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Pediatric Cardiovascular System

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A baby has been sedated in order to get an Echo. What medication was most likely used and what are the nursing implications of this?
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Versed. The baby needs to be monitored every 15 minutes from the administration of the drug and for at least 1-2 hours post-procedure.
What is a transesophageal echocardiogram (TEE) and when would it be used?
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It is a transducer inserted into the mouth to the esophagus. It transmits ultrasound waves through less tissue to achieve high quality images of the heart. Can be used for same purposes of regular echo. It would be used when there is too much interference during a standard echo from fat, bone or other tissues
A pediatric patient is scheduled to have TEE. What are the nursing implications related to this procedure that should be considered in advance?
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The patient should be NPO 4-6 hours prior. Babies can be given glucose water up until 1-2 hours before. Need to get informed consent
Why is Versed used for a TEE?
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The patient needs to be able to swallow during the procedure, requiring conscious sedation
During a TEE, viscous lidocaine is given before the probe is inserted and then Hurricane spray is sprayed into the back of the throat. What is the best indication that the throat is numb?
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Absence of a gag reflex
T/F A bite block is used during a TEE in case a seizure occurs to prevent damage to the patient's tongue.
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False. A bite block is inserted to protect the probe from being bitten
What are some nursing implication during and after a TEE?
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VItals need to be monitored frequently, the patient is NPO until the gag reflex returns, and they need to be monitored for aspiration and respiratory depression.
What is a cardiac catheterization used to assess?
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It is used to visualize coronary perfusion (but usually not a problem in babies), measure different pressures in the different chambers, visualize blood flow (using IV contrast).
What diagnostic test is used to visualize coronary perfusion, measure different pressures in the different chambers of the heart, and visualize blood flow (using IV contrast).
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Cardiac catheterization
A child is having a cardiac catheterization to visualize the left side of the heart. You know that the catheter will need to be inserted into a/an ________.
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Artery, usually the femoral
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A child is having a cardiac catheterization to visualize the right side of the heart. You know that the catheter will need to be inserted into a/an ________.
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Vein, the right side of the heart is venous
What are pre-procedural activities for a cardiac catheterization?
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Get informed consent, assess for allergies to the dye (shellfish/iodine, measure pulses distal to the insertion site, and mark them with a marker so they can be easily relocated. Educate them on what to expect Need to assess BUN/creatinine in advance to ensure kidney function is good. Want to look for s/s of infections prior to the procedure. Must be NPO about 8 hours, but again, babies/infants can have sugar water up to 1-2 hours prior. Morning meds may be held, anything that will thin their blood will definitely be held (like aspirin).
Prior to a cardiac catheterization, allergies to ________ must be assessed.
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Shellfish (iodine is used)
Prior to a cardiac catheterization, the presence of ___________ is an absolute contraindication for the procedure.
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Diaper rash.
T/F A patient who has an allergy to shellfish will be unable to have a cardiac catheterization due to the use of dye during the procedure.
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False, medications are given in advance to prevent a reaction from occurring.
T/F A patient who has poor kidney function will be unable to have a cardiac catheterization due to the use of dye during the procedure.
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False, medication is given in advance to prevent injury to the kidneys
T/F Prior to a cardiac catheterization, distal pulses should be assessed and the area marked with a marker so they can be easily found again post-procedure.
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True
After a cardiac catheterization, vital signs and pulses will be assessed every ________.
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15 minutes
It is important to assess the extremities distal to the insertion site of a cardiac catheter. What specifically is assessed?
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Pulses, capillary refill, warmth, color, and sensation.
What is a patient likely to feel when the dye is injected during a cardiac catheterization?
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A warm, flushed feeling or they may feel like the peed on the table. Warm them of this possibility prior to the procedure.
After a cardiac catheterization, what is it important to monitor the patient for in order to recognize potential complications?
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Hypotension, bleeding from the insertion site, loss of circulation to the extremities, dysrhythmias, development of a hematoma, nausea or vomiting
  
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