A nurse is providing discharge education to the parents of an 8-year-old client post cardiac surgery. Parents ask a nurse about son’s activity level after cardiac surgery. Which response would be best?

Heart failure is a serious condition where the heart cannot pump blood effectively enough to meet the body’s needs. It does not mean the heart has stopped, but rather that it is weakened or stiff, leading to symptoms such as shortness of breath, fatigue, and swelling in the legs or abdomen.

Rationale for the correct answer:

B. Digoxin is classified as a cardiac glycoside. It works by increasing the force of myocardial contraction (positive inotrope) and slowing the heart rate by enhancing vagal tone. These effects improve cardiac output and circulation in clients with heart failure.

Rationale for incorrect answers:

A. Angiotensin-converting enzyme (ACE) inhibitor such as enalapril and captopril reduce afterload and preload by blocking the renin–angiotensin–aldosterone system. Digoxin does not act on this system.

C. Diuretic such as furosemide reduce fluid overload by increasing urine output. Digoxin does not promote diuresis.

D. Vasodilator decrease vascular resistance to improve forward blood flow. Digoxin’s primary action is increasing contractility, not dilating blood vessels.

Test-taking strategy:

• If the medication is digoxin/Lanoxin, think cardiac glycoside.
• Associate digoxin with increased contractility + slowed heart rate, not fluid removal or blood pressure control.

Take home points

• Digoxin is a cardiac glycoside.
• It improves cardiac output by strengthening contractions.
• It slows heart rate and improves filling time.
• Digoxin requires close monitoring due to a narrow therapeutic range.

Post–cardiac surgery care in children focuses on gradual recovery, energy conservation, and prevention of complications. Activity guidance must be realistic, flexible, and developmentally appropriate, rather than overly restrictive or unsafe.

Rationale for the correct answer:

C. Encourage a balance of rest and exercise: After cardiac surgery, children fatigue easily due to healing tissues, altered circulation, and reduced endurance. A balance of rest and activity allows the child to gradually rebuild strength and stamina without overexertion. This guidance supports safe recovery, promotes normal growth and development, and helps parents monitor tolerance (e.g., stopping activity if the child becomes tired, short of breath, or uncomfortable).

Rationale for incorrect answers:

A. There are no exercise limitations: This is unsafe and incorrect. Children typically have temporary activity restrictions following cardiac surgery to protect the sternum, incision, and heart. Overexertion can increase the risk of complications.

B. The child may resume school in 3 days: Return to school is not standardized and depends on the child’s recovery, endurance, and provider recommendations. Most children require more than a few days before resuming full school activities.

D. Climbing and contact sports are restricted for 1 week: Contact sports and climbing are usually restricted for several weeks, not just one. The sternum and surgical site require adequate healing to prevent injury or wound disruption.

Test-taking strategy:

• Avoid answers that are absolute or overly specific when recovery timelines vary.
• Choose responses that emphasize individualized care and gradual progression, which are commonly correct in pediatric postoperative questions.

Take home points

• Children recovering from cardiac surgery need gradual activity progression.
• Fatigue is expected; rest periods are essential.
• High-risk activities (contact sports, climbing) are restricted for weeks, not days.
• Balanced, flexible guidance is safer than rigid timelines.