Chapter 21: Alterations in Cardiovascular Function

Question 1

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

Answer 1

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.

Question 2

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.

Answer 2

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.

Question 3

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

Answer 3

C) Higher heart rate

Rationale: A higher heart rate helps compensate for the limited functional capacity of the immature heart under acute stress.

Question 4

What is the most common initial response to hypoxemia in children?

A) Tachycardia
B) Hypotension
C) Bradycardia
D) Cyanosis

Answer 4

C) Bradycardia

Rationale: Severe hypoxemia leads to bradycardia, a significant warning sign of cardiac arrest in children.

Question 5

Which diagnostic test evaluates fluid status in children with suspected cardiac alterations?

A) Electrocardiogram
B) Chest X-ray
C) Echocardiogram
D) Serum electrolytes

Answer 5

D) Serum electrolytes

Rationale: Serum electrolytes help assess fluid balance and are part of the diagnostic evaluation for cardiac issues.

Question 6

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

Answer 6

B) Smaller myocardial cells

Rationale: Pediatric myocardial cells are less developed, resulting in reduced functional capacity.

Question 7

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

Answer 7

C) By 9 years of age

Rationale: The heart weight increases sixfold by age 9 due to ongoing myocardial development

Question 8

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

Answer 8

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.

Question 9

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

Answer 9

D) Decreased cardiac output

Rationale: Decreased cardiac output leads to fluid retention as the body attempts to compensate for poor perfusion.

Question 10

What is a common sign of congestive heart failure in infants?

A) Tachypnea
B) Hypertension
C) Bradycardia
D) Hypothermia

Answer 10

B) Tachypnea

Rationale: Tachypnea is a common sign of congestive heart failure in infants due to increased work of breathing from pulmonary congestion.

Question 11

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

Answer 11

B) Sudden bradycardia

Rationale: Bradycardia is an early warning sign of cardiac arrest in children, often occurring in response to severe hypoxemia.

Question 12

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

Answer 12

C) Immature conduction system

Rationale: The immature conduction system in children makes their hearts more susceptible to arrhythmias.

Question 13

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

Answer 13

A) Chest auscultation

Rationale: Chest auscultation is essential to assess for signs of fluid overload, such as crackles, which may indicate heart failure.

Question 14

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

Answer 14

C) Correct the underlying hypoxemia

Rationale: Correcting the underlying hypoxemia is the primary treatment goal to reverse bradycardia and prevent cardiac arrest

Question 15

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.

Answer 15

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.

Question 16

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

Answer 16

D) Edema

Rationale: Edema is common in children with heart failure due to fluid retention associated with decreased cardiac output.

Question 17

What is a common side effect of medications used to treat heart failure in children?

A) Hypokalemia
B) Hyperglycemia
C) Hyperkalemia
D) Increased appetite

Answer 17

A) Hypokalemia

Rationale: Diuretics used in heart failure treatment may lead to hypokalemia due to increased potassium excretion.

Question 18

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

Answer 18

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.

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

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%

Answer 21

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.

Question 22

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

Answer 22

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.

Question 23

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

Answer 23

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.

Question 24

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

Answer 24

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.

Question 25

Congenital heart defects can be categorized by which of the following pathophysiological characteristics? (Select all that apply)

A. Increased pulmonary blood flow
B. Cyanosis presence
C. Obstructed systemic blood flow
D. Decreased pulmonary blood flow

Answer 25

A. Increased pulmonary blood flow
C. Obstructed systemic blood flow
D. Decreased pulmonary blood flow

Rationale: Congenital heart defects are categorized by pathophysiology and hemodynamics, such as increased pulmonary blood flow, obstructed systemic blood flow, and decreased pulmonary blood flow, rather than by the presence of cyanosis.

Question 26

n mixed congenital heart defects, what is crucial for the infant’s survival?

A. Early surgical intervention
B. Mixing of systemic and pulmonary blood
C. Increased oxygen therapy
D. Preventing infections

Answer 26

B. Mixing of systemic and pulmonary blood

Rationale: For infants with mixed congenital heart defects, their survival depends on the mixing of systemic and pulmonary blood, which helps maintain adequate oxygenation and circulation.

Question 27

A nurse is assessing a child with Tetralogy of Fallot (TOF). Which clinical manifestation should the nurse expect to find?

A. Tachypnea and murmur
B. Poor color and delayed capillary refill time
C. Cyanosis and hypoxic spells
D. Diaphoresis and frequent respiratory infections

Answer 27

C. Cyanosis and hypoxic spells

Rationale: Tetralogy of Fallot (TOF) is a defect that results in decreased pulmonary blood flow, leading to cyanosis and hypoxic spells as clinical manifestations.

Question 28

Which heart defect is likely to present with diminished pulses, poor color, and decreased urine output?

A. Coarctation of the aorta (COA)
B. Tricuspid atresia
C. Atrial septal defect (ASD)
D. Double outlet right ventricle

Answer 28

A. Coarctation of the aorta (COA)

Rationale: Coarctation of the aorta (COA) is an obstructive defect that can present with diminished pulses, poor color, and decreased urine output due to impaired blood flow to the systemic circulation.

Question 29

An infant with transposition of the great arteries (TGA) requires postnatal survival through which crucial physiological process?

A. Immediate surgical intervention
B. Mixing of systemic and pulmonary blood
C. Increased oxygen therapy
D. Frequent respiratory infections

Answer 29

B. Mixing of systemic and pulmonary blood

Rationale: In transposition of the great arteries (TGA), postnatal survival depends on the mixing of systemic and pulmonary blood to maintain adequate oxygenation.

Question 30

Which clinical manifestations are associated with defects causing increased pulmonary blood flow? (Select all that apply)

A. Tachypnea and tachycardia
B. Cyanosis and hypoxic spells
C. Poor weight gain and diaphoresis
D. Diminished pulses and decreased urine output

Answer 30

A. Tachypnea and tachycardia

C. Poor weight gain and diaphoresis

Rationale: Defects causing increased pulmonary blood flow, such as PDA, ASD, VSD, and AV canal, often present with tachypnea, tachycardia, poor weight gain, and diaphoresis due to the increased workload on the heart and lungs.

Question 31

What is the purpose of newborn screening with pulse oximetry in the context of congenital heart disease?

A. To measure blood glucose levels
B. To diagnose anemia
C. To identify critical congenital heart disease
D. To assess pulmonary function

Answer 31

C. To identify critical congenital heart disease

Rationale: Newborn screening with pulse oximetry is used to identify critical congenital heart disease by detecting low oxygen levels in the blood, which can indicate a serious heart defect.

Question 32

Which statement best describes the purpose of a palliative procedure in the treatment of congenital heart defects?

A. It temporarily supports the infant, allowing for growth before definitive surgery.

B. It restores normal hemodynamics and physiology.

C. It is a definitive corrective surgery performed in the first week of life.

D. It increases the severity of the symptoms temporarily.

Answer 32

A. It temporarily supports the infant, allowing for growth before definitive surgery.

Rationale: A palliative procedure is a surgical intervention that temporarily supports the infant with a potentially fatal or lethal condition, allowing them to grow before definitive corrective surgery is performed.

Question 33

The nurse has admitted a child with tricuspid atresia. The nurse would expect which initial lab result?

1. A high hemoglobin
2. A low hematocrit
3. A high WBC count
4. A low platelet count

Answer 33

1. A high hemoglobin

Rationale: The child’s bone marrow responds to chronic hypoxemia by producing more RBCs to increase the amount of hemoglobin available to carry oxygen to the tissues. This occurs in cases of cyanotic heart defects such as tricuspid atresia. Therefore, the hematocrit would not be low, the WBC count would not be high (unless an infection were present), and the platelets would be normal.

Question 34

A child has been admitted to the hospital unit in congestive heart failure (CHF). Which symptom would the nurse anticipate upon assessment of the child?

1. Weight loss
2. Bradycardia
3. Tachycardia
4. Increased blood pressure

Answer 34

3. Tachycardia

Rationale: Tachycardia is a sign of congestive heart failure because the heart attempts to improve cardiac output by beating faster. Bradycardia is a serious sign and can indicate impending cardiac arrest. Blood pressure does not increase in CHF, and the weight, instead of decreasing, increases because of retention of fluids.

Question 35

A toddler is started on digoxin (Lanoxin) for cardiac failure. Which is the initial symptom the nurse would assess if the child develops digoxin (Lanoxin) toxicity?

1. Lowered blood pressure
2. Tinnitus
3. Ataxia
4. A change in heart rhythm

Answer 35

4. A change in heart rhythm

Rationale: An early sign of digoxin (Lanoxin) toxicity is a change in heart rhythm. Digoxin (Lanoxin) toxicity does not cause lowered blood pressure, tinnitus (ringing in the ears), or ataxia (unsteady gait).

Question 36

The nurse is checking peripheral perfusion to a child’s extremity following a cardiac catheterization. Which assessment finding indicates adequate peripheral circulation to the affected extremity?

1. A capillary refill of greater than three seconds
2. A palpable dorsalis pedis pulse but a weak posterior tibial pulse
3. A decrease in sensation with a weakened dorsalis pedis pulse
4. A capillary refill of less than three seconds with palpable warmth

Answer 36

4. A capillary refill of less than three seconds with palpable warmth

Rationale: The nurse checks the extremity to determine adequacy of circulation following a cardiac catheterization. An extremity that is warm with capillary refill of less than three seconds has adequate circulation. Other indicators of adequate circulation include palpable pedal (dorsalis and posterior tibial) pulses, adequate sensation, and pinkness of skin color. If the capillary refill is over three seconds; if any of the pedal pulses are absent and/or weakened; or if the extremity is cool, cyanotic, or lacking sensation, circulation may not be adequate.

Question 37

he nurse admits a child with a ventricular septal defect (VSD) to the unit. Which nursing diagnosis for this child is the most appropriate?

1. Impaired Gas Exchange Related to Pulmonary Congestion Secondary to the Increased Pulmonary Blood Flow
2. Deficient Fluid Volume Related to Hyperthermia Secondary to the Congenital Heart Defect
3. Acute Pain Related to the Effects of a Congenital Heart Defect
4. Hypothermia Related to Decreased Metabolic State

Answer 37

1. Impaired Gas Exchange Related to Pulmonary Congestion Secondary to the Increased Pulmonary Blood Flow

Rationale: Because of the increased pulmonary congestion, Impaired Gas Exchange would be an appropriate nursing diagnosis. Ventricular septal defects do not cause pain, fever, or deficient fluid volume.

Question 38

The nurse is teaching the parents of a group of cardiac patients. Which teaching guideline will the nurse include for any child who has undergone cardiac surgery?

1. The child should be restricted from most play activities.
2. The child should be evaluated to determine if prophylactic antibiotics for dental, oral, or upper-respiratory-tract procedures are necessary.
3. The child should not receive routine immunizations.
4. The child can be expected to have a fever for several weeks following the surgery.

Answer 38

2. The child should be evaluated to determine if prophylactic antibiotics for dental, oral, or upper-respiratory-tract procedures are necessary.

Rationale: Parents should be taught that the child may need prophylactic antibiotics for some dental procedures, according to the American Heart Association, to prevent endocarditis. The child should live a normal and active life following repair of a cardiac defect. Immunizations should be provided according to the schedule, and any unexplained fever should be reported.

Question 39

An infant with tetralogy of Fallot is having a hypercyanotic episode (“tet” spell). Which nursing interventions are appropriate for the nurse to implement for this infant? Select all that apply.

1. Place the child in knee-chest position.
2. Draw blood for a serum hemoglobin.
3. Administer oxygen.
4. Administer morphine and propranolol intravenously as ordered.
5. Administer Benadryl as ordered.

Answer 39

1. Place the child in knee-chest position.
2. Administer oxygen.
3. Administer morphine and propranolol intravenously as ordered.

Rationales:

1. When an infant with tetralogy of Fallot has a hypercyanotic episode, interventions should be geared toward decreasing the pulmonary vascular resistance. Therefore, the nurse would place the infant in knee-chest position (to decrease venous blood return from the lower extremities), and administer oxygen, morphine, and propranolol (to decrease the pulmonary vascular resistance). The nurse would not draw blood until the episode had subsided, because unpleasant procedures are postponed. Benadryl is not appropriate for this child.
2. When an infant with tetralogy of Fallot has a hypercyanotic episode, interventions should be geared toward decreasing the pulmonary vascular resistance. Therefore, the nurse would place the infant in knee-chest position (to decrease venous blood return from the lower extremities), and administer oxygen, morphine, and propranolol (to decrease the pulmonary vascular resistance). The nurse would not draw blood until the episode had subsided, because unpleasant procedures are postponed. Benadryl is not appropriate for this child.
3. When an infant with tetralogy of Fallot has a hypercyanotic episode, interventions should be geared toward decreasing the pulmonary vascular resistance. Therefore, the nurse would place the infant in knee-chest position (to decrease venous blood return from the lower extremities), and administer oxygen, morphine, and propranolol (to decrease the pulmonary vascular resistance). The nurse would not draw blood until the episode had subsided, because unpleasant procedures are postponed. Benadryl is not appropriate for this child.

Question 40

8) A child recently had a heart transplant and the nurse teaches the parents the importance of administering cyclosporine A. Which statement by the parents indicates an appropriate understanding of the teaching session?

1. “Cyclosporin A reduces serum-cholesterol level.”
2. “Cyclosporin A prevents rejection.”
3. “Cyclosporin A treats hypertension.”
4. “Cyclosporin A treats infections.”

Answer 40

2. “Cyclosporin A prevents rejection.”

Rationale: Cyclosporin A is given to prevent rejection. Lovastatin is given to reduce serum-cholesterol level, calcium channel blockers may be used to treat hypertension, and an antibiotic may be given to treat an infection.

Question 41

Which athletic activity can the nurse recommend for a school-age client with pulmonary-artery hypertension?

1. Cross-country running
2. Soccer
3. Golf
4. Basketball

Answer 41

3. Golf

Rationale: A child with pulmonary-artery hypertension should have exercise tailored to avoid dyspnea. Golf would require less exertion than soccer, basketball, or cross-country running.

Question 42

A child is admitted with infective endocarditis. Which nursing intervention is most appropriate for this child?

1. Start an intravenous line.
2. Place the child in contact isolation.
3. Place the child on seizure precautions.
4. Assist with a lumbar puncture.

Answer 42

1. Start an intravenous line.

Rationale: Infective endocarditis is treated with intravenous antibiotics for 2 to 8 weeks. It is not contagious, so the child is not placed in contact isolation. Seizures are not a risk of infective endocarditis. A lumbar puncture is not a diagnostic test done for infective endocarditis.

Question 43

The mother of a child with a heart defect is questioning the nurse about the child’s diuretic. When teaching the mother about the medication, what should the emphasis from the nurse?

1. Close monitoring of output
2. The digitalization process
3. The possibility that pulses in the child might be weak
4. The child’s increased appetite

Answer 43

1. Close monitoring of output

Rationale: It is important to monitor the output of the child on a diuretic to determine effectiveness of the drug. Digitalization pulses are not associated with diuretics. The child will usually have a decreased appetite.

Question 44

The nurse is performing the initial assessment of a child newly diagnosed Kawasaki disease. Which symptoms would the nurse expect to assess with this child?

1. Dry, swollen, fissured lips
2. Nonpalpable lymph nodes
3. Conjunctivitis with exudates
4. Cyanosis of the hands and feet

Answer 44

1. Dry, swollen, fissured lips

Rationale: Dry, swollen, fissured lips are symptoms of Kawasaki disease. Lymph nodes can be palpable, conjunctivitis is present but without exudates, and hands and feet are typically erythematous.

Question 45

The nurse finds that an infant has stronger pulses in the upper extremities than in the lower extremities, and higher blood pressure readings in the arms than in the legs. Which assessment will the nurse perform next on this infant?

1. Pedal pulses
2. Pulse oximetry level
3. Hemoglobin and hematocrit values
4. Blood pressure of the four extremities

Answer 45

4. Blood pressure of the four extremities

Rationale: Coarctation of the aorta can present with stronger pulses in the upper extremities than in the lower extremities and higher blood pressure readings in the arms than in the legs because of obstruction of circulation to the lower extremities. Blood pressure values of the four limbs should be the next assessment data collected. Pedal pulses, pulse oximetry, and labs themselves will not provide the data needed.

Question 46

The nurse is admitting an infant diagnosed with supraventricular tachycardia. Which intervention is the priority for this infant?

1. Apply ice to the face.
2. Perform Valsalva’s maneuver.
3. Administer a beta blocker.
4. Prepare for cardioversion.

Answer 46

1. Apply ice to the face.

Rationale: Supraventricular tachycardia episodes are initially treated with vagal maneuvers to slow the heart rate when the infant is stable. In stable infants, the application of ice or iced saline solution to the face can reduce the heart rate. The infant is not capable of performing Valsalva’s maneuver. Calcium channel blockers, not beta blockers, are the drugs of choice. Cardioversion is used in an urgent situation, but is not typically the initial treatment.

Question 47

The nurse is preparing to discharge an infant with a congenital heart defect. The infant will be cared for at home by the parents until surgery. Which items will the nurse include in the discharge teaching for this infant and family? Select all that apply.

1. Allow the infant to feed for 60 minutes.
2. Hold the infant at a 45-degree angle.
3. Encourage frequent hand hygiene.
4. Notify the health care provider for fever.
5. Pump the breasts and feed with a bottle if weight gain is an issue.

Answer 47

2. Hold the infant at a 45-degree angle.
3. Encourage frequent hand hygiene.
4. Notify the health care provider for fever.
5. Pump the breasts and feed with a bottle if weight gain is an issue.

Question 48

The nurse is providing care to an adolescent child who is at risk for developing adult-onset cardiovascular disease. Which teaching points will decrease the adolescent’s risk? Select all that apply.

1. Encourage a decrease in smoking.
2. Limit fat intake to 20 to 35 percent of intake.
3. Encourage participation in vigorous exercise for at least 30 minutes.
4. Maintain a normal weight.
5. Include high-fat dairy products in the daily diet.

Answer 48

2. Limit fat intake to 20 to 35 percent of intake.
3. Encourage participation in vigorous exercise for at least 30 minutes.
4. Maintain a normal weight.

Question 49

The nurse is providing care to a school-age client admitted to the emergency department following a motor vehicle crash. The client is exhibiting symptoms of hypovolemic shock. Which nursing interventions are appropriate for this client? Select all that apply.

1. Monitor hemoglobin and hematocrit.
2. Monitor liver enzymes.
3. Administer oxygen, as needed.
4. Administer a dextrose solution.
5. Monitor blood glucose.

Answer 49

1. Monitor hemoglobin and hematocrit.
2. Administer oxygen, as needed.
3. Monitor blood glucose.

Question 50

The child and family come to the clinic requesting information about causes of cardiac defects. The father has high incidence of cardiac defects in his family, and the child is frequently cyanotic around the lips. What causes should the nurse tell the family about? Select all that apply.

1. Decreased maternal age
2. Chromosomal abnormalities
3. Fetal exposure to maternal drugs
4. Maternal viral infections
5. Maternal metabolic disorders

Answer 50

2. Chromosomal abnormalities
3. Fetal exposure to maternal drugs
4. Maternal viral infections
5. Maternal metabolic disorders

Question 51

The family has just been informed by the healthcare provider that their newborn is diagnosed with a congenital heart defect, Tetralogy of Fallot (TOF). The family tells the nurse that the healthcare provider told them that TOF is comprised of several defects, and they ask the nurse what the defects are. What will the nurse tell the family? Select all that apply.

1. Pulmonary stenosis
2. Coarctation of the aorta
3. Right ventricular hypertrophy
4. Ventral septal defect
5. Overriding aorta

Answer 51

1. Pulmonary stenosis
2. Right ventricular hypertrophy
3. Ventral septal defect
4. Overriding aorta

Question 52

How do infants and children under 5 years of age increase their cardiac output?

A. By increasing stroke volume
B. By increasing the heart rate
C. By decreasing blood pressure
D. By reducing oxygen consumption

Answer 52

B. By increasing the heart rate

Rationale: Infants and children under 5 years of age increase their cardiac output by increasing the heart rate.

Question 53

During which period of gestation do most congenital heart defects develop?

A. First 4 weeks
B. First 8 weeks
C. First 12 weeks
D. First 16 weeks

Answer 53

B. First 8 weeks

Rationale: Most congenital heart defects develop during the first 8 weeks of gestation, often due to genetic and environmental factors.

Question 54

Which congenital heart defects increase pulmonary blood flow? (SATA)

A. Patent ductus arteriosus
B. Atrial septal defect
C. Ventricular septal defect
D. Atrioventricular canal

Answer 54

all of the choice are correct

Rationale: Congenital heart defects that increase pulmonary blood flow include patent ductus arteriosus, atrial septal defect, ventricular septal defect, and atrioventricular canal.

Question 55

Which congenital heart defects decrease pulmonary blood flow? (SATA)

A. Pulmonic stenosis
B. Tetralogy of Fallot
C. Pulmonary atresia
D. Tricuspid atresia

Answer 55

all of the choices are correct

Rationale: Congenital heart defects that decrease pulmonary blood flow include pulmonic stenosis, tetralogy of Fallot, pulmonary atresia, and tricuspid atresia.

Question 56

Which congenital heart defects decrease systemic blood flow? (SATA)

A. Aortic stenosis
B. Coarctation of the aorta
C. Hypoplastic left heart syndrome
D. Patent ductus arteriosus

Answer 56

A. Aortic stenosis
B. Coarctation of the aorta
C. Hypoplastic left heart syndrome

Rationale: Congenital heart defects that decrease systemic blood flow include aortic stenosis, coarctation of the aorta, and hypoplastic left heart syndrome.

Question 57

What are examples of mixed defects that require mixing of the pulmonary and systemic circulations for survival during the neonatal period?

A. Tetralogy of Fallot and tricuspid atresia

B. Transposition of the great arteries and truncus arteriosus

C. Aortic stenosis and coarctation of the aorta

D. Pulmonic stenosis and pulmonary atresia

Answer 57

B. Transposition of the great arteries and truncus arteriosus

Rationale: Transposition of the great arteries and truncus arteriosus are examples of mixed defects that require mixing of the pulmonary and systemic circulations for survival during the neonatal period.

Question 58

What is the primary use of cardiac catheterization in children?

A. To repair some heart defects

B. To evaluate hemodynamics and pressure gradients

C. To assess respiratory function

D. To diagnose genetic conditions

Answer 58

A. To repair some heart defects

Rationale: Cardiac catheterization is more commonly used in children to intervene or repair some heart defects rather than to evaluate the hemodynamics and pressure gradients within the heart.

Question 59

Why are infants with congenital heart defects that increase pulmonary blood flow at high risk for development of congestive heart failure?

A. Due to increased blood flow to the lungs

B. Due to decreased oxygen consumption

C. Due to enhanced myocardial function

D. Due to reduced blood pressure

Answer 59

A. Due to increased blood flow to the lungs

Rationale: Infants with congenital heart defects that increase pulmonary blood flow are at high risk for developing congestive heart failure due to increased blood flow to the lungs.

Question 60

What are the life-threatening consequences of congenital heart defects that decrease pulmonary blood flow in children?

A. Hypertension

B. Weight gain

C. Hypoxic episodes

D. Increased appetite

Answer 60

C. Hypoxic episodes

Rationale: The child with a congenital heart defect that decreases pulmonary blood flow may have life-threatening hypoxic episodes requiring emergency treatment

Question 61

What are the signs and symptoms associated with congenital heart defects that obstruct systemic blood flow? (SATA)

A. Diminished pulses
B. Poor color
C. Prolonged capillary refill time
D. Decreased urinary output

Answer 61

all of the choices are correct

Rationale: Congenital heart defects that obstruct systemic blood flow cause signs and symptoms associated with low cardiac output, including diminished pulses, poor color, prolonged capillary refill time, and decreased urinary output.

Question 62

Why are infants more sensitive to volume or pressure overload, making them at risk of heart failure?

A. Due to increased physical activity

B. Due to underdeveloped myocardial fibers

C. Due to higher metabolic rate

D. Due to enhanced respiratory function

Answer 62

B. Due to underdeveloped myocardial fibers

Rationale: Infants are at risk of heart failure as they are more sensitive to volume or pressure overload due to underdeveloped myocardial fibers.

Question 63

What are common signs of congestive heart failure in children?

A. Tachypnea and tachycardia

B. Pallor or cyanosis

C. Nasal flaring, grunting, and retractions

D. Cough, crackles, periorbital and facial edema, jugular vein distention, and hepatomegaly

Answer 63

all of the choices are correct

Rationale: Common signs of congestive heart failure in children include tachypnea, tachycardia, pallor or cyanosis, nasal flaring, grunting, retractions, cough, crackles, periorbital and facial edema, jugular vein distention, and hepatomegaly.

Question 64

During which stages of childhood does cardiomyopathy occur most often?

A. Infancy and adolescence

B. Early childhood and adulthood

C. Middle childhood and late adolescence

D. Neonatal period and toddlerhood

Answer 64

A. Infancy and adolescence

Rationale: Cardiomyopathy during childhood occurs most often in infancy and adolescence.

Question 65

What are the major causes of mortality and morbidity during the first year following a heart transplant in children?

A. Hypertension and diabetes
B. Rejection and infection
C. Obesity and hyperlipidemia
D. Hypothyroidism and dehydration

Answer 65

B. Rejection and infection

Rationale: Rejection and infection are the major causes of mortality and morbidity during the first year following a heart transplant in infants and children.

Question 66

What are irreversible pulmonary vascular changes associated with pulmonary artery hypertension?

A. Improved oxygenation
B. Increased lung function
C. Enhanced cardiovascular performance
D. Inflammation, hypertrophy of pulmonary vessels, and fibrosis

Answer 66

D. Inflammation, hypertrophy of pulmonary vessels, and fibrosis

Rationale: Irreversible pulmonary vascular changes associated with pulmonary artery hypertension include inflammation, hypertrophy of pulmonary vessels, and fibrosis.

Question 67

What conditions increase the risk of infective endocarditis in children?

A. Gastrointestinal disorders
B. Respiratory infections
C. Dermatological conditions
D. Congenital heart defects, following heart surgery with patching or artificial valves, rheumatic heart disease, or a central venous catheter

Answer 67

D. Congenital heart defects, following heart surgery with patching or artificial valves, rheumatic heart disease, or a central venous catheter

Rationale: Conditions that increase the risk of infective endocarditis in children include congenital heart defects, following heart surgery with patching or artificial valves, rheumatic heart disease, or a central venous catheter.

Question 68

What is the cause of rheumatic fever?

A. Viral infection
B. Streptococcal infection
C. Fungal infection
D. Parasitic infection

Answer 68

B. Streptococcal infection

Rationale: Rheumatic fever is an inflammatory connective tissue disease following a streptococcal infection that may affect the heart, joints, skin, or central nervous system.

Question 69

What are the significant complications of Kawasaki disease?

A. Coronary artery inflammation
B. Neurological deficits
C. Gastrointestinal issues
D. Respiratory failure

Answer 69

A. Coronary artery inflammation

Rationale: Kawasaki disease is an acute febrile, systemic inflammatory illness with an unknown etiology.

Question 70

Which two cardiac arrhythmias are potentially life-threatening in children?

A. Sinus bradycardia and sinus arrhythmia
B. Atrial fibrillation and ventricular fibrillation
C. Atrial flutter and short QT syndrome
D. Supraventricular tachycardia and long QT syndrome

Answer 70

D. Supraventricular tachycardia and long QT syndrome

Rationale: Two potentially life-threatening cardiac arrhythmias in children are supraventricular tachycardia and long QT syndrome.

Question 71

What initial therapies are recommended for children with familial or lifestyle-related dyslipidemia?

A. Medication therapy and surgery
B. Dietary intervention and exercise regimens
C. Surgery and exercise regimens
D. Complete bed rest dietary intervention

Answer 71

B. Dietary intervention and exercise regimens

Rationale: Children with familial or lifestyle-related dyslipidemia need dietary intervention and exercise regimens as initial therapies to manage cholesterol or triglyceride levels.

Question 72

At what percentile for age, gender, and height is hypertension diagnosed in children?

A. 50th percentile
B. 75th percentile
C. 90th percentile
D. 95th percentile

Answer 72

D. 95th percentile

Rationale: Hypertension is diagnosed in children with systolic or diastolic blood pressure at the 95th percentile for age, gender, and height percentile.

Question 73

What are signs that a child is in compensated hypovolemic shock?

A. Bradycardia, normal respiratory effort, normal capillary refill time, and warm extremities

B. Hypertension, hyperactivity, and increased appetite

C. Tachycardia, increased respiratory effort, prolonged capillary refill time, weak peripheral pulses, pallor, and cold extremities

D. Normal heart rate and respiratory rate, and pink extremities

Answer 73

C. Tachycardia, increased respiratory effort, prolonged capillary refill time, weak peripheral pulses, pallor, and cold extremities

Rationale: Signs that a child is in compensated hypovolemic shock include tachycardia, increased respiratory effort, prolonged capillary refill time, weak peripheral pulses, pallor, and cold extremities.

Question 74

What causes distributive shock?

A. Increased vascular resistance
B. Decrease in vascular resistance and abnormal distribution of blood volume
C. Enhanced blood flow to vital organs
D. Increased cardiac output

Answer 74

B. Decrease in vascular resistance and abnormal distribution of blood volume

Rationale: Distributive shock is caused by a decrease in vascular resistance and abnormal distribution of blood volume, which may result from conditions such as anaphylaxis, sepsis, or spinal cord injury.

Question 75

What are potential causes of obstructive shock in children?

A. Hyperactivity and high blood pressure
B. Increased dietary fat intake
C. Compression on the vena cava
D. Enhanced physical endurance

Answer 75

C. Compression on the vena cava

Rationale: Obstructive shock occurs when circulation is impeded by conditions such as compression on the vena cava due to tension pneumothorax, aortic stenosis, or coarctation of the aorta.

Question 76

What is a myocardial contusion, and what causes it?

A. An injury to the heart muscle caused by a strong, blunt force against the chest wall
B. A genetic heart disorder; inherited from parents
C. A viral infection of the heart
D. A bacterial infection of the myocardium

Answer 76

A. An injury to the heart muscle caused by a strong, blunt force against the chest wall

Rationale: Myocardial contusion results from a strong, blunt force against the chest wall that injures the heart muscle and may cause an arrhythmia.

Question 77

What are the signs of myocardial contusion in a child?

A. Hyperactivity and increased appetite
B. Chest wall tenderness or pain
C. Normal heart rate and respiratory function
D. Increased physical endurance

Answer 77

B. Chest wall tenderness or pain

Rationale: Signs of myocardial contusion in a child include chest wall tenderness or pain, arrhythmias, and elevated cardiac troponin I levels.

Question 78

Why are congenital heart defects the most common birth defect?

A. Because of their high visibility during pregnancy
B. Because they are easily preventable
C. Because they always have severe symptoms
D. Because they occur in approximately 1% of all live births

Answer 78

D. Because they occur in approximately 1% of all live births

Rationale: Congenital heart defects are the most common birth defect because they occur in approximately 1% of all live births.

Question 79

Why do infants with congenital heart defects often develop congestive heart failure?

A. Due to increased blood flow to the lungs

B. Due to decreased myocardial function

C. Due to enhanced cardiovascular endurance

D. Due to reduced metabolic rate

Answer 79

A. Due to increased blood flow to the lungs

Rationale: Infants with congenital heart defects often develop congestive heart failure due to increased blood flow to the lungs or volume or pressure overload, which their underdeveloped myocardial fibers cannot handle.

Question 80

Which congenital heart defects may cause life-threatening hypoxic episodes in children? (SATA)

A. Pulmonic stenosis
B. Tetralogy of Fallot
C. Pulmonary atresia
D. Tricuspid atresia

Answer 80

all of the choices are correct

Rationale: Congenital heart defects that decrease pulmonary blood flow, such as pulmonic stenosis, tetralogy of Fallot, pulmonary atresia, and tricuspid atresia, may cause life-threatening hypoxic episodes in children.

Question 81

Why is cardiac catheterization commonly used in children?

A. To evaluate cardiac function
B. To measure blood glucose levels
C. To intervene or repair some heart defects
D. To diagnose gastrointestinal disorders

Answer 81

C. To intervene or repair some heart defects

Rationale: Cardiac catheterization is commonly used in children to intervene or repair some heart defects rather than to evaluate the hemodynamics and pressure gradients within the heart.

Question 82

What are the common signs of congestive heart failure in infants?

A. Tachypnea, tachycardia, pallor or cyanosis

B. Nasal flaring, grunting, retractions,

C. Cough, crackles, periorbital and facial edema

D. jugular vein distention, and hepatomegaly

Answer 82

all of the choices are correct

Rationale: Common signs of congestive heart failure in infants include tachypnea, tachycardia, pallor or cyanosis, nasal flaring, grunting, retractions, cough, crackles, periorbital and facial edema, jugular vein distention, and hepatomegaly.

Question 83

What is the major challenge during the first year following a heart transplant in children?

A. Managing increased appetite
B. Preventing rejection and infection
C. Improving cardiovascular endurance
D. Reducing weight gain

Answer 83

B. Preventing rejection and infection

Rationale: Preventing rejection and infection are the major challenges during the first year following a heart transplant in infants and children.

Question 84

What conditions increase the risk of infective endocarditis in children?

A. Congenital heart defects

B. Following heart surgery with patching or artificial valves

C. Rheumatic heart disease,

D. Central venous catheter

Answer 84

all of the choices are correct

Rationale: Conditions that increase the risk of infective endocarditis in children include congenital heart defects, following heart surgery with patching or artificial valves, rheumatic heart disease, or a central venous catheter.