14.) Cardiac Dysfunction (part 2)

Question 1

You notice a 3-year-old child in the playroom at the hospital who keeps squatting down from time to time and then is up and running again. These episodes are best associated with what diagnosis?

a. ) Coarctation of the Aorta
b. ) Tetralogy of Fallot
c. ) Aortic Stenosis
d. ) Patent Ductus Arteriosus

Answer 1

b.) Tetralogy of Fallot

Question 2

A serious potential side effect of untreated progressive left to right shunt lesions is

a. ) Pulmonary Hypertension
b. ) Hepatomegaly
c. ) Flail Chest
d. ) Cardiomegaly

Answer 2

a.) Pulmonary Hypertension

Question 3

The primary reason for the closure of the ductus venosus is:

a. ) increase in systemic vascular resistance.
b. ) abruption in blood flow from umbilical vein.
c. ) decrease in pulmonary vascular resistance
d. ) lung inflation with first breath.

Answer 3

b.) abruption in blood flow from umbilical vein.

Question 4

A 9-year-old with a history of Tetralogy of Fallot has an upcoming dentist appointment. As the nurse working with him you understand the importance of providing him with which of the following secondary to his cardiac history?

a. ) Bacterial Endocarditis Prophylaxis
b. ) Sedation to keep him calm
c. ) Digoxin
d. ) O2 during procedures

Answer 4

a.) Bacterial Endocarditis Prophylaxis

Question 5

The most common left to right shunt lesion is

a. ) Hypoplastic Left Heart Syndrome
b. ) Patent Ductus Arteriosus
c. ) Ventricular Septal Defect
d. ) Atrial Septal Defect

Answer 5

c.) Ventricular Septal Defect

Question 6

The right side of the heart carries oxygenated blood.

a. ) True
b. ) False

Answer 6

b.) False

Question 7

Right to left shunt.

a. ) Pulmonic Stenosis
b. ) Atrial Septal Defect
c. ) Patent Ductus Arteriosus
d. ) Tetralogy of Fallot

Answer 7

a.) Pulmonic Stenosis

Question 8

Are often acyanotic.

a. ) Pulmonic Stenosis
b. ) Atrial Septal Defect
c. ) Patent Ductus Arteriosus
d. ) Tetralogy of Fallot

Answer 8

b.) Atrial Septal Defect

Question 9

Prostaglandins to keep open; indomethacin to close.

a. ) Pulmonic Stenosis
b. ) Atrial Septal Defect
c. ) Patent Ductus Arteriosus
d. ) Tetralogy of Fallot

Answer 9

Patent Ductus Arteriosus

Question 10

Hypercyanotic spells.

a. ) Pulmonic Stenosis
b. ) Atrial Septal Defect
c. ) Patent Ductus Arteriosus
d. ) Tetralogy of Fallot

Answer 10

d.) Tetralogy of Fallot

Question 11

A 3-month-old infant has a hypercyanotic spell. What should be the nurse’s first action?

a. ) Assess for neurologic defects.
b. ) Prepare the family for imminent death.
c. ) Begin cardiopulmonary resuscitation.
d. ) Place the child in the knee–chest position.

Answer 11

d.) Place the child in the knee–chest position.

The first action is to place the infant in the knee–chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. Preparing the family for imminent death or beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

Question 12

A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition?

a. ) Cyanosis
b. ) Heart failure
c. ) Decreased pulmonary blood flow
d. ) Bounding pulses in upper extremities

Answer 12

b.) Heart failure

As blood is shunted into the right side of the heart, there is increased pulmonary blood flow and the child is at high risk for heart failure.

Cyanosis usually occurs in defects with decreased pulmonary blood flow.

Bounding upper extremity pulses are a manifestation of coarctation of the aorta.

Question 13

What blood flow pattern occurs in a ventricular septal defect?

a. ) Mixed blood flow
b. ) Increased pulmonary blood flow
c. ) Decreased pulmonary blood flow
d. ) Obstruction to blood flow from ventricles

Answer 13

b.) Increased pulmonary blood flow

The opening in the septal wall allows for blood to flow from the higher pressure left ventricle into the lower pressure right ventricle. This left-to-right shunt creates increased pulmonary blood flow.

The shunt is one way, from high pressure to lower pressure; oxygenated and unoxygenated blood do not mix.

The outflow of blood from the ventricles is not affected by the septal defect.

Question 14

The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication?

a. ) Hypoxemia
b. ) Right-to-left shunt of blood
c. ) Decreased workload on the left side of the heart
d. ) Pulmonary vascular congestion

Answer 14

d.) Pulmonary vascular congestion

In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular congestion. Hypoxemia usually results from defects with mixed blood flow and decreased pulmonary blood flow.

The shunt is from left to right in a PDA. The closure would stop this. There is increased workload on the left side of the heart with a PDA.

Question 15

What cardiovascular defect results in obstruction to blood flow?

a. ) Aortic stenosis
b. ) Tricuspid atresia
c. ) Atrial septal defect
d. ) Transposition of the great arteries

Answer 15

a.) Aortic stenosis

Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion.

Tricuspid atresia results in decreased pulmonary blood flow.

The atrial septal defect results in increased pulmonary blood flow.

Transposition of the great arteries results in mixed blood flow.

Question 16

What structural defects constitute tetralogy of Fallot?

a. ) Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
b. ) Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
c. ) Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy
d. ) Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

Answer 16

a.) Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.

Question 17

A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38° C (100.4° F), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother?

a. ) Immediately bring the child to the clinic for evaluation.
b. ) Come to the clinic next week on a scheduled appointment.
c. ) Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness.
d. ) Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.

Answer 17

a.) Immediately bring the child to the clinic for evaluation.

These are the insidious symptoms of bacterial endocarditis. Because the child is in a high-risk group for this disorder (VSD repair), immediate evaluation and treatment are indicated to prevent cardiac damage.

With appropriate antibiotic therapy, bacterial endocarditis is successfully treated in approximately 80% of the cases. The child’s complaints should not be dismissed. The low-grade fever is not a symptom that the child can fabricate.

Question 18

An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented?

a. ) Leukopenia
b. ) Polycythemia
c. ) Anemia
d. ) Increased platelet level

Answer 18

b.) Polycythemia

Persistent hypoxemia that occurs with tetralogy of Fallot stimulates erythropoiesis, which results in polycythemia, an increased number of red blood cells.

Question 19

What child has a cyanotic congenital heart defect?

a. ) An infant with patent ductus arteriosus
b. ) A 1-year-old infant with atrial septal defect
c. ) A 2-month-old infant with tetralogy of Fallot
d. ) A 6-month-old infant with repaired ventricular septal defect

Answer 19

c.) A 2-month-old infant with tetralogy of Fallot

Tetralogy of Fallot is a cyanotic congenital heart defect.

Patent ductus arteriosus, atrial septal defect, and ventricular septal defect are acyanotic congenital heart defects.

Question 20

The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication?

a. ) Pulmonary hypertension
b. ) Right-to-left shunt of blood
c. ) Pulmonary embolism
d. ) Left ventricular hypertrophy

Answer 20

a.) Pulmonary hypertension

Congenital heart defects with a large left-to-right shunt (e.g., in ventricular septal defect, patent ductus arteriosus, or complete AV canal), which cause increased pulmonary blood flow, may result in pulmonary hypertension.

If these defects are not repaired early, the high pulmonary flow will cause changes in the pulmonary artery vessels, and the vessels will lose their elasticity.

The blood does not shunt right to left, a pulmonary embolism is not a complication of ventricular septal defect, and the left ventricle does not hypertrophy.

Question 21

A 1-year-old has been admitted for complete repair of a tetralogy of Fallot. What assessment finding should the nurse expect to be documented?

a. ) Weight gain
b. ) Pale skin color
c. ) Increasing cyanosis
d. ) Decrease in hemoglobin and hematocrit

Answer 21

c.) Increasing cyanosis

Elective repair of tetralogy of Fallot is usually performed in the first year of life. Indications for repair include increasing cyanosis and the development of hypercyanotic spells.

The child would not have a weight gain, pale skin color, or decrease in hemoglobin and hematocrit.

Question 22

A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what?

a. ) Tetralogy of Fallot
b. ) Coarctation of the aorta
c. ) Pulmonary stenosis
d. ) Ventricular septal defect

Answer 22

d.) Ventricular septal defect

Heart failure is common with ventricular septal defect that causes failure to thrive, respiratory infections, and an increase in exhaustion during feedings. There is a characteristic murmur. The other defects do not have left-to-right shunting.