A nurse cares for a client who has an 80% blockage of the right coronary artery (RCA) and is scheduled for bypass surgery. Which intervention should the nurse be prepared to implement while this client waits for surgery?

Correct Answer: B

Rationale: In this scenario, the correct intervention for the nurse to implement while the client with an 80% blockage of the right coronary artery (RCA) waits for bypass surgery is option B: Initiation of an external pacemaker. Rationale for the correct answer: Initiating an external pacemaker is crucial in this situation because a blockage in the RCA can lead to significant cardiac complications, including arrhythmias or heart block. By preparing to initiate an external pacemaker, the nurse can ensure prompt management of any potential dysrhythmias that may arise, providing hemodynamic support and maintaining cardiac output until the surgery can be performed. Rationale for why the other options are incorrect: A) Administration of IV furosemide (Lasix): This option is not the priority intervention in this case. While diuretics like furosemide are commonly used in heart failure management, they are not the immediate concern for a client with a significant blockage in the RCA. C) Assistance with endotracheal intubation: Intubation is not indicated based on the information provided. The client's airway and respiratory status are not directly compromised by the blockage in the RCA. D) Placement of central venous access: While central venous access may be necessary in some cases, it is not the most urgent intervention needed for a client with a blockage in the RCA awaiting bypass surgery. Educational context: Understanding the rationale behind the choice of interventions in cardiovascular disorders, especially in pediatric patients, is crucial for nurses caring for these clients. By prioritizing interventions based on the client's specific condition and needs, nurses can provide safe and effective care, ultimately improving patient outcomes.

Correct Answer: D

Rationale: The child’s leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent’s lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.

Correct Answer: A

Rationale: Tetralogy of Fallot has these four characteristics: pulmonic stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not atrial stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy, is present in tetralogy of Fallot. Tetralogy of Fallot has right ventricular hypertrophy, not left ventricular hypertrophy, and an atrial septal defect, not aortic hypertrophy.

Correct Answer: A

Rationale: In pediatric cardiovascular disorders, the use of angiotensin-converting enzyme (ACE) inhibitors like Captopril (Capoten) is crucial for managing conditions such as hypertension, heart failure, and certain congenital heart defects. The correct answer is A) Captopril (Capoten) because ACE inhibitors work by dilating blood vessels, reducing blood pressure, and improving cardiac function by inhibiting the conversion of angiotensin I to angiotensin II. Option B) Furosemide (Lasix) is a loop diuretic used to treat fluid overload by increasing urine output, but it does not have the same mechanism of action as ACE inhibitors in managing pediatric cardiovascular disorders. Option C) Spironolactone (Aldactone) is a potassium-sparing diuretic that works by blocking aldosterone receptors, mainly used for conditions like heart failure and edema, but not as the first-line treatment for pediatric cardiovascular disorders requiring ACE inhibitors. Option D) Chlorothiazide (Diuril) is a thiazide diuretic used to treat hypertension and edema by increasing urine output, but it does not have the same mechanism of action as ACE inhibitors in managing pediatric cardiovascular disorders. Educationally, understanding the rationale behind selecting the appropriate medication for pediatric cardiovascular disorders is crucial for nurses to ensure safe and effective pharmacological management. Knowledge of drug classes, mechanisms of action, and indications is essential for providing quality care to pediatric patients with cardiovascular conditions.

Correct Answer: A

Rationale: The metabolic rate of infants with heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue. Infants with heart failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest, and a 4-hour schedule is too long. Fluids must be carefully monitored because of the heart failure. Infants do not require supplemental oxygen with feedings.