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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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.
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.
The nurse has admitted a child with tricuspid atresia. The nurse would expect which initial lab result?
- A high hemoglobin
- A low hematocrit
- A high WBC count
- A low platelet count
- 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.
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?
- Weight loss
- Bradycardia
- Tachycardia
- Increased blood pressure
- 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.
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?
- Lowered blood pressure
- Tinnitus
- Ataxia
- A change in heart rhythm
- 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).
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?
- A capillary refill of greater than three seconds
- A palpable dorsalis pedis pulse but a weak posterior tibial pulse
- A decrease in sensation with a weakened dorsalis pedis pulse
- A capillary refill of less than three seconds with palpable warmth
- 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.
he nurse admits a child with a ventricular septal defect (VSD) to the unit. Which nursing diagnosis for this child is the most appropriate?
- Impaired Gas Exchange Related to Pulmonary Congestion Secondary to the Increased Pulmonary Blood Flow
- Deficient Fluid Volume Related to Hyperthermia Secondary to the Congenital Heart Defect
- Acute Pain Related to the Effects of a Congenital Heart Defect
- Hypothermia Related to Decreased Metabolic State
- 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.
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?
- The child should be restricted from most play activities.
- The child should be evaluated to determine if prophylactic antibiotics for dental, oral, or upper-respiratory-tract procedures are necessary.
- The child should not receive routine immunizations.
- The child can be expected to have a fever for several weeks following the surgery.
- 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.
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.
- Place the child in knee-chest position.
- Draw blood for a serum hemoglobin.
- Administer oxygen.
- Administer morphine and propranolol intravenously as ordered.
- Administer Benadryl as ordered.
- Place the child in knee-chest position.
- Administer oxygen.
- Administer morphine and propranolol intravenously as ordered.
Rationales:
- 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.
- 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.
- 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.
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?
- “Cyclosporin A reduces serum-cholesterol level.”
- “Cyclosporin A prevents rejection.”
- “Cyclosporin A treats hypertension.”
- “Cyclosporin A treats infections.”
- “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.
Which athletic activity can the nurse recommend for a school-age client with pulmonary-artery hypertension?
- Cross-country running
- Soccer
- Golf
- Basketball
- 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.
A child is admitted with infective endocarditis. Which nursing intervention is most appropriate for this child?
- Start an intravenous line.
- Place the child in contact isolation.
- Place the child on seizure precautions.
- Assist with a lumbar puncture.
- 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.
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?
- Close monitoring of output
- The digitalization process
- The possibility that pulses in the child might be weak
- The child’s increased appetite
- 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.
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?
- Dry, swollen, fissured lips
- Nonpalpable lymph nodes
- Conjunctivitis with exudates
- Cyanosis of the hands and feet
- 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.
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?
- Pedal pulses
- Pulse oximetry level
- Hemoglobin and hematocrit values
- Blood pressure of the four extremities
- 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.
The nurse is admitting an infant diagnosed with supraventricular tachycardia. Which intervention is the priority for this infant?
- Apply ice to the face.
- Perform Valsalva’s maneuver.
- Administer a beta blocker.
- Prepare for cardioversion.
- 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.
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.
- Allow the infant to feed for 60 minutes.
- Hold the infant at a 45-degree angle.
- Encourage frequent hand hygiene.
- Notify the health care provider for fever.
- Pump the breasts and feed with a bottle if weight gain is an issue.
- Hold the infant at a 45-degree angle.
- Encourage frequent hand hygiene.
- Notify the health care provider for fever.
- Pump the breasts and feed with a bottle if weight gain is an issue.
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.
- Encourage a decrease in smoking.
- Limit fat intake to 20 to 35 percent of intake.
- Encourage participation in vigorous exercise for at least 30 minutes.
- Maintain a normal weight.
- Include high-fat dairy products in the daily diet.
- Limit fat intake to 20 to 35 percent of intake.
- Encourage participation in vigorous exercise for at least 30 minutes.
- Maintain a normal weight.
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.
- Monitor hemoglobin and hematocrit.
- Monitor liver enzymes.
- Administer oxygen, as needed.
- Administer a dextrose solution.
- Monitor blood glucose.
- Monitor hemoglobin and hematocrit.
- Administer oxygen, as needed.
- Monitor blood glucose.
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.
- Decreased maternal age
- Chromosomal abnormalities
- Fetal exposure to maternal drugs
- Maternal viral infections
- Maternal metabolic disorders
- Chromosomal abnormalities
- Fetal exposure to maternal drugs
- Maternal viral infections
- Maternal metabolic disorders
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.
- Pulmonary stenosis
- Coarctation of the aorta
- Right ventricular hypertrophy
- Ventral septal defect
- Overriding aorta
- Pulmonary stenosis
- Right ventricular hypertrophy
- Ventral septal defect
- Overriding aorta
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
B. By increasing the heart rate
Rationale: Infants and children under 5 years of age increase their cardiac output by increasing the heart rate.
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
B. First 8 weeks
Rationale: Most congenital heart defects develop during the first 8 weeks of gestation, often due to genetic and environmental factors.
Which congenital heart defects increase pulmonary blood flow? (SATA)
A. Patent ductus arteriosus
B. Atrial septal defect
C. Ventricular septal defect
D. Atrioventricular canal
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.
Which congenital heart defects decrease pulmonary blood flow? (SATA)
A. Pulmonic stenosis
B. Tetralogy of Fallot
C. Pulmonary atresia
D. Tricuspid atresia
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.
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
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.
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
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.
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
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.
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
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.
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
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
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
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.
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
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.
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
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.
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
A. Infancy and adolescence
Rationale: Cardiomyopathy during childhood occurs most often in infancy and adolescence.
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
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.
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
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.
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
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.
What is the cause of rheumatic fever?
A. Viral infection
B. Streptococcal infection
C. Fungal infection
D. Parasitic infection
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.
What are the significant complications of Kawasaki disease?
A. Coronary artery inflammation
B. Neurological deficits
C. Gastrointestinal issues
D. Respiratory failure
A. Coronary artery inflammation
Rationale: Kawasaki disease is an acute febrile, systemic inflammatory illness with an unknown etiology.
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
D. Supraventricular tachycardia and long QT syndrome
Rationale: Two potentially life-threatening cardiac arrhythmias in children are supraventricular tachycardia and long QT syndrome.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
