Nokea
A 6-year-old child is scheduled for a cardiac catheterization. What consideration is most important in planning preoperative teaching?
- A. Preoperative teaching should be directed at his parents because he is too young to understand.
- B. Preoperative teaching should be adapted to his level of development so that he can understand.
- C. Preoperative teaching should be done several days before the procedure so he will be prepared.
- D. Preoperative teaching should provide details about the actual procedures so he will know what to expect.
Correct Answer: B
Rationale: Teaching adapted to a 6-year-old?s developmental level ensures understanding and reduces anxiety. Parents benefit but the child needs tailored explanations. Detailed procedures are too complex for this age, and teaching close to the procedure time is sufficient.
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What statement best identifies the cause of heart failure (HF)?
- A. Disease related to cardiac defects
- B. Consequence of an underlying cardiac defect
- C. Inherited disorder associated with a variety of defects
- D. Result of diminished workload imposed on an abnormal myocardium
Correct Answer: B
Rationale: Heart failure results from the heart?s inability to pump sufficient blood, often due to congenital defects causing increased volume or pressure. It?s not a primary disease, not typically inherited, and involves increased, not diminished, myocardial workload.
A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate?
- A. 60 beats/min
- B. 90 beats/min
- C. 100 beats/min
- D. 120 beats/min
Correct Answer: B
Rationale: For infants and young children, digoxin is withheld if the 1-minute apical pulse is below 90 beats/min to prevent toxicity. A rate of 60 is the adult threshold, and 100-120 beats/min are acceptable for administration.
Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infants status, which finding is indicative of achieving this goal?
- A. Irritability when awake
- B. Capillary refill of more than 5 seconds
- C. Appropriate weight gain for age 18
- D. Positioned in high Fowler position to maintain oxygen saturation at 90%
Correct Answer: C
Rationale: Appropriate weight gain indicates successful feeding and reduced caloric loss, reflecting decreased cardiac demand. Irritability and prolonged capillary refill suggest ongoing HF, and high Fowler positioning aids breathing but doesn?t confirm reduced cardiac strain.
The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. What strategy is an important objective to decrease this risk?
- A. Minimize seizures.
- B. Prevent dehydration.
- C. Promote cardiac output.
- D. Reduce energy expenditure.
Correct Answer: B
Rationale: Preventing dehydration reduces stroke risk in hypoxic children with polycythemia, as dehydration increases blood viscosity. Seizure control, cardiac output, and energy expenditure are important but don?t directly address stroke risk.
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 which condition?
- A. Cyanosis
- B. Heart failure
- C. Decreased pulmonary blood flow
- D. Bounding pulses in upper extremities
Correct Answer: B
Rationale: Left-to-right shunting increases pulmonary blood flow, overloading the right heart and leading to heart failure. Cyanosis and decreased pulmonary flow occur with right-to-left shunts, and bounding pulses are specific to coarctation of the aorta.