PEDIATRIC HEART DISEASE RN PEDIA Flashcards
- Nurse Jobs is conducting a thorough assessment of Kobe, a child diagnosed with coarctation of the aorta. She knows the specific clinical features associated with this condition and is vigilant in her examination. Which of the following findings would Nurse Jobs anticipate when assessing Kobe?
A. Weak or absent femoral pulses.
B. Intense cyanosis immediately after birth.
C. Episodes of cyanosis (“tet” spells).
D. Preference for a squatting posture
Correct answer:
Weak or absent femoral pulses. Coarctation of the aorta (CoA) is characterized by a narrowing of the aorta, which obstructs blood flow from the heart to the lower part of the body. This obstruction leads to increased pressure in the upper body and decreased pressure in the lower body. As a result, one of the key clinical features of CoA is weak or absent femoral pulses, which can be detected during a physical examination. This finding is due to reduced blood flow past the point of coarctation, affecting the blood supply to the lower extremities.
- Nurse Hernandez is closely monitoring Brad, a patient with heart failure who is on digoxin therapy. She is particularly vigilant for signs of digoxin toxicity. Which of the following symptoms would Nurse Hernandez identify as a key indicator of digoxin toxicity in Brad?
A. Significantly slow heart rate or extreme bradycardia.
B. Difficulty breathing or respiratory distress.
C. Difficulty with bowel movements or constipation.
D. Pain in the head or headache.
✔Correct answer:
Significantly slow heart rate or extreme bradycardia. One of the key indicators of digoxin toxicity is bradycardia, or an abnormally slow heart rate. Digoxin works by increasing the force of cardiac contractions and slowing the heart rate to improve cardiac output in heart failure patients. However, excessive levels of digoxin can cause significant bradycardia, leading to symptoms such as dizziness, fatigue, and fainting. Monitoring heart rate is crucial in patients receiving digoxin therapy to detect signs of toxicity early.
- Nurse Wilson is guiding her nursing students through the intricacies of the heart’s conduction system. She’s challenging them to correctly order the components through which an action potential travels during a heartbeat. Which sequence correctly reflects this path?
A. Atrioventricular bundle — SA node — Purkinje fibers — Right and Left bundle branches — AV node.
B. Purkinje fibers — SA node — Atrioventricular bundle — Right and Left bundle branches — AV node.
C. Purkinje fibers — SA node — Right and Left bundle branches — Atrioventricular bundle — AV node.
D. SA node — AV node — Atrioventricular bundle — Right and Left bundle branches — Purkinje fibers.
✔Correct answer:
SA node — AV node — Atrioventricular bundle — Right and Left bundle branches — Purkinje fibers. The correct sequence of the heart’s conduction system is as follows:
SA node (Sinoatrial node): The action potential originates here. The SA node is located in the right atrium and serves as the heart’s natural pacemaker.
AV node (Atrioventricular node): The impulse then travels to the AV node, which is located at the junction of the atria and ventricles. The AV node slows the electrical signal before it moves to the ventricles.
Atrioventricular bundle (Bundle of His): From the AV node, the impulse travels to the atrioventricular bundle, which is a pathway that conducts the signal to the ventricles.
Right and Left bundle branches: The signal then travels down the right and left bundle branches, which run along the interventricular septum.
Purkinje fibers: Finally, the impulse reaches the Purkinje fibers, which distribute the electrical signal throughout the ventricles, causing them to contract.
- Nurse Carter is reviewing the fetal circulation with a group of nursing students and emphasizes the role of the ductus arteriosus during intrauterine life. She explains its function in detail. According to Nurse Carter, what is the primary function of the ductus arteriosus in fetal circulation?
A. It channels the combined cardiac output from the aorta to the pulmonary artery and then to the right ventricle.
B. It transfers the combined cardiac output from the pulmonary artery to the aorta and then to the lungs.
C. It diverts the combined cardiac output from the aorta to the pulmonary artery, which then leads to the pulmonary veins.
D. It redirects the combined cardiac output from the pulmonary artery directly into the systemic circulation.
✔Correct answer:
It redirects the combined cardiac output from the pulmonary artery directly into the systemic circulation. The ductus arteriosus is a crucial vessel in fetal circulation that connects the pulmonary artery to the aorta. During intrauterine life, the lungs are not yet functional, and the fetus receives oxygenated blood from the placenta. The ductus arteriosus allows most of the blood from the right ventricle to bypass the non-functioning lungs and flow directly into the systemic circulation, ensuring that oxygen-rich blood is delivered to the body.
- Nurse Davis is closely monitoring Justin, an 9-year-old boy with heart failure, to ensure he adheres to his therapeutic regimen. She reviews his health records and observations to determine if Justin is following the treatment plan effectively. Which of the following would indicate that Justin is adhering to his therapeutic regimen for heart failure?
A. Maintaining a normal weight for his age.
B. A pulse rate consistently below 50 beats per minute.
C. An increase in his red blood cell (RBC) count.
D. Taking an antibiotic daily.
✔Correct answer:
Maintaining a normal weight for his age. Maintaining a normal weight for his age indicates that Justin is likely adhering to his therapeutic regimen for heart failure. Effective management of heart failure often includes dietary modifications to control fluid retention and prevent malnutrition. Regular monitoring of weight is crucial as it helps in assessing fluid balance and nutritional status. If Justin’s weight is within the normal range for his age, it suggests that he is following dietary recommendations, adhering to fluid restrictions, and taking his medications as prescribed, all of which are vital components of heart failure management.
- Nurse Thompson is caring for a child with heart disease and recognizes the importance of interventions that reduce cardiac demands and minimize the workload of the heart. In her plan of care, which intervention should Nurse Thompson prioritize to achieve this goal?
A. Organizing care activities to ensure the infant has periods of undisturbed rest.
B. Extending the duration of feedings for the infant.
C. Crafting and executing a predictable and steady care routine.
D. Giving in to the infant’s preferences to prevent any form of conflict.
✔Correct answer:
Organizing care activities to ensure the infant has periods of undisturbed rest. For a child with heart disease, reducing cardiac demands is crucial to minimize the workload on the heart. Prioritizing periods of undisturbed rest helps achieve this goal by preventing excessive energy expenditure and allowing the heart to function more efficiently. Ensuring the infant has adequate rest periods reduces the physiological stress on the heart, thereby helping to manage symptoms and promote better overall health.
- Nurse Thompson is preparing a newborn patient with Transposition of the Great Arteries (TGA) for surgery to correct the heart defect. She explains to the anxious parents that the upcoming procedure is essential for shifting the high pressure from the right ventricle to the left ventricle. Which procedure is Nurse Thompson discussing?
A. Jatene Procedure
B. Pulmonary Artery Banding
C. Rastelli Procedure
D. Rashkind Procedure
✔Correct answer:
Jatene Procedure. The Jatene procedure, also known as the arterial switch operation, is the surgery Nurse Thompson is referring to. This procedure is performed to correct Transposition of the Great Arteries (TGA), a congenital heart defect where the positions of the main arteries (the aorta and the pulmonary artery) are switched. In TGA, the aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle, resulting in the circulation of deoxygenated blood through the body and oxygenated blood through the lungs, which is not sustainable for life.
The Jatene procedure involves switching the aorta and pulmonary artery to their correct anatomical positions. This procedure redirects the blood flow so that the left ventricle pumps oxygenated blood to the body and the right ventricle pumps deoxygenated blood to the lungs, correcting the circulation.
- Nurse Carter is reviewing cardiac conditions with her nursing students, focusing on those that result in cyanosis due to deoxygenated blood mixing with oxygenated blood in the systemic circulation. She asks the students to identify the disorder that typically causes this phenomenon. Which disorder should the students correctly identify?
A. Tetralogy of Fallot.
B. Persistent opening between the aorta and the pulmonary artery.
C. Narrowing of the aortic valve.
D. Narrowing of the aorta.
✔Correct answer:
Tetralogy of Fallot. Tetralogy of Fallot is a congenital heart defect that typically results in cyanosis due to the mixing of deoxygenated blood with oxygenated blood in the systemic circulation. This condition consists of four anatomical abnormalities:
Ventricular Septal Defect (VSD): A hole between the right and left ventricles allows deoxygenated blood from the right ventricle to mix with oxygenated blood in the left ventricle.
Pulmonary Stenosis: Narrowing of the pulmonary valve or artery reduces blood flow to the lungs, increasing pressure in the right ventricle and exacerbating the mixing of blood.
Overriding Aorta: The aorta is positioned directly above the ventricular septal defect, receiving blood from both the right and left ventricles.
Right Ventricular Hypertrophy: Thickening of the right ventricular muscle due to increased workload from the pulmonary stenosis.
These defects work together to reduce the amount of oxygenated blood delivered to the body, leading to cyanosis, a bluish tint to the skin, lips, and nails due to low oxygen levels.
- Nurse Thompson is discussing with Mr. and Mrs. Bacon the best strategies to ensure their infant daughter, who is diagnosed with heart failure, receives optimal nutrition. Considering the infant’s condition, which intervention should Nurse Thompson recommend to facilitate effective feeding for the infant?
A. Utilizing nipples that require minimal effort for the infant to suck.
B. Giving substantial feedings at intervals of every 4 hours.
C. Giving formula enriched with high levels of sodium and calories.
D. Letting the infant feed for a duration of at least one hour.
✔Correct answer:
Utilizing nipples that require minimal effort for the infant to suck. For an infant with heart failure, feeding can be particularly challenging due to the increased energy expenditure and potential for fatigue. Using nipples that require minimal effort for the infant to suck helps to reduce the energy required for feeding, making it easier for the infant to obtain adequate nutrition without becoming overly tired. This strategy helps to ensure the infant can feed effectively and gain necessary nutrients for growth and health.
- Nurse Thompson is monitoring Helen, a 6-year-old girl who has been diagnosed with Kawasaki disease. In discussing Helen’s condition with her parents, Nurse Thompson explains that, aside from the known symptoms of Kawasaki disease, there is another potential complication they should be aware of. Which of the following should Nurse Thompson include in her discussion?
A. The potential development of meningitis.
B. The likelihood of aneurysm formation.
C. The risk of sepsis.
D. The onset of mitral valve disease.
✔Correct answer:
The likelihood of aneurysm formation. One of the most serious complications of Kawasaki disease is the formation of coronary artery aneurysms. Kawasaki disease causes inflammation of the blood vessels throughout the body, including the coronary arteries, which supply blood to the heart. This inflammation can lead to weakening and bulging of the artery walls, resulting in aneurysms. These aneurysms can increase the risk of blood clots, heart attacks, and other cardiovascular complications, even after the acute phase of the disease has resolved.
- During a teaching session with a group of nursing students, Nurse Parker is discussing the anatomy of the heart. She asks the students to identify the term that refers to the bluntly rounded lower tip of the heart. Which term should the students select?
A. Aorta
B. Apex
C. Base
D. Pericardium
✔Correct answer:
Apex. The apex of the heart refers to the bluntly rounded lower tip of the heart. It is located at the bottom of the heart and points downward, forward, and to the left. The apex is an important landmark in cardiac anatomy and is the point where the heart’s strongest contractions are felt, typically where the apical pulse can be auscultated or palpated.
- Nurse Carter is conducting a review session on the cardiac conduction system with her students. She presents a series of statements and asks the students to identify the one that accurately describes the conduction system of the heart. Which statement should the students correctly choose?
A. The SA node is positioned on the upper wall of the left atrium.
B. The AV node swiftly transmits action potentials.
C. The atrioventricular bundle conducts action potentials at a slow pace.
D. The sinoatrial (SA) node functions as the heart’s natural pacemaker.
✔Correct answer:
The sinoatrial (SA) node functions as the heart’s natural pacemaker. The sinoatrial (SA) node is located in the right atrium and is responsible for initiating the electrical impulses that set the rate and rhythm of the heart, thus functioning as the heart’s natural pacemaker. It generates action potentials that spread through the atria, causing them to contract and push blood into the ventricles.
- Nurse Rodriguez is designing an educational program for the parents of Larsa, who has been diagnosed with pulmonic stenosis (PS). To ensure the parents have a clear understanding of their child’s condition, she plans to explain the specific nature of this heart disorder. Which of the following aspects should Nurse Rodriguez include to accurately describe pulmonic stenosis?
A. A blockage hampers blood flow from the left ventricle.
B. A blockage impedes blood flow from the right ventricle.
C. Blood returning to the heart bypasses the left atrium.
D. One blood vessel originates from both the left and right ventricles.
✔Correct answer:
A blockage impedes blood flow from the right ventricle. Pulmonic stenosis (PS) is a heart condition characterized by a narrowing (stenosis) at the pulmonary valve or just below it, which obstructs the flow of blood from the right ventricle to the pulmonary artery. This obstruction increases the pressure in the right ventricle as it works harder to pump blood through the narrowed valve, leading to right ventricular hypertrophy over time. It’s crucial for parents to understand that this blockage can impact the efficiency of blood flow to the lungs for oxygenation.
- Nurse Martinez is preparing a teaching plan for Cherry, who has been diagnosed with rheumatic fever. The focus of the plan is to highlight preventive measures that can avert the initial development of the condition. What crucial advice should Nurse Martinez include in her teaching to effectively prevent the onset of rheumatic fever for Cherry?
A. Addressing streptococcal throat infections promptly with antibiotics.
B. Administering corticosteroids to decrease inflammation.
C. Taking antibiotics prophylactically before any dental procedures.
D. Prescribing penicillin specifically for rheumatic fever treatment.
✔Correct answer:
Addressing streptococcal throat infections promptly with antibiotics. Rheumatic fever is a serious inflammatory disease that can develop as a complication of untreated or inadequately treated streptococcal throat infections (streptococcal pharyngitis or strep throat) caused by group A Streptococcus bacteria. Prompt and effective treatment of strep throat with appropriate antibiotics, such as penicillin, is crucial in preventing the initial onset of rheumatic fever. This helps eradicate the streptococcal bacteria, preventing the immune response that can lead to rheumatic fever.
- The Smith Family is gathered at the hospital where their youngest child, Jordan, is being treated for a complex heart condition known as tetralogy of Fallot. Nurse Walters is explaining to the family the specific heart defects that make up this condition. Which combination of defects should Nurse Walters describe to the Smith Family as characteristic of tetralogy of Fallot?
A. Aorta exits from the right ventricle, pulmonary artery exits from the left ventricle, and two noncommunicating circulations.
B. Tricuspid valve atresia, atrial septal defect, ventricular septal defect, and hypoplastic right ventricle.
C. Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy.
D. Coarctation of aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus.
✔Correct answer:
Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy. Tetralogy of Fallot is a congenital heart defect that involves four key anatomical abnormalities. Nurse Walters should explain these four defects to the Smith Family:
Ventricular Septal Defect (VSD): A hole between the right and left ventricles that allows oxygen-poor blood to mix with oxygen-rich blood.
Overriding Aorta: The aorta is positioned directly above the ventricular septal defect, receiving blood from both the right and left ventricles.
Pulmonic Stenosis (PS): Narrowing of the pulmonary valve or artery, which reduces blood flow to the lungs.
Right Ventricular Hypertrophy: Thickening of the muscular walls of the right ventricle due to the increased workload caused by the other defects.
These defects work together to decrease the amount of oxygen-rich blood that is delivered to the body, leading to symptoms like cyanosis (a bluish tint to the skin).
