NURS 232 PEDS EXAM 4 | LATEST 2023-2024 | REAL EXAM WITH 200 QUESTIONS & COMPREHENSIVE,
VERIFIED ANSWERS WITH RATIONALES
What should nurses stress when counseling parents regarding the home care of the child with a
cardiac defect before corrective surgery?
a) The importance of reducing caloric intake to decrease cardiac demands
b) The importance of relaxing discipline and limit setting to prevent crying
c) The need to be extremely concerned about cyanotic spells
d) The desirability of promoting normalcy within the limits of the child's condition
d) The desirability of promoting normalcy within the limits of the child's condition
*child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be
encouraged to promote as normal a life as possible for their child.
*child needs increased caloric intake after cardiac surgery.
*cyanotic spells will occur in children with some defects, the parents need to be taught how to assess
for and manage them appropriately, thereby decreasing their anxiety and concern.
A young child with tetralogy of Fallot (TOF) may assume a posturing position as a compensatory
mechanism. The position automatically assumed by the child is
a) the low Fowler position.
b) the prone position.
c) the supine position.
d) the squatting position.
d) the squatting position.
*squatting or knee-chest position increases the return of blood flow to the heart for oxygenation in a
child with a defect that consists of decreased pulmonary blood flow
What is an important nursing responsibility when a dysrhythmia is suspected?
a) Order an immediate electrocardiogram.
b) Count the radial pulse every 1 minute for five times.
c) Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate.
d) Have someone else take the radial pulse simultaneously with the apical pulse.
c) Count the apical pulse for 1 full min and compare the rate with the radial pulse rate.
*If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate.
What is considered a mixed cardiac defect?
a) Pulmonic stenosis (PS)
b) Atrial septal defect (ASD)
c) Patent ductus arteriosus (PDA)
d) Transposition of the great arteries (TGA)
d) Transposition of the great arteries
*allows the mixing of both oxygenated and unoxygenated blood in the heart.
,*PS is an obstructive defect
*ASD and PDA increased pulmonary blood flow
What is the cast care that should be taught to families?
*refer to "families want to know care of the child w a cast"
-check skin around edges for irritation, rubbing, blistering
-cleanse skin just under cast edges w cotton-tipped applicator & rubbing alcohol
-no lotions, oils, or powder near cast
-no poking objects down inside cast
-keep cast dry; protect w cast shoe, thick sock, or sling
-allow new west cast air-dry 24 hrs and raise on pillow above heart to prevent swelling
-begin walking on leg cast ONLY when physician approves
-skin should be pink, warm, & blanch when pinched
What should the parents of a child w cast be educated on when to notify the physician?
*refer to families want to know care of child w cast
**NOTIFY:
-unusual odor, burning, tingling, numbness, drainage, swelling
-fingers/toes blue or white and inability to move
-slippage of cast
-cracked, soft, or loose cast
-sudden unexplained fever
-unusual fussiness or irritability in child
-pain that's not relieve by comfort (repositioning or pain meds)
After a patient returns from cardiac catheterization, the nurse notes that the pulse distal to the
catheter insertion site is weaker (+1). The most appropriate nursing intervention is to
a) elevate the affected extremity.
b) document the findings and continue to monitor.
c) notify the health care provider of the finding.
d) apply warm compresses to the insertion site.
b) document the findings and continue to monitor.
*Weaker distal pulse is expected for the first few hours after catheterization. It should gradually
increase in strength.
*The extremity is kept straight and immobile, but elevation is not necessary.
*The insertion site is kept dry. Warm compresses would increase the risk of bleeding from the
insertion
Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on
the nurse's knowledge of congenital heart defects, this system in clinical practice is
a) helpful, because it explains the hemodynamics involved.
b) helpful, because children with cyanotic defects are easily identified.
,c) problematic, because cyanosis is rarely present in children.
d) problematic, because children with acyanotic heart defects may develop cyanosis.
d) problematic, because children with acyanotic heart defects may develop cyanosis.
*does not reflect the blood flow within the heart. Cardiac defects are best described by using the
actual pathophysiologic process and mechanism. Cyanosis is present when children have defects
where there is mixing of oxygenated blood with unoxygenated blood.
Nursing care of the infant and child with congestive heart failure includes
a) force fluids appropriate to age.
b) monitor respirations during active periods.
c) organize activities to allow for uninterrupted sleep.
d) give larger feedings less often to conserve energy.
c) organize activities to allow for uninterrupted sleep.
*needs to be well rested before feeding and their needs should be met to minimize crying. The nurse
must organize care to decrease energy expenditure.
*pts w CHF have an excess of fluid, so forcing fluids is contraindicated.
*Monitoring of VS is appropriate, but minimizing energy expenditure is a priority.
*often cannot tolerate larger feedings; small, frequent feedings should be given
A physician suspects that a child may have congenital cardiac disease. Which noninvasive diagnostic
procedure would help to confirm the possibility of heart disease?
a) EKG
b) Echocardiogram
c) Chest x-ray
d) Pulse oximetry
b) Echocardiogram
* used to identify either a cardiac anomaly or evidence of heart disease.
*EKG provides evidence of electrical system conduction.
*Pulse oximetry provides information relative to perfusion.
*chest x-ray focuses on lungs and airway exchange, it may not be sensitive and specific to determine
cardiac pathology.
An adolescent is being treated for new-onset HTN. 1st line therapy previously tried was with dietary
management but the decision has now been made to start oral meds. Which complaint if provided by
the pt would indicate a potential concern?
a) Pt states that he is no longer losing weight after being on the med for one week's time.
b) Pt states he is maintaining his oral intake of 8 glasses of water a day.
c) He is taking the med in the evening rather than taking the medication in the morning as prescribed
as he thinks that he feels better and has less side effects.
d) He reports that he occasionally feels "lightheaded" when getting out of a chair during the course of
the school day in some of his classes.
, d) He reports that he occasionally feels "lightheaded" when getting out of a chair during the course of
the school day in some of his classes.
*Safety aspects should be considered with use of anti-hypertensives and the possibility of orthostatic
hypotension
The goals of therapeutic management for CHF is to
a) increase afterload and perfusion to tissues.
b) decrease preload and increase afterload.
c) decrease preload, afterload and increase contractility.
d) decrease contractility and increase preload and afterload.
c) decrease preload and afterload, and increase contractility.
*Treatment is aimed at decreasing preload (volume), afterload (resistance) and increasing
contractility (improving efficiency).
The nurse should explain to the parents that their child is receiving furosemide (Lasix) for CHF bc of its
effects as a
a) diuretic.
b) beta-blocker.
c) form of digitalis.
d) ACE inhibitor.
a) diuretic.
*loop diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated
w CHF which can result from increased amount of blood pumped to lungs
*CHF is the priority complication of increased pulmonary blood flow like ASD, VSD, or PDA; mixed
defects like TGA
*can also treat CHF by correcting defect, other diuretic like aldactone, ACEI, digoxin
What procedure uses high-frequency sound waves obtained by a transducer to produce an image of
cardiac structures?
a) Echocardiography
b) Electrocardiography
c) Cardiac catheterization
d) Electrophysiology
a) Echocardiography
* The child must lie completely still.
*With the improvements in technology, a diagnosis can sometimes be made without cardiac
catheterization.
What is an early sign of congestive heart failure that the nurse should recognize?
a) Tachypnea
VERIFIED ANSWERS WITH RATIONALES
What should nurses stress when counseling parents regarding the home care of the child with a
cardiac defect before corrective surgery?
a) The importance of reducing caloric intake to decrease cardiac demands
b) The importance of relaxing discipline and limit setting to prevent crying
c) The need to be extremely concerned about cyanotic spells
d) The desirability of promoting normalcy within the limits of the child's condition
d) The desirability of promoting normalcy within the limits of the child's condition
*child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be
encouraged to promote as normal a life as possible for their child.
*child needs increased caloric intake after cardiac surgery.
*cyanotic spells will occur in children with some defects, the parents need to be taught how to assess
for and manage them appropriately, thereby decreasing their anxiety and concern.
A young child with tetralogy of Fallot (TOF) may assume a posturing position as a compensatory
mechanism. The position automatically assumed by the child is
a) the low Fowler position.
b) the prone position.
c) the supine position.
d) the squatting position.
d) the squatting position.
*squatting or knee-chest position increases the return of blood flow to the heart for oxygenation in a
child with a defect that consists of decreased pulmonary blood flow
What is an important nursing responsibility when a dysrhythmia is suspected?
a) Order an immediate electrocardiogram.
b) Count the radial pulse every 1 minute for five times.
c) Count the apical pulse for 1 full minute, and compare the rate with the radial pulse rate.
d) Have someone else take the radial pulse simultaneously with the apical pulse.
c) Count the apical pulse for 1 full min and compare the rate with the radial pulse rate.
*If a dysrhythmia is occurring, the radial pulse rate may be lower than the apical pulse rate.
What is considered a mixed cardiac defect?
a) Pulmonic stenosis (PS)
b) Atrial septal defect (ASD)
c) Patent ductus arteriosus (PDA)
d) Transposition of the great arteries (TGA)
d) Transposition of the great arteries
*allows the mixing of both oxygenated and unoxygenated blood in the heart.
,*PS is an obstructive defect
*ASD and PDA increased pulmonary blood flow
What is the cast care that should be taught to families?
*refer to "families want to know care of the child w a cast"
-check skin around edges for irritation, rubbing, blistering
-cleanse skin just under cast edges w cotton-tipped applicator & rubbing alcohol
-no lotions, oils, or powder near cast
-no poking objects down inside cast
-keep cast dry; protect w cast shoe, thick sock, or sling
-allow new west cast air-dry 24 hrs and raise on pillow above heart to prevent swelling
-begin walking on leg cast ONLY when physician approves
-skin should be pink, warm, & blanch when pinched
What should the parents of a child w cast be educated on when to notify the physician?
*refer to families want to know care of child w cast
**NOTIFY:
-unusual odor, burning, tingling, numbness, drainage, swelling
-fingers/toes blue or white and inability to move
-slippage of cast
-cracked, soft, or loose cast
-sudden unexplained fever
-unusual fussiness or irritability in child
-pain that's not relieve by comfort (repositioning or pain meds)
After a patient returns from cardiac catheterization, the nurse notes that the pulse distal to the
catheter insertion site is weaker (+1). The most appropriate nursing intervention is to
a) elevate the affected extremity.
b) document the findings and continue to monitor.
c) notify the health care provider of the finding.
d) apply warm compresses to the insertion site.
b) document the findings and continue to monitor.
*Weaker distal pulse is expected for the first few hours after catheterization. It should gradually
increase in strength.
*The extremity is kept straight and immobile, but elevation is not necessary.
*The insertion site is kept dry. Warm compresses would increase the risk of bleeding from the
insertion
Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on
the nurse's knowledge of congenital heart defects, this system in clinical practice is
a) helpful, because it explains the hemodynamics involved.
b) helpful, because children with cyanotic defects are easily identified.
,c) problematic, because cyanosis is rarely present in children.
d) problematic, because children with acyanotic heart defects may develop cyanosis.
d) problematic, because children with acyanotic heart defects may develop cyanosis.
*does not reflect the blood flow within the heart. Cardiac defects are best described by using the
actual pathophysiologic process and mechanism. Cyanosis is present when children have defects
where there is mixing of oxygenated blood with unoxygenated blood.
Nursing care of the infant and child with congestive heart failure includes
a) force fluids appropriate to age.
b) monitor respirations during active periods.
c) organize activities to allow for uninterrupted sleep.
d) give larger feedings less often to conserve energy.
c) organize activities to allow for uninterrupted sleep.
*needs to be well rested before feeding and their needs should be met to minimize crying. The nurse
must organize care to decrease energy expenditure.
*pts w CHF have an excess of fluid, so forcing fluids is contraindicated.
*Monitoring of VS is appropriate, but minimizing energy expenditure is a priority.
*often cannot tolerate larger feedings; small, frequent feedings should be given
A physician suspects that a child may have congenital cardiac disease. Which noninvasive diagnostic
procedure would help to confirm the possibility of heart disease?
a) EKG
b) Echocardiogram
c) Chest x-ray
d) Pulse oximetry
b) Echocardiogram
* used to identify either a cardiac anomaly or evidence of heart disease.
*EKG provides evidence of electrical system conduction.
*Pulse oximetry provides information relative to perfusion.
*chest x-ray focuses on lungs and airway exchange, it may not be sensitive and specific to determine
cardiac pathology.
An adolescent is being treated for new-onset HTN. 1st line therapy previously tried was with dietary
management but the decision has now been made to start oral meds. Which complaint if provided by
the pt would indicate a potential concern?
a) Pt states that he is no longer losing weight after being on the med for one week's time.
b) Pt states he is maintaining his oral intake of 8 glasses of water a day.
c) He is taking the med in the evening rather than taking the medication in the morning as prescribed
as he thinks that he feels better and has less side effects.
d) He reports that he occasionally feels "lightheaded" when getting out of a chair during the course of
the school day in some of his classes.
, d) He reports that he occasionally feels "lightheaded" when getting out of a chair during the course of
the school day in some of his classes.
*Safety aspects should be considered with use of anti-hypertensives and the possibility of orthostatic
hypotension
The goals of therapeutic management for CHF is to
a) increase afterload and perfusion to tissues.
b) decrease preload and increase afterload.
c) decrease preload, afterload and increase contractility.
d) decrease contractility and increase preload and afterload.
c) decrease preload and afterload, and increase contractility.
*Treatment is aimed at decreasing preload (volume), afterload (resistance) and increasing
contractility (improving efficiency).
The nurse should explain to the parents that their child is receiving furosemide (Lasix) for CHF bc of its
effects as a
a) diuretic.
b) beta-blocker.
c) form of digitalis.
d) ACE inhibitor.
a) diuretic.
*loop diuretic used to eliminate excess water and salt to prevent the accumulation of fluid associated
w CHF which can result from increased amount of blood pumped to lungs
*CHF is the priority complication of increased pulmonary blood flow like ASD, VSD, or PDA; mixed
defects like TGA
*can also treat CHF by correcting defect, other diuretic like aldactone, ACEI, digoxin
What procedure uses high-frequency sound waves obtained by a transducer to produce an image of
cardiac structures?
a) Echocardiography
b) Electrocardiography
c) Cardiac catheterization
d) Electrophysiology
a) Echocardiography
* The child must lie completely still.
*With the improvements in technology, a diagnosis can sometimes be made without cardiac
catheterization.
What is an early sign of congestive heart failure that the nurse should recognize?
a) Tachypnea
