NURS 167: Nursing Care of Children & Families

Quiz # 2
Unit 3: Circulation
Unit 4: Oxygentation

Hockenberry & Wilson: Wong’s Essentials of Pediatric Nursing, 8th Edition

Chapter 25: The Child with Cardiovascular Dysfunction

1. The nurse’s observations after cardiac catheterization include pedal pulses, temperature
and color of extremities, vital signs every 15 minutes, review of blood pressure for patterns
of hypotension, and evidence of bleeding or hematoma at the site.

2. Classification of congenital heart defects using hemodynamic characteristics divides the

anomalies into four flow patterns: (1. increased pulmonary blood flow, (2) decreased
pulmonary blood flow, (3) obstruction to blood flow, and (4) mixed blood flow.

3. Obstructive defects are those in which blood exiting the heart meets an area of anatomic
narrowing (stenosis).

4. To decrease cardiac demands in an infant with congestive heart failure, the nurse should
organize nursing activities to allow for uninterrupted periods of sleep limit energy
expenditures during feeding, and maintain a normal body temperature.

5. In recent years, hypertension has been detected with routine

measurements in asymptomatic children, especially teenagers. Evidence is accumulating to
indicate that this disorder of adulthood may have its origin in childhood; thus its early
detection is important for prevention and treatment.

6. Describe the pathophysiology, signs/symptoms, and treatment of Tetralogy of Fallot.

Depending on the degree of pulmonary stenosis, size of ventricular septal defect, and pulmonary/systemic
resistance to flow will determine the hemodynamics of the shunt direction. If pulmonary vascular direction is
higher than systemic, then the shunt is right to left. If systemic resistance is higher than pulmonary
resistance, the shunt is from left to right. Pulmonary stenosis decreases blood flow to lungs also affecting the
amount of oxygenated blood that returns to the left side of the heart. Depending on the position of the aorta,
blood from both ventricles can be distributed systemically.
Symptoms/Signs: Some infants may be cyanotic at birth; cyanosis may progress over one year as pulmonary
stenosis worsens; systolic murmur at moderate in intensity. Episodes of cyanosis & hypoxia, anoxic spells
may occur when O2 requirements exceed the blood supply during crying or after feeding. Risk for emboli,
seizures, loss of consciousness, and sudden death from anoxic spell.
Treatment: Elective (complete) repair performed in the first year life, which involves closure of the
ventricular septal defect. If infant cannot undergo primary repair, a palliative to increase pulmonary blood
flow and increase O2 saturation-a modified Blalock-Taussig shunt operation.

7. Streptococcus viridans is the most common causative agent for bacterial endocarditis?
 NURS 167: Nursing Care of Children & Families
Hockenberry & Wilson: Wong’s Essentials of Pediatric Nursing, 8th Edition

Chapter 23: The Child with Respiratory Dysfunction

1. Acute infection of the respiratory tract is the most common

cause of illness in infancy and childhood.

2. Croup syndromes involve acute inflammation and variable

degrees of obstruction of the epiglottis, larynx, or trachea.

3. Common infections of the lower airways are pneumonia,

bronchitis, and respiratory syncytial virus or bronchiolitis.
4. Foreign-born children under 14 years of age have accounted
for more than one third of newly diagnosed cases of tuberculosis in children.

5. Indoor exposure to passive or environmental tobacco smoke

has been linked to asthma in children.

6. What are the three clinical observations that are predictive of epiglottis?
a. absence of spontaneous cough

b. presence of drooling

c. agitation

7. Why should the nurse not examine the throat of a child with suspected epiglottis with a tongue
depressor? Throat inspection should only be attempted when immediate endotracheal
intubation can be performed if needed.

8. Describe the pathophysiology of cystic fibrosis. CF is characterized by increased viscosity of

mucous gland secretions, high elevation of sweat electrolytes, increase in several organic and enzymatic
constituents of saliva, and abnormalities in autonomic nervous system function. The defect is primarily a
result of abnormal chloride movement- decreased pancreatic secretion in both saliva & sweat. The sweat
abnormality is present from birth, continues throughout life, and is unrelated to the severity of the disease or
extent other organs are related. The primary factor involved with many clinical manifestations of the disease
is mechanical obstruction caused by the increased mucus gland secretions.

9. Meconium ileus is the first clinical manifestation of cystic fibrosis.

10. Describe the stools of a child with cystic fibrosis. Bulky, large stools that are frothy from
undigested fat (steatorrhea) and foul smelling from putrefied protein (azotorrhea).

11. What is the purpose of pancreatic enzymes for a child with cystic fibrosis? The pancreatic
enzymes become blocked and therefore do not reach the duodenum causing significant impairment in
digestion and absorption of nutrients.

12. Describe the suggested diet for a child with cystic fibrosis? CF patients require a well balanced,
high protein, high caloric diet up to 150% more of the recommended daily allowances to meet their daily
need for growth and development.