The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to:

Correct Answer: D

Rationale: In this scenario, the correct action for the nurse to take is option D, which is to apply direct pressure 1 inch above the puncture site. This is the most appropriate initial intervention to control the bleeding from the cardiac catheterization site. Direct pressure helps to promote hemostasis and prevent further blood loss, which is crucial in this situation to stabilize the child. Option A, calling the interventional cardiologist, and option B, notifying the cardiac catheterization laboratory, are not the first actions to take in a situation where active bleeding is present. These actions may lead to delays in providing immediate care to the child. Option C, applying a bulky pressure dressing over the present dressing, is also not the best initial action as it does not address the source of bleeding directly. In cases of active bleeding, direct pressure is more effective in controlling and stopping the bleeding. In an educational context, it is important for nurses caring for pediatric patients post-cardiac catheterization to be prepared to manage potential complications such as bleeding. Understanding the correct steps to take in emergency situations like this can help nurses provide prompt and effective care to ensure the safety and well-being of their patients.

Correct Answer: B

Rationale: In the context of a pediatric nursing cardiovascular NCLEX practice quiz, the correct answer to the question, "Which finding might delay a cardiac catheterization procedure on a 1-year-old?" is option B) Severe diaper rash. Rationale: Severe diaper rash can delay a cardiac catheterization procedure in a 1-year-old due to the risk of infection. Performing a cardiac catheterization involves inserting a catheter through the skin into blood vessels, which can introduce bacteria and increase the risk of infection. Therefore, it is crucial to ensure that the skin is free from any open wounds or infections before proceeding with the procedure. Option A) 30th percentile for weight is not a contraindication for cardiac catheterization. While weight can be a factor in determining medication dosages or equipment sizes, it alone would not usually delay the procedure. Option C) Allergy to soy is also not directly related to delaying a cardiac catheterization procedure unless the contrast medium used during the procedure contains soy, which can be easily substituted with a different contrast medium if needed. Option D) Oxygen saturation of 91% on room air is slightly lower than the normal range but is not significantly low enough to typically delay a cardiac catheterization procedure. Oxygen supplementation can be provided if necessary during the procedure to maintain adequate oxygenation. Educational Context: Understanding the factors that can impact procedural readiness in pediatric patients is crucial for nurses and healthcare providers. In this scenario, recognizing the potential complications of performing a cardiac catheterization in the presence of severe diaper rash highlights the importance of maintaining skin integrity to prevent infections and ensure optimal patient outcomes. This knowledge is essential for providing safe and effective care to pediatric patients undergoing cardiac procedures.

Correct Answer: D

Rationale: The correct answer is D) "I will mix the digoxin in some formula to make it taste better." This statement indicates the need for further education because digoxin should not be mixed with food as it can affect the absorption and effectiveness of the medication. It is important to administer digoxin on an empty stomach to ensure proper absorption and consistent blood levels. Option A) "I will give the medication at regular 12-hour intervals" is correct as digoxin should be administered at regular intervals to maintain therapeutic levels in the body. Option B) "If he vomits, I will not give a make-up dose" is also correct because administering a double dose due to vomiting can lead to overdose and toxicity. Option C) "If I miss a dose, I will not give an extra dose" is correct since doubling the dose to make up for a missed one can result in digoxin toxicity. Educationally, it is crucial to emphasize to parents the proper administration techniques for medications, especially in pediatric patients with CHF. Providing clear instructions on medication administration can prevent errors and ensure the child's safety and treatment effectiveness. It is important for parents to understand the rationale behind each instruction to promote adherence to the treatment plan and optimize the child's health outcomes.

Correct Answer: B

Rationale: In pediatric patients with congenital heart defects (CHD) characterized by decreased pulmonary blood flow, such as Tetralogy of Fallot, the nurse would expect to see polycythemia as a laboratory finding. Polycythemia is the body's compensatory mechanism to increase red blood cell production in response to chronic hypoxia, which is common in CHD patients with decreased pulmonary blood flow. The increased red blood cell count helps improve oxygen-carrying capacity in an attempt to meet the body's oxygen demands. Regarding the other options: A) Decreased platelet count: This is not typically associated with CHD of decreased pulmonary blood flow. Platelet count is more related to clotting disorders or certain medications. C) Decreased ferritin level: Ferritin is a marker for iron storage in the body and is not directly related to the pathophysiology of CHD with decreased pulmonary blood flow. D) Shift to the left: This term refers to an increase in immature white blood cells and is usually seen in cases of infection or inflammation, not specifically in CHD patients with decreased pulmonary blood flow. Understanding these laboratory findings in the context of pediatric patients with CHD is crucial for nurses caring for these vulnerable populations. Monitoring laboratory values helps in assessing the patient's response to treatment and identifying any complications early on. It also aids in providing holistic care tailored to the individual needs of each pediatric patient with a congenital heart defect.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) tetralogy of Fallot. Left ventricular hypertrophy with a superior QRS axis typically indicates right ventricular hypertrophy, a common finding in tetralogy of Fallot due to the right ventricular outflow tract obstruction. This condition leads to unequal pressures between the right and left ventricles, causing the left ventricle to become hypertrophied. Option A) tricuspid atresia is incorrect because it typically presents with right axis deviation on ECG due to right ventricular hypertrophy. Option B) Ebstein anomaly is incorrect as it is characterized by a low voltage QRS complex and right axis deviation on ECG. Option C) pulmonary atresia is incorrect as it would show right axis deviation on ECG due to right ventricular hypertrophy. Educationally, understanding the ECG findings in different congenital heart defects is crucial for pediatric nurses to provide appropriate care and interventions. Recognizing specific ECG patterns can aid in the early identification of potential cardiac issues in pediatric patients, leading to timely interventions and improved outcomes.