Chapter 21: Alterations in Cardiovascular Function Flashcards
Which physiological change occurs during the transition from fetal to pulmonary circulation?
A) Permanent closure of the foramen ovale by 2 years of age
B) Increased blood flow through the ductus venosus
C) Permanent closure of the ductus arteriosus within a few hours after birth
D) Decreased pulmonary vascular resistance immediately after birth
C) Permanent closure of the ductus arteriosus within a few hours after birth
Rationale: The ductus arteriosus closes permanently within a few hours of birth as oxygen levels increase and prostaglandin levels decrease.
Why are premature infants at higher risk for heart failure compared to term infants?
A) They have increased blood volume.
B) Their immature hearts are more sensitive to volume or pressure overload.
C) They have a decreased metabolic demand.
D) Their muscle fibers are fully developed.
B) Their immature hearts are more sensitive to volume or pressure overload.
Rationale: The immature heart of premature infants is less compliant and more sensitive to overload, making it prone to failure.
What compensatory mechanism does a child’s heart use during acute stress?
A) Increased myocardial contraction strength
B) Lower heart rate
C) Higher heart rate
D) Decreased red blood cell production
C) Higher heart rate
Rationale: A higher heart rate helps compensate for the limited functional capacity of the immature heart under acute stress.
What is the most common initial response to hypoxemia in children?
A) Tachycardia
B) Hypotension
C) Bradycardia
D) Cyanosis
C) Bradycardia
Rationale: Severe hypoxemia leads to bradycardia, a significant warning sign of cardiac arrest in children.
Which diagnostic test evaluates fluid status in children with suspected cardiac alterations?
A) Electrocardiogram
B) Chest X-ray
C) Echocardiogram
D) Serum electrolytes
D) Serum electrolytes
Rationale: Serum electrolytes help assess fluid balance and are part of the diagnostic evaluation for cardiac issues.
What characteristic of the pediatric heart limits its functional capacity?
A) Increased compliance
B) Smaller myocardial cells
C) Reduced oxygen requirements
D) Fully developed muscle fibers
B) Smaller myocardial cells
Rationale: Pediatric myocardial cells are less developed, resulting in reduced functional capacity.
When does the weight of the pediatric heart typically increase sixfold?
A) By 2 years of age
B) By 5 years of age
C) By 9 years of age
D) By adolescence
C) By 9 years of age
Rationale: The heart weight increases sixfold by age 9 due to ongoing myocardial development
Which of the following is a common diagnostic test for pediatric heart conditions?
A) Blood gas analysis
B) Echocardiogram
C) Stress test
D) Cardiac catheterization
B) Echocardiogram
Rationale: An echocardiogram is a common and non-invasive test used to assess the structure and function of the heart in pediatric patients.
Which of the following is a primary reason for fluid retention in children with heart failure?
A) Increased metabolic rate
B) Increased blood volume
C) Hypoxia
D) Decreased cardiac output
D) Decreased cardiac output
Rationale: Decreased cardiac output leads to fluid retention as the body attempts to compensate for poor perfusion.
What is a common sign of congestive heart failure in infants?
A) Tachypnea
B) Hypertension
C) Bradycardia
D) Hypothermia
B) Tachypnea
Rationale: Tachypnea is a common sign of congestive heart failure in infants due to increased work of breathing from pulmonary congestion.
Which of the following is an early warning sign of cardiac arrest in children?
A) Hypotension
B) Sudden bradycardia
C) Sudden hypertension
D) Irregular heart rhythms
B) Sudden bradycardia
Rationale: Bradycardia is an early warning sign of cardiac arrest in children, often occurring in response to severe hypoxemia.
What factor makes pediatric hearts more vulnerable to cardiac arrhythmias?
A) Larger myocardial cells
B) Increased resting heart rate
C) Immature conduction system
D) High metabolic demand
C) Immature conduction system
Rationale: The immature conduction system in children makes their hearts more susceptible to arrhythmias.
Which of the following physical assessments should be prioritized for a child with suspected heart failure?
A) Chest auscultation
B) Abdominal palpation
C) Urine output measurement
D) Blood glucose monitoring
A) Chest auscultation
Rationale: Chest auscultation is essential to assess for signs of fluid overload, such as crackles, which may indicate heart failure.
What is the primary treatment goal for children with hypoxemia leading to bradycardia?
A) Increase fluid intake
B) Administer vasopressors
C) Correct the underlying hypoxemia
D) Perform immediate CPR
C) Correct the underlying hypoxemia
Rationale: Correcting the underlying hypoxemia is the primary treatment goal to reverse bradycardia and prevent cardiac arrest
Which of the following is true regarding pediatric cardiac anatomy?
A) The heart size doubles after birth.
B) The heart undergoes rapid development through childhood.
C) The heart remains the same size through infancy.
D) The myocardial cells fully mature by 6 months of age.
B) The heart undergoes rapid development through childhood.
Rationale: The pediatric heart undergoes rapid growth and development through childhood, which includes increases in muscle mass and functional capacity.
In children, which of the following is commonly seen in cases of congestive heart failure?
A) Increased urine output
B) Hyperactivity
C) Hypoglycemia
D) Edema
D) Edema
Rationale: Edema is common in children with heart failure due to fluid retention associated with decreased cardiac output.
What is a common side effect of medications used to treat heart failure in children?
A) Hypokalemia
B) Hyperglycemia
C) Hyperkalemia
D) Increased appetite
A) Hypokalemia
Rationale: Diuretics used in heart failure treatment may lead to hypokalemia due to increased potassium excretion.
In pediatric patients with heart failure, what is a key indicator that fluid status is improving?
A) Increased heart rate
B) Increased urine output
C) Decreased blood pressure
D) Decreased respiratory rate
B) Increased urine output
Rationale: Increased urine output is a key indicator that the body is successfully excreting excess fluid, a sign that heart failure management is effective.
What should be monitored regularly in children receiving medications for heart failure?
A) Blood pressure and respiratory rate
B) Blood glucose and liver function
C) Electrolyte levels and renal function
D) Hemoglobin and hematocrit
C) Electrolyte levels and renal function
Rationale: Electrolyte levels and renal function are critical to monitor in children receiving heart failure medications, as these drugs can affect fluid and electrolyte balance.
Which congenital heart defect results from the persistence of a fetal structure and often requires emergency intervention in the first days or weeks of life?
A. Coarctation of the aorta
B. Patent ductus arteriosus
C. Tetralogy of Fallot
D. Atrial septal defect
B. Patent ductus arteriosus
Rationale: Patent ductus arteriosus (PDA) is a congenital heart defect that results from the persistence of the fetal ductus arteriosus after birth. It often requires emergency intervention, such as medication, catheter-based procedures, or surgery, especially in critical cases.
What percentage of infant deaths related to a birth defect in the first year of life are attributed to critical congenital heart defects?
A. 15%
B. 25%
C. 35%
D. 45%
B. 25%
Rationale: Critical congenital heart defects account for 25% of infant deaths related to a birth defect during the first year of life. These defects are life-threatening and often require immediate medical attention.
During which time period do most congenital heart defects develop?
A. The first 2 weeks of gestation
B. The first 4 weeks of gestation
C. The first 8 weeks of gestation
D. The second trimester
C. The first 8 weeks of gestation
Rationale: Most congenital heart defects develop during the first 8 weeks of gestation, as the heart and great vessels are forming.
Which of the following maternal factors is NOT typically associated with the development of congenital heart defects in a fetus?
A. Fetal exposure to lithium
B. Maternal viral infection with rubella
C. Maternal hyperthyroidism
D. Increased maternal age
C. Maternal hyperthyroidism
Rationale: Maternal hyperthyroidism is not typically listed as a factor associated with the development of congenital heart defects, whereas fetal exposure to lithium, maternal viral infections like rubella, and increased maternal age are known risk factors.
Which chromosomal abnormalities are associated with an increased incidence of congenital heart defects? (Select all that apply)
A. Turner syndrome
B. Marfan syndrome
C. Down syndrome (trisomy 21)
D. Klinefelter syndrome
A. Turner syndrome
B. Marfan syndrome
C. Down syndrome (trisomy 21)
Rationale: Chromosomal abnormalities such as Turner syndrome, Marfan syndrome, and Down syndrome (trisomy 21) are associated with an increased incidence of congenital heart defects.