allot has these four characteristics: pulmonary stenosis" ventricular septal
defect" overriding aorta" and right ventricular hypertrophy.
2. There is pulmonary stenosis but not atrial stenosis in tetralogy of 5allot.
+. :ight ventricular hypertrophy" not left ventricular hypertrophy is present in tetralogy of
5allot.
.. :ight ventricular hypertrophy" not left ventricular hypertrophy is present in tetralogy of
5allot" and an atrial septal defect" not aortic hypertrophy" is present.
Assessment
5
Test ;an!
12. $hich of the following defects results in decreased pulmonary blood flow%
1. Atrial septal defect
2. Tetralogy of 5allot
+. Fentricular septal defect
.. ,atent ductus arteriosus
A/): 2
2. Tetralogy of 5allot 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.
1" +" and .. Atrial and ventricular septal defects and patent ductus arteriosus result in increased
pulmonary blood flow.
Assessment
1+. $hich of the following is best described as the inability of the heart to pump an adeAuate
amount of blood to the systemic circulation at normal filling pressures%
1. ,ulmonary congestion
2. Congenital heart defect
+. Congestive heart failure
.. )ystemic venous congestion
A/): +
+. The definition of congestive heart failure is the inability of the heart to pump an adeAuate
amount of blood to the systemic circulation at normal filling pressures to meet the metabolic
demands of the body.
1. ,ulmonary congestion is an e'cessive accumulation of fluid in the lungs.
2. Congenital heart defect is a malformation of the heart present at birth.
.. )ystemic venous congestion is an e'cessive accumulation of fluid in the systemic
vasculature.
Assessment
1.. $hich of the following is a clinical manifestation of the systemic venous congestion that can
occur with congestive heart failure%
1. Tachypnea
2. Tachycardia
+. ,eripheral edema
.. ,ale" cool e'tremities
B
Test ;an!
A/): +
+. ,eripheral edema" especially periorbital edema" is a clinical manifestation of systemic venous
congestion.
1. Tachypnea is a manifestation of pulmonary congestion.
2 and .. Tachycardia and pale" cool e'tremities are clinical manifestations of impaired
myocardial function.
Assessment
15. A beneficial effect of administering digo'in 26ano'in4 is that it:
1. Decreases edema.
2. Decreases cardiac output.
+. 0ncreases heart si-e.
.. 0ncreases venous pressure.
A/): 1
1. Digo'in has a rapid onset and is useful increasing cardiac output" decreasing venous
pressure" and as a result" decreasing edema.
2. Cardiac output is increased by digo'in.
+. 9eart si-e is decreased by digo'in.
.. Digo'in decreases venous pressure.
0mplementation
*)C: Area of Client /eeds: ,hysiological 0ntegrity: ,harmacologic and ,arenteral Therapy
1B. $hich of the following drugs is an angiotensin(converting en-yme 2AC14 inhibitor%
1. Captopril 2Capoten4
2. 5urosemide 26asi'4
+. )pironolactone 2Aldactone4
.. Chlorothia-ide 2Diuril4
A/): 1
1. Capoten is a drug which is an AC1 inhibitor.
2. 6asi' is a loop diuretic.
+. Aldactone bloc!s the action of aldosterone.
.. Diuril wor!s on the distal tubules.
0mplementation
1D. An >(year(old child is receiving digo'in 26ano'in4. The nurse should notify the practitioner
and withhold the medication if the apical pulse is less than which of the following%
D
Test ;an!
1. B=
2. D=
+. E=
.. 1==
A/): 2
2. 0f a 1(minute apical pulse is less than D= for an older child" the digo'in is withheld.
1. This is the cut(off for holding the digo'in dose in an adult.
+ and .. ;elow E= to 1== is the determination for not giving a digo'in dose to infants and young
children.
Assessment
1>. A B(month(old infant is receiving digo'in 26ano'in4. The nurse should notify the practitioner
and withhold the medication if the apical pulse is less than which of the following%
1. B=
2. D=
+. E= to 11=
.. 11= to 12=
A/): +
+. 0f the 1(minute apical is below E= to 11=" the digo'in should not be given to a B(month(old.
1. This is the cut(off for holding the digo'in dose in an adult.
2. This is the determining heart rate to hold a dose of digo'in for an older child.
.. This is an acceptable heart rate to administer digo'in to a B(month(old.
0mplementation
1E. $hich of the following is a common sign of digo'in to'icity%
1. )ei-ures
2. Fomiting
+. ;radypnea
.. Tachycardia
A/): 2
2. Fomiting is a common sign of digo'in to'icity.
1. )ei-ures are not associated with digo'in to'icity.
+. The child will have a slower heart rate" not respiratory rate.
.. The heart rate will be slower" not faster.
0mplementation
>
Test ;an!
2=. The parents of a young child with congestive heart failure tell the nurse that they are
#nervous& about giving digo'in. The nurses response should be based on which of the
following%
1. 0t is a very safe" freAuently used drug.
2. 0t is difficult to either overmedicate or undermedicate with digo'in.
+. ,arents lac! the e'pertise necessary to administer digo'in.
.. ,arents must learn specific" important guidelines for administration of digo'in.
A/): .
.. Digo'in has a narrow therapeutic range. The margin of safety between therapeutic" to'ic" and
lethal doses is very small. )pecific guidelines are available for parents to learn how to
administer the drug safely and to monitor for side effects.
1 and 2. Digo'in is a freAuently used drug" but it has a narrow therapeutic range. Fery small
amounts of the liAuid are given to infants ma!ing it easy to over( or undermedicate.
+. ,arents may lac! the necessary e'pertise to administer the drug at first" but with discharge
preparation" they should be prepared to administer the drug safely.
D05: Cognitive 6evel: Analysis
T7,: 0ntegrated ,rocess: Teaching86earning *)C: Area of Client /eeds:
,hysiological 0ntegrity: ,harmacologic and ,arenteral Therapy
21. The infant with congestive heart failure has a need for:
1. 0ncreased calories.
2. 0ncreased fluids.
+. Decreased protein.
.. Decreased fat.
A/): 1
1. The metabolic rate of infants with congestive heart failure is greater because of poor cardiac
function and increased heart and respiratory rates. Their caloric needs are greater than those
of the average infants" yet their ability to ta!e in the calories is diminished by their fatigue.
2. 5luids must be carefully monitored because of the congestive heart failure.
+ and .. The diet should include increased protein and increased fat to facilitate the childs
inta!e of sufficient calories.
D05: Cognitive 6evel: Analysis
T7,: 0ntegrated ,rocess: /ursing ,rocess: ,lanning *)C: Area of Client /eeds:
,hysiological 0ntegrity: ,hysiological Adaptation
22. As part of the treatment for congestive heart failure" the child ta!es the diuretic furosemide.
As part of teaching home care" the nurse encourages the family to give the child foods such
as bananas" oranges" and leafy vegetables. These foods are recommended for this child
because they are high in which of the following%
1. Chlorides
E
Test ;an!
2. ,otassium
+. )odium
.. Fitamins
A/): 2
2. Diuretics that wor! on the pro'imal and distal renal tubules contribute to increased losses of
potassium. The childs diet should be supplemented with this electrolyte.
1" +" and .. $ith this type of diuretic" potassium must be monitored and supplemented as
needed.
D05: Cognitive 6evel: Comprehension T7,: 0ntegrated ,rocess: Teaching86earning
2+. $hich of the following is a sign of hypo!alemia%
1. Apnea
2. 7liguria
+. Twitching
.. *uscle wea!ness
A/): .
.. *uscle wea!ness is a characteristic clinical manifestation of hypo!alemia.
1" 2" and +. These are not indications of hypo!alemia.
Assessment
2.. An >(month(old infant has a hypercyanotic spell while blood is being drawn. The nurses
first action should be which of the following%
1. Assess for neurologic defects.
2. ,lace the child in the !nee(chest position
+. ;egin cardiopulmonary resuscitation.
.. ,repare family for imminent death.
A/): 2
2. The first action is to place the infant in the !nee(chest position. ;low(by o'ygen may be
indicated.
1. /eurologic defects are unli!ely.
+ and .. The child should be assessed for airway" breathing" and circulation. 7ften" calming the
child and administering o'ygen and morphine can alleviate the hypercyanotic spell.
D05: Cognitive 6evel: Application T7,: 0ntegrated ,rocess: /ursing ,rocess:
0mplementation
1=
Test ;an!
25. The nurse is caring for a child with persistent hypo'ia secondary to a cardiac defect. The
nurse recogni-es that a ris! e'ists of cerebrovascular accidents 2stro!es4. $hich of the
following is an important obGective to decrease this ris!%
1. *inimi-e sei-ures
2. ,revent dehydration
+. ,romote cardiac output
.. :educe energy e'penditure
A/): 2
2. 0n children with persistent hypo'ia" polycythemia develops. Dehydration must be prevented
in hypo'emic children because it potentiates the ris! of stro!es.
1" +" and .. *inimi-ing sei-ures" promoting cardiac output" and reducing energy e'penditure
will not reduce the ris! of cerebrovascular accidents.
0mplementation
2B. ,arents of a +(year(old child with congenital heart disease are afraid to let their child play
with other children because of possible overe'ertion. The nurses reply should be based on
which of the following%
1. Child needs opportunities to play with peers.
2. Child needs to understand that peers activities are too strenuous.
+. ,arents can meet all the childs needs.
.. Constant parental supervision is needed to avoid overe'ertion.
A/): 1
1. The child needs opportunities for social development. Children usually limit their activities if
allowed to set their own pace.
2. The child will limit activities as necessary.
+. ,arents must be encouraged to see! appropriate social activities for the child" especially
before !indergarten. The child needs to have activities that foster independence.
.. The child will be able to regulate activities.
D05: Cognitive 6evel: Analysis T7,: 0ntegrated ,rocess: Teaching86earning
*)C: Area of Client /eeds: ,sychosocial 0ntegrity: Coping and Adaptation
2D. $hich of the following should the nurse consider when preparing a school(age child and the
family for heart surgery%
1. Hnfamiliar eAuipment should not be shown.
2. 6et child hear the sounds of an 1C3 monitor.
+. Avoid mentioning postoperative discomfort and interventions.
.. 1'plain that an endotracheal tube will not be needed if the surgery goes well.
A/): 2
11
Test ;an!
2. The child and family should be e'posed to the sights and sounds of the intensive care unit
20CH4. All positive" nonfrightening aspects of the environment are emphasi-ed.
1. The child should be shown unfamiliar eAuipment and its use demonstrated on a doll.
+ and .. Carefully prepare the child for the postoperative e'perience" including intravenous 20F4
lines" incision" and endotracheal tube.
D05: Cognitive 6evel: Analysis T7,: 0ntegrated ,rocess: Teaching86earning
*)C: Area of Client /eeds: ,sychosocial 0ntegrity: Coping and Adaptation
2>. )eventy(two hours after cardiac surgery" a young child has a temperature of 1=1I 5. The
nurse should do which of the following%
1. Jeep child warm with blan!ets.
2. Apply a hypothermia blan!et.
+. :ecord temperature on nurses notes.
.. :eport findings to physician.
A/): .
.. 0n the first 2. to .> hours after surgery" the body temperature may increase to +D.DI C or 1==I
5 as part of the inflammatory response to tissue trauma. 0f the temperature is higher or
continues after this period" it is most li!ely a sign of an infection and immediate investigation
is indicated.
1. ;lan!ets should be removed from the child to !eep the temperature from increasing.
2. 9ypothermia blan!et is not indicated for this level of temperature.
+. The temperature should be recorded" but the physician must be notified for evaluation.
Assessment
2E. $hich of the following is an important nursing consideration when suctioning a young child
who has had heart surgery%
1. ,erform suctioning at least every hour.
2. )uction for no longer than += seconds at a time.
+. Administer supplemental o'ygen before and after suctioning.
.. 1'pect symptoms of respiratory distress when suctioning.
A/): +
+. 0f suctioning is indicated" supplemental o'ygen is administered with a manual resuscitation
bag before and after the procedure to prevent hypo'ia.
1. )uctioning should be done only as indicated" not on a routine basis.
2. The child should be suctioned for no more than 5 seconds at one time.
.. )ymptoms of respiratory distress are to be avoided by using appropriate techniAue.
12
Test ;an!
0mplementation
+=. The nurse is caring for a child after heart surgery. $hich of the following should the nurse do
if evidence is found of cardiac tamponade%
1. 0ncrease analgesia.
2. Apply warming blan!ets.
+. 0mmediately report this to physician.
.. 1ncourage child to cough" turn" and breathe deeply.
A/): +
+. 0f evidence is noted of cardiac tamponade" blood or fluid in the pericardial space constricting
the heart" the physician is notified immediately of this life(threatening complication.
1. This may be done before the physician drains the fluid" but the physician must be notified.
2. $arming blan!ets are not indicated at this time.
.. This should be deferred till after the evaluation by the physician.
0mplementation
+1. $hich of the following is an important nursing consideration when chest tubes will be
removed from a child%
1. 1'plain that it is not painful.
2. 1'plain that only a ;and(Aid will be needed
+. Administer analgesics before procedure.
.. 1'pect bright red drainage for several hours after removal.
A/): +
+. 0t is appropriate to prepare the child for the removal of chest tubes with analgesics. )hort(
acting medications can be used that are administered through an e'isting 0F line.
1. A sharp" momentary pain is felt. This should not be misrepresented to the child.
2. A petroleum gau-e8air(tight dressing will be needed" but it is not a pain(free procedure.
.. 6ittle or no drainage should be found on removal.
,lanning
1+
Test ;an!
+2. $hat is the most common causative agent of bacterial endocarditis%
1. Staphylococcus albus
2. Streptococcus hemolyticus
+. Staphylococcus albicans
.. Streptococcus viridans
A/): .
.. Staphylococcus viridans is the most common causative agent in bacterial 2infective4
endocarditis.
1" 2" and +. These are not common causative agents.
Assessment
++. $hat painful" tender" pea(si-ed nodules may appear on the pads of the fingers or toes in
bacterial endocarditis%
1. 7sler nodes
2. ?aneway lesions
+. )ubcutaneous nodules
.. Aschoff nodes
A/): 1
1. 7sler nodes are red" painful" intradermal nodes found on pads of the phalanges in bacterial
endocarditis.
2. ?aneway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis.
+. )ubcutaneous nodules are nontender swellings" located over bony prominences" commonly
found in rheumatic fever.
.. Aschoff nodules are small nodules composed of cells and leu!ocytes found in the interstitial
tissues of the heart in rheumatic myocarditis.
Assessment
+.. The primary nursing intervention to prevent bacterial endocarditis is which of the following%
1. 0nstitute measures to prevent dental procedures.
2. Counsel parents of high(ris! children about prophylactic antibiotics.
+. 7bserve children for complications" such as embolism and heart failure.
.. 1ncourage restricted mobility in susceptible children.
A/): 2
2. The obGective of nursing care is to counsel the parents of high(ris! children about both the
need for prophylactic antibiotics for dental procedures and the necessity of maintaining
e'cellent oral health. The childs dentist should be aware of the childs cardiac condition.
1.
Test ;an!
1. Dental procedures should be done to maintain a high level of oral health. ,rophylactic
antibiotics are necessary.
+ and .. These should be done" but maintaining good oral health and prophylactic antibiotics is
important.
Assessment
+5. $hich of the following is a common" serious complication of rheumatic fever%
1. )ei-ures
2. Cardiac arrhythmias
+. ,ulmonary hypertension
.. Cardiac valve damage
A/): .
.. Cardiac valve damage is the most significant complication of rheumatic fever.
1" 2" and +. These are not common complications of rheumatic fever.
Assessment
+B. $hich of the following is a maGor clinical manifestation of rheumatic fever%
1. ,olyarthritis
2. 7sler nodes
+. ?aneway spots
.. )plinter hemorrhages of distal third of nails
A/): 1
1. ,olyarthritis" which is swollen" hot" red" and painful Goints. The affected Goints will change
every 1 to 2 days. ,rimarily the large Goints are affected.
2" +" and .. 7sler nodes" ?aneway spots" and splinter hemorrhages are characteristic of infective
endocarditis.
Assessment
+D. Therapeutic management of the child with rheumatic fever includes:
1. Administration of penicillin.
2. Avoid salicylates 2aspirin4.
+. )trict bed rest for . to B wee!s.
15
Test ;an!
.. Administration of corticosteroids if chorea develops.
A/): 1
1. The goal of medical management is the eradication of the hemolytic streptococci. ,enicillin
is the drug of choice.
2. )alicylates can be used to control the inflammatory process" especially in the Goints" and
reduce the fever and discomfort.
+. ;ed 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.
0mplementation
+>. $hich of the following actions by the school nurse is important in the prevention of
rheumatic fever%
1. 1ncourage routine cholesterol screenings.
2. Conduct routine blood pressure screenings.
+. :efer children with sore throats for throat cultures.
.. :ecommend salicylates instead of acetaminophen for minor discomforts.
A/): +
+. /urses have a role in preventionK primarily in screening school(age children for sore throats
caused by group A streptococci. This can be by actively participating in throat culture
screening or by referring children with possible streptococcal sore throats for testing.
1 and 2. These do not facilitate the recognition and treatment of group A hemolytic streptococci.
.. )alicylates should be avoided routinely because of the ris! of :eye syndrome after viral
illnesses.
,lanning
+E. $hen discussing hyperlipidemia with a group of adolescents" the nurse should e'plain that
high levels of what are thought to protect against cardiovascular disease%
1. Cholesterol
2. Triglycerides
+. 6ow(density lipoproteins 26D6s4
.. 9igh(density lipoproteins 29D6s4
1B
Test ;an!
A/): .
.. 9D6s contain very low concentrations of triglycerides" relatively little cholesterol" and high
levels of proteins. 0t is thought that 9D6s protect against cardiovascular disease.
1" 2" and +. Cholesterol" triglycerides" and 6D6s are not protective against cardiovascular
disease.
.=. $hich of the following is the leading cause of death after heart transplantation%
1. 0nfection
2. :eGection
+. Cardiomyopathy
.. Congestive heart failure
A/): 2
2. The posttransplant course is comple'. The leading cause of death after cardiac transplant is
reGection.
1. 0nfection is a continued ris! secondary to the immunosuppression necessary to prevent
reGection.
+. Cardiomyopathy is one of the indications for cardiac transplant.
.. This is not a leading cause of death.
Assessment
.1. $hen caring for the child with Jawasa!i disease" the nurse should !now which of the
following%
1. Childs fever is usually responsive to antibiotics within .> hours.
2. ,rincipal area of involvement is the Goints.
+. Aspirin is contraindicated.
.. Therapeutic management includes administration of gamma globulin and aspirin.
A/): .
.. 9igh(dose 0F gamma globulin and aspirin therapy is indicated to reduce the incidence of
coronary artery abnormalities when given within the first 1= days of the illness.
1. The fever of Jawasa!i disease is unresponsive to antibiotics and antipyretics.
2. *ucous membranes" conGunctiva" changes in the e'tremities" and cardiac involvement are
seen.
+. Aspirin is part of the therapy.
0mplementation
1D
Test ;an!
.2. 7ne of the most freAuent causes of hypovolemic shoc! in children is which of the following%
1. )epsis
2. ;lood loss
+. Anaphyla'is
.. Congenital heart disease
A/): 2
2. ;lood loss is the most freAuent cause of hypovolemic shoc! in children.
1. )epsis causes septic shoc!" which is overwhelming sepsis and circulating bacterial to'ins.
+. Anaphylactic shoc! results from e'treme allergy or hypersensitivity to a foreign substance.
.. Congenital heart disease contributes to hypervolemia" not hypovolemia.
Assessment
.+. $hich of the following types of shoc! is characteri-ed by a hypersensitivity reaction causing
massive vasodilation and capillary lea!s" which may occur with drug or late' allergy%
1. /eurogenic shoc!
2. Cardiogenic shoc!
+. 9ypovolemic shoc!
.. Anaphylactic shoc!
A/): .
.. Anaphylactic shoc! results from e'treme allergy or hypersensitivity to a foreign substance.
1. /eurogenic shoc! results from loss of neuronal control" such as the interruption of neuronal
transmission that occurs from a spinal cord inGury.
2. Cardiogenic shoc! is decreased cardiac output.
+. 9ypovolemic shoc! is a reduction in the si-e of the vascular compartment" decreasing blood
pressure" and low central venous pressure.
Assessment
... $hich of the following clinical manifestations would the nurse e'pect to see as shoc!
progresses in a child and becomes uncompensated shoc!%
1. Thirst
2. 0rritability
+. Apprehension
.. Confusion and somnolence
A/): .
.. Confusion and somnolence are beginning signs of uncompensated shoc!.
1" 2" and +. Thirst" irritability" and apprehension are signs of compensated shoc!.
1>
Test ;an!
Assessment
.5. $hich of the following occurs in septic shoc!%
1. 9ypothermia
2. 0ncreased cardiac output
+. Fasoconstriction
.. Angioneurotic edema
A/): 2
2. 0ncreased cardiac output" which results in warm" flushed s!in" is one of the manifestations of
septic shoc!.
1. 5ever and chills are characteristic of septic shoc!.
+. Fasodilation is more common.
.. Angioneurotic edema occurs as a manifestation in anaphylactic shoc!.
Assessment
.B. The nurse suspects shoc! in a child who is 1(day after surgery. The initial nursing action
should be which of the following%
1. 7btain blood gases.
2. Administer o'ygen.
+. ,lace on cardiac monitor.
.. ,lace in Trendelenburg position.
A/): 2
2. The initial nursing action in shoc! is to establish ventilatory support. This would be done by
the administration of o'ygen.
1. 7'ygen saturation monitoring should be begun. ;lood gases would be indicated if alternative
methods of monitoring o'ygen therapy were not available.
+. *onitoring would be indicated to assess the childs status further.
.. This would not be indicated.
0mplementation
.D. A child is brought to the emergency department e'periencing an anaphylactic reaction to a
bee sting. $hile an airway is being established" the nurse should prepare which of the
following medications for immediate administration%
1. Diphenhydramine 2;enadryl4
2. Dopamine
+. 1pinephrine
1E
Test ;an!
.. Calcium chloride
A/): +
+. After the first priority of establishing an airway" administration of epinephrine is the drug of
choice.
1. Diphenhydramine" an antihistamine" is usually not used for severe reactions.
2 and .. These are not appropriate drugs for this type of reaction.
Assessment
.>. Clinical manifestations of to'ic shoc! syndrome include which of the following%
1. )evere hypertension
2. )ubnormal temperature
+. 1rythematous macular rash
.. ,apular rash over e'tremities
A/): +
+. 7ne of the diagnostic criteria for to'ic shoc! syndrome is a diffuse macular erythroderma.
1. 9ypotension is one of the manifestations.
2. 5ever of +>.EI C or higher is a characteristic.
.. DesAuamation of the palms and soles of the feet occurs about 1 to 2 wee!s.
Assessment
2=

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Hockenberry, et al.

: Wong's Essential of Pediatric Nursing, 8

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