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WorksheetsPEDS Chapter 21: Cardiac
Total questions: 117
Worksheet time: 1hrs 13mins
In response to higher O2 levels, what anatomic structure begins closing 10-15 hours after birth?
Aortic valve
Ductus arteriosus
foramen ovale
tricuspid valve
Due to the increase in left arterial pressure, what structure begins to close after birth?
Foramen ovale
ductus arteriousus
tricuspid valve
atrial valve
Because circulation shifts from fetal to pulmonary circulation within a few hours after birth, what is the result?
Pulmonary blood flow and pulmonary vascular resistance bot increase.
Pulmonary blood flow increases and pulmonary vascular resistance decreases
Pulmonary blood flow decreases and pulmonary vascular resistance increases
Pulmonary blood flow and pulmonary vascular resistance both decrease.
Oxygenated blood moves from the pulmonary vein then to?
Left atrium--> through mitral valve-->Right ventricle-->Aortic valve--> Aorta--> Rest of body.
Left atrium-> through mitral valve->Left ventricle->Aortic valve-> Aorta-> Rest of body.
Mitral Valve ->Aortic valve-> rest of body
Right Atrium->tricuspid Valve-> right ventricle->pulmonary valve->pulmonary artery->lungs
Deoxygenated blood begins from Superior Vena Cava to?
Left Atrium->mitral valve->left ventricle->Aortic valve->Aorta->rest of body
tricuspid valve->right atrium-> right ventricle->pulmonary valve->pulmonary artery->lungs
Right Atrium->tricuspid Valve-> right ventricle->pulmonary valve->pulmonary artery->lungs
Mitral valve->left atrium-> left ventricle-> Aortic valve->aorta->rest of body
An infant comes into the ER. Vitals are taken. What is the abnormality?
BP: 80/40
HR: 170 bmp
BP
HR
Everything is normal
Vitals were measured on a toddler. What is the abnormality?
HR: 120
BP: 90/50
HR
BP
Everything is normal
A school age child comes in and the nurse measures vital signs? What is the abnormality?
HR: 86
BP: 82/48
HR
BP
everything is normal
Vital signs have been taken on a 16 year old. What is the abnormality? Results are:
HR: 45
BP: 118/54
HR
BP
Everything is normal
Mother is worried about her toddler because she saw that her child's HR is 120 bpm and thinks her child needs immediate attention. What should the nurse say to the mother?
"I will call the provider immediately."
"You're child's HR is too high. So, I will go get the medication that will lower the HR."
"This is a normal finding with you're child's age. Normal HR is 80-125 bmp"
"This is a normal finding with you're child's age. Normal HR is 90-160."
What are some Cardiac pediatric differences the new nurse should be aware of?
They have a higher HR but decreases with age.
They have a reduced stroke volume due to limited heart capacity, which puts them at greater risk for heart failure.
They have a greater metabolic need, which increases their heart rate so they can have a higher cardiac output.
Fever, exercise stress, and respiratory distress will result in bradycardia.
What Congenital Heart Diseases are considered increased pulmonary blood flow?
Tetralogy of Fallot
PDA
VSD
ASD
What Congenital heart diseases are considered decreased pulmonary blood flow?
Rheumatic fever
VSD
Tetralogy of Fallot
Tricuspid Atresia
What are considered mixed systemic and pulmonary blood flow?
Tricuspid Atresia
Transportation of the Great Arteries (TGA)
Truncus Arteriosus
Tetralogy of Fallot
How many known congenital heart defects are there?
Only 35 known defects
Only 5 known defects
More than 35 known defect
Less than 35 known defects.
What is the survivability percentage of a congenital heart defect if found early?
20%
65%
greater than 85%
70%
What would you try and look for upon auscultation with a patient with a CHD? (select all that apply)
Tachypnea
Murmurs
Wt. gain
Fluid in lungs
What would you try and look for upon inspection with a toddler suspected to have a CHD? (select all that apply)
sunken fontanel
Cyanosis
sunken eyes
Squatting
Edema in face
What would you palpate on a child suspected to have CHD? (select all that apply)
Normal Pulses felt
Diminished pulses
Peripheral edema
No peripheral edema
A nurse assesses a toddler suspected to have a congenital defect. What findings should be expected?
Tachycardia
Tachypnea
URI
Cyanosis
What are manifestations of congestive heart failure in an infant? (select all that apply)
Gains weight
Sweats
Tires easily when feeding
irritable
What are manifestations of CHF in a child? (select all that apply)
tachypnea
Exercise intolerance
abdominal pain
Peripheral Edema
Skin mottling
What are signs of fluid retention?
grunting
Edema in face
crackles
Jugular Vein Distention
To treat congestive heart failure, we must reduce cardiac workload. How do we do this?
ambulation
Rest
oxygen
positioning
To treat CHF, we must improve cardiac output. How do we do this?
positioning
Digoxin
diuretics
rest
To treat CHF, we must remove excess fluid. How do we do this?
digoxin
positioning
Diuretics
rest
As CHF progresses, what will the nurse expect to find?
stridor
Tachycardia
tachypnea
Nasal flaring and grunting
dyspnea
What would you find in an ultra sound with a child with CHF?
Hydronephrosis
Hepatomegaly
Colitis
Cardiomegaly
A child with CHF has an order of Digoxin. What must the nurse do before administering the medication?
Give diuretic instead if you notice child has more facial edema.
Administer it as ordered.
Palpate apical pulse for 1 minute.
Ask parent if child needs it.
An infant has an order for Digoxin for CHF. The nurse palpates a pulse of 92 bpm. What should the nurse do next?
Administer the medication.
Hold and call the provider.
What should the nurse monitor for a child on diuretics for CHF?
Monitor Electrolytes
Accurate I&O
Respiratory sounds
cardiac sounds.
A child with CHF should have rest as treatment. What should the nurse intervene?
Plan to give all meds at the same time.
Plan activities
Plan feeding schedule
What interventions should the nurse do for a child with CHF?
promote high-calorie nutrition
protect skin
rest
infection control
What family teaching should the nurse do for a child who has CHF?
educate on who can be in the room with child
educate on medication administration and side effects
support child and family by educating on effects of disease, tx, emotional, and financial impact
educate on optimizing development physically and cognitively
Which increased pulmonary blood flow defect is the only one that shows cyanosis in a child?
PDA
VSD
ASD
Which defect is a failure of the ductus arteriosus to close within the first few weeks of life ?
PDA
VSD
ASD
Who is at risk for having a PDA?
children ages 2-4
Premature infants
Adolescents who play football
infants in high altitudes.
What is the treatment for PDA? (select all that apply)
Zofran
Ibuprofen
indomethacin
Aspirin
If medication doesn't work to close the ductus arteriosus in a child with PDA, What kind of surgery will then be done?
Heart transplant
Ligation
CABG
Aortic valve replacement
Upon physical examination of an infant with PDA, what will the nurse expect to find? (select all that apply)
widened pulse pressure
Tachycardia
Tachypnea
Bounding peripheral pulses
cyanosis
A nurse will know that it is PDA when they find out what during collecting information on health history?
frequent respiratory infections
fatigue
poor growth and development
Squating
What defect is a hole in the wall dividing the right and left atrium?
ASD
VSD
PDA
What kind of shunting does ASD permit?
Left to right
right to left
no shunting
In ASD, if the hole is small, approximately what age will it spontaneously close?
2 years old
4 years old
6 years old
3 years old
A parent is concerned about her child because the doctor says that her child will need surgical closure of her ASD if it does not close by 2 years of age. What signs and symptoms should the parent be educated on until then?
Pulmonary HTN
S/S of CHF
Atrial arrhythmias
Cyanosis
A parent feels guilty because she did not know her child had an ASD from birth. What should the nurse tell the parent?
"Most kids are asymptomatic, but can exhibit SOB, fatigue, and growth retardation. So, you couldn't have known."
"It's okay. We will do the best we can to save your child"
"Your child should have shown many symptoms. You shouldn't feel guilty if you didn't notice them."
What defect is an opening between the right and left ventricles?
ASD
VSD
PDA
What is the most common defect ?
VSD
ASD
PDA
TGA
With VSD, small holes can close on their own by what age?
4 years old
3 months
6 months
10-21 days
What is Eisenmenger Syndrome?
Squatting and cyanosis
An infection in a valve
A type of Murmur
Pulmonary HTN and Cyanosis
VSD can develop into what syndrome?
Pulmonic stenosis
Eisenmenger syndrome
Polycythemia
What is an infant with VSD at risk for?
Infective endocarditis
Pulmonic stenosis
Rheumatic fever
Aortic valve regurgitation
Upon auscultation of an infant with VSD, what should the nurse expect to auscultate?
Diastolic harsh murmur along right sternal border
Systolic harsh murmur along right sternal border
Diastolic harsh murmur along left sternal border
Systolic harsh murmur along left sternal border
What 4 signs indicate the child might have a DECREASED pulmonary blood flow?
Clubbing
Squating
Cyanosis
Syncope
URI
With Decreased pulmonary blood flow what side does the shunting occur?
right to left
left to right
What may result due to hypoxia of the kidneys with Tetralogy of Fallot?
hyperlipidemia
Polycythemia
Thrombocytosis
hypokalemia
What 4 defects does tetralogy of Fallot consists of?
pulmonary stenosis
overriding Aorta
VSD
Right ventricular hypertrophy
rheumatic fever
With Tetralogy of Fallot, You hear a murmur as while what structure closes?
Ductus arteriosus
foramen ovale
How is Tetralogy of Fallot diagnosed in 1st weeks of life?
Cyanosis
tachypnea
Murmur
tachycardia
What is a characteristic of Tetralogy of Fallot?
Loud, harsh systolic murmur
cyanotic squat
polycythemia
poor growth
What might a nurse find with tetralogy of Fallot?
Hypercyanotic spells
Polycythemia
poor growth
edema in face
Children with a decreased pulmonary blood flow defect will squat. Why?
because they have gas they want to release
because it will increase the return of systemic venous blood to the heart.
Because it will decrease the return of systemic venous blood to the heart.
Because it gives a warning to the parent that they can't breathe.
What is polycythemia?
it occurs when the kidneys stimulate increased RBC by producing erythropoietin causing the blood to be viscous and increasing the work load of the heart.
it occurs when the kidneys stop producing erythropoietin causing the blood to be viscous and increasing the work load of the heart.
What is pulmonic stenosis?
the pulmonary valve dilates causing blood to flow to the pulmonary artery
the pulmonary valve is narrowed an causing blood flow to obstruct to the pulmonary artery.
An infant with pulmonic stenosis is treated with antibiotics lifelong to prevent what?
rheumatic fever
strep A
infective Endocarditis
A pulmonic stenosis is treated with what?
ligation
Balloon dilation of the valve
valvotomy
Valve replacement
Mild pulmonic stenosis shows what symptoms?
Cyanosis
assymptomatic
Murmur
chest pain
Moderate pulmonic stenosis shows what symptoms?
dyspnea
fatigue with exertion
cyanosis
murmur
Severe Pulmonic Stenosis shows what symptoms?
asymptomatic
Heart Failure
Chest pain
cyanosis
Loud ejection murmur
When a child is having a hypercyanotic episode what is the first thing you do?
give O2
Put in knee to chest to increase systemic vascular resistance
administer Morphine
start an IV fluid bolus
After placing an infant in knee to chest position during a Hyper Cyanotic Episode and it does not work, what should you do next?
Give 02
Reduce irritating/painful stimuli
Morphine
Beta blocker
What defect is when a pulmonary artery and aorta are transposed from their normal positions?
TGA
VSD
ASD
PDA
What defect almost always occurs with a TGA to allow survival of infant?
PDA
ASD
VSD
What structure do we want to keep open with TGA because if it stays open will worsen symptoms?
Ductus arteriosus
Foramen Ovale
Corrective surgery for TGA is within how many days of age?
4 to 7 days of age
10-14 days of age
2-3 days of age
With TGA, if the parent decides that they don't want their child to have surgery, what is the most important information they must know?
without surgery the defect will correct itself at 4 yoa.
Without surgery the child will die.
without surgery the child will develop rheumatic fever
What is administered to keep PDA open for TGA until corrective surgery?
Ibuprophen
ASA
Zofran
Prostaglandin E
A toddler is started on digoxin (Lanoxin) for cardiac failure. Which is the initial symptom the nurse would assess if the child develops digoxin (Lanoxin) toxicity?
Lowered BP
Ataxia
Change in heart rhythm
Tinnitus
With TGA what will the infant have?
Cyanosis
child will be Hypoxic
CHF
FTT
Dyspnea
With Truncus arteriosus, a single vessel empties both ventricles and provides....
Systemic
pulmonary
coronary circulation
lymphatic
With Truncus Arteriosus, the infant will have?
dyspnea
Cyanosis
CHF
increased pulse pressure
How is truncus arteriosus treated?
Diuretics
digoxin
VSD is closed
ASA
Ibuprophen
What is a condition when all of the structures on the left side of the heart are severely undeveloped?
TGA
Hypoplastic left heart syndrome (HLHS)
ASD
VSD
With HLHS, what valves are completely closed or very small?
Pulmonary
Mitral
Aortic
tricuspid
What is the treatment for HLHS ?
Hospice care
Palliative care
Palliative reconstructive surgery consisting of 3 stages
Cardiac transplantation
What S/S are found in an infant with HLHS?
increased WOB
Tachycardia
Tachypnea
hypothermia
No cyanosis
Upon auscultation of an infant with HLHS what would you expect to hear?
Holosystolic murmur
gallop rhythm
single second heart sound
soft systolic ejection
Loud harsh systolic murmur
Cardiac pediatric patient need what nutrition wise?
Need more calories
Feed high calorie, small amounts
Brest feed to keep sucking reflex then finish with NG tube
Low-residue food
What puts a child at risk for an acquired heart disease?
Dehydration
Post-strep infection
Post-heart surgery
Congenital heart defects
How do you diagnose infective carditis?
Echocardiogram
Blood culture
CBC
Urinalysis
Lipid panel
For infective endocarditis, what does a urinalysis show?
elevated specific gravity
yellow, cloudy urine
hematuria
decreased specific gravity
With a CBC for infective endocarditis, what are the expected findings?
ESR and CRP elevated
Anemia
leukocytosis
thrombocytosis
With infective endocarditis, an echocardiogram will show?
area of vegetation
cardiomegaly
abnormal valve function
small heart
An infant comes into the ER with symptoms of fever, HA, joint and muscle pain, wt. loss, and diaphoresis. What is the most likely cause?
infective endocarditis
rheumatic fever
kawasaki disease
Dyslipidemia
What are Roth Spots?
red painful nodules on finger and toe pads
Exudative lesions on retina.
bulging eyes
What is olser nodes?
Red painful nodules on finger and toe pads
exudative lesions on retina
bulging eyes
a type of dehydration
What can occur with having infective endocarditis?
Bulging eyes
Roth Spots
Osler Nodes
Hepatomegaly
What are Janeway lesions and what does it occur with?
occurs with infective endocarditis and is nontender, blanching macular lesions on palms and soles.
It occurs with rheumatic fever and is nontender, blanching macular lesions on palms and soles.
occurs with infective endocarditis and is tender, nonblanching macular lesions on palms and soles.
What should the child be on prophylactically with infective endocarditis?
ASA to prevent chest pain
antibiotics prior to surgical procedures and 6 months after
antibiotics prior to dental procedures; amoxicillin or ampicillin 30-60 minutes prior to procedure
ibuprofen to prevent fever
Rheumatic fever follows group A strep infection how many weeks after?
1-2 weeks
2-3 weeks
3-4 weeks
Due to the damage to the heart and valves with rheumatic fever what can develop?
infective endocarditis
Congestive heart failure
Kawasaki disease
Dyslipidemia
What is a hallmark sign in rheumatic fever?
infective endocarditis after 1-3 weeks of untreated step A
new murmur 1-3 weeks after untreated step A
How do we diagnose rheumatic fever?
strep test
2 major from Jones Criteria
1 major, 2 minor, throat culture or ASO titer
temperature
How can you treat rheumatic fever?
10 day PCN
Corticosteroids
NSAIDS-ASA
ibuprofen
With rheumatic fever, the child should be prophylactically on?
ASA
PCN monthly IM until adult hood without valve disease or 40 yoa with valve disease
Ibuprofen
What are major criteria in jones criteria ?
carditis
Sydenham chorea
fever
subcutaneous nodules
migratory polyarthritis
what are minor criteria from Jones criteria?
erythema marginatum
arthralgia
elevated erythrocyte sedimentation rate or CRP
prolonged PR interval
fever
A child comes into ER with suspected Kawasaki Disease (Vasculitis). The child has chills, malaise, vomiting diarrhea, strawberry tongue, and high fever for 5 days now that is unresponsive to antibiotics. What stage is the child in?
convalescent stage
subacute
Acute
What surgical procedure is done to permanently correct an SVT?
ligation
Ablation
Valve replacement
An infant comes into the ER with signs of poor feeding, irritability and pallor. What might this indicate?
SVT
ASD
TGA
PDA
Adolescent comes to ER with suspected SVT. What symptoms will confirm this?
Palpitations and Syncope
Chest pain and SOB
Exercise intolerance and diaphoresis
Cyanosis and irritability
The nurse is admitting an infant diagnosed with supraventricular tachycardia. Which intervention is the priority for this infant?
Apply ice to face
perform Valsalva maneuver
cardioversion
Administer beta blocker
The nurse is providing care to a school-age client admitted to the emergency department following a motor vehicle crash. The client is exhibiting symptoms of hypovolemic shock. Which nursing interventions are appropriate for this client? Select all that apply.
Monitor hemoglobin and hematocrit.
Monitor liver enzymes.
Administer oxygen, as needed.
Administer a dextrose solution.
Monitor blood glucose.
What medication is the first given drug for SVT?
adenosine
Amiodarone
Aspirin
Ibuprofen
If vagal stimulation and medications don't permanently make an SVT go away, what should they try next?
Valsalva maneuver
Albation
Cardioversion
ice to face
How many bmp in an infant and child will indicate SVT?
160/min for children
220/min for infants
180/min for children
125/min for infants
Long QT syndrome is inherited.
True
False
