Pediatric Cardiac Questions With Complete Solutions
A 3-month-old infant has a hypercyanotic spell. The nurse's first
action should be which of the following?
a. Assess for neurologic defects.
b. Prepare family for imminent death.
c. Begin cardiopulmonary resuscitation.
d. Place child in the knee-chest position. Correct Answer ANS:
D
The first action is to place the infant in the knee-chest position.
Blow-by oxygen may be indicated. Neurologic defects are
unlikely. Preparing the family for imminent death or beginning
cardiopulmonary resuscitation should be unnecessary. The child
is assessed for airway, breathing, and circulation. Often, calming
the child and administering oxygen and morphine can alleviate
the hypercyanotic spell.
A cardiac defect that allows blood to shunt from the (high
pressure) left side of the heart to the (lower pressure) right side
can result in:
a. cyanosis.
b. congestive heart failure.
c. decreased pulmonary blood flow.
d. bounding pulses in upper extremities. Correct Answer ANS:
B
As blood is shunted into the right side of the heart, there is
increased pulmonary blood flow and the child is at high risk for
congestive heart failure. Cyanosis usually occurs in defects with
,decreased pulmonary blood flow. Bounding upper extremity
pulses are a manifestation of coarctation of the aorta.
A chest x-ray examination is ordered for a child with suspected
cardiac problems. The child's parent asks the nurse, "What will
the x-ray show about the heart?" The nurse's response should be
based on knowledge that the x-ray film will do which of the
following?
a. Show bones of chest but not the heart
b. Evaluate the vascular anatomy outside of the heart
c. Show a graphic measure of electrical activity of the heart
d. Provide information on heart size and pulmonary blood flow
patterns Correct Answer ANS: D
Chest x-ray films provide information on the size of the heart
and pulmonary blood flow patterns. The bones of the chest are
visible on the chest x-ray film, but the heart and blood vessels
are also seen. Magnetic resonance imaging is a noninvasive
technique that allows for evaluation of vascular anatomy outside
of the heart. A graphic measure of electrical activity of the heart
is provided by electrocardiography.
A child diagnosed with tetralogy of fallot becomes upset, crying
and thrashing around when a blood specimen is obtained. The
child's color becomes blue and respiratory rate increases to 44
bpm. Which of the following actions would the nurse do first?
a) obtain an order for sedation for the child
b) assess for an irregular heart rate and rhythm
c) explain to the child that it will only hurt for a short time
, d) place the child in knee-to-chest position Correct Answer
Answer: D.
the child is experiencing a "tet spell" or hypoxic episode.
Therefore the nurse should place the child in a knee-to-chest
position. Flexing the legs reduces venous flow of blood from
lower extremities and reduces the volume of blood being
shunted through the interventricular septal defect and the
overriding aorta in the child with tetralogy of fallot. As a result,
the blood then entering the systemic circulation has higher
oxygen content, and dyspnea is reduced. Flexing the legs also
increases vascular resistance and pressure in the left ventricle.
An infant often assumes a knee-to-chest position to relieve
dyspnea. If this position is ineffective, then the child may need
sedative. Once the child is in this position, the nurse may assess
for an irregular heart rate and rhythm. Explaining tho the child
that it will only hurt for a short time does nothing to alleviate
hypoxia.
A mother states that she brought her child to the clinic because
the 3-year-old girl was not keeping up with her siblings. During
physical assessment, the nurse notes that the child has pale skin
and conjunctiva and has muscle weakness. The hemoglobin on
admission is 6.4 g/dl. After notifying the practitioner of the
results, the nurse's priority intervention is to:
a. reduce environmental stimulation to prevent seizures.
b. have the laboratory repeat the analysis with a new specimen.
c. minimize energy expenditure to decrease cardiac workload.
d. administer intravenous fluids to correct the dehydration.
Correct Answer ANS: C
A 3-month-old infant has a hypercyanotic spell. The nurse's first
action should be which of the following?
a. Assess for neurologic defects.
b. Prepare family for imminent death.
c. Begin cardiopulmonary resuscitation.
d. Place child in the knee-chest position. Correct Answer ANS:
D
The first action is to place the infant in the knee-chest position.
Blow-by oxygen may be indicated. Neurologic defects are
unlikely. Preparing the family for imminent death or beginning
cardiopulmonary resuscitation should be unnecessary. The child
is assessed for airway, breathing, and circulation. Often, calming
the child and administering oxygen and morphine can alleviate
the hypercyanotic spell.
A cardiac defect that allows blood to shunt from the (high
pressure) left side of the heart to the (lower pressure) right side
can result in:
a. cyanosis.
b. congestive heart failure.
c. decreased pulmonary blood flow.
d. bounding pulses in upper extremities. Correct Answer ANS:
B
As blood is shunted into the right side of the heart, there is
increased pulmonary blood flow and the child is at high risk for
congestive heart failure. Cyanosis usually occurs in defects with
,decreased pulmonary blood flow. Bounding upper extremity
pulses are a manifestation of coarctation of the aorta.
A chest x-ray examination is ordered for a child with suspected
cardiac problems. The child's parent asks the nurse, "What will
the x-ray show about the heart?" The nurse's response should be
based on knowledge that the x-ray film will do which of the
following?
a. Show bones of chest but not the heart
b. Evaluate the vascular anatomy outside of the heart
c. Show a graphic measure of electrical activity of the heart
d. Provide information on heart size and pulmonary blood flow
patterns Correct Answer ANS: D
Chest x-ray films provide information on the size of the heart
and pulmonary blood flow patterns. The bones of the chest are
visible on the chest x-ray film, but the heart and blood vessels
are also seen. Magnetic resonance imaging is a noninvasive
technique that allows for evaluation of vascular anatomy outside
of the heart. A graphic measure of electrical activity of the heart
is provided by electrocardiography.
A child diagnosed with tetralogy of fallot becomes upset, crying
and thrashing around when a blood specimen is obtained. The
child's color becomes blue and respiratory rate increases to 44
bpm. Which of the following actions would the nurse do first?
a) obtain an order for sedation for the child
b) assess for an irregular heart rate and rhythm
c) explain to the child that it will only hurt for a short time
, d) place the child in knee-to-chest position Correct Answer
Answer: D.
the child is experiencing a "tet spell" or hypoxic episode.
Therefore the nurse should place the child in a knee-to-chest
position. Flexing the legs reduces venous flow of blood from
lower extremities and reduces the volume of blood being
shunted through the interventricular septal defect and the
overriding aorta in the child with tetralogy of fallot. As a result,
the blood then entering the systemic circulation has higher
oxygen content, and dyspnea is reduced. Flexing the legs also
increases vascular resistance and pressure in the left ventricle.
An infant often assumes a knee-to-chest position to relieve
dyspnea. If this position is ineffective, then the child may need
sedative. Once the child is in this position, the nurse may assess
for an irregular heart rate and rhythm. Explaining tho the child
that it will only hurt for a short time does nothing to alleviate
hypoxia.
A mother states that she brought her child to the clinic because
the 3-year-old girl was not keeping up with her siblings. During
physical assessment, the nurse notes that the child has pale skin
and conjunctiva and has muscle weakness. The hemoglobin on
admission is 6.4 g/dl. After notifying the practitioner of the
results, the nurse's priority intervention is to:
a. reduce environmental stimulation to prevent seizures.
b. have the laboratory repeat the analysis with a new specimen.
c. minimize energy expenditure to decrease cardiac workload.
d. administer intravenous fluids to correct the dehydration.
Correct Answer ANS: C
