Week 6 Congenital Heart Defects Flashcards
While discussing the diagnosis of tetralogy of fallot (TOF) with a graduate nurse (GN), the registered nurse (RN) reviews which defect as a part of TOF? Select all that apply.
aortic stenosis
ventricular septal defect
pulmonic stenosis
overriding aorta
right ventricular hypertrophy
ventricular septal defect
pulmonic stenosis
overriding aorta
right ventricular hypertrophy
In tetralogy of fallot, the classic four defects include: ventral septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. The alteration in hemodynamics varies widely, depending primarily on the degree of pulmonary stenosis. It also depends on the size of the ventricular septal defect and the pulmonary and systemic resistance to flow. Because the ventricular septal defect is usually large, pressures may be equal in the right and left ventricles. Therefore the shunt direction depends on the difference between pulmonary and systemic vascular resistance.
While caring for an infant diagnosed with Down’s syndrome, the registered nurse (RN) notes cyanosis that increases with crying, and recognizes that this clinical presentation is an indicator of what congenital heart defect?
patent ductus arteriosus
atrial septal defect
ventricular septal defect
atrioventricular canal defect
atrioventricular canal defect
This answer is correct because atrioventricular canal defect is the most common cardiac defect in children diagnosed with Down’s syndrome. The child with this defect usually has moderate to severe heart failure. There is a characteristic mid-systolic murmur. There may be mild cyanosis that increases with crying. Treatment involves surgical repair.
After verifying a diagnosis of coarctation of the aorta in a pediatric male client, the registered nurse (RN) anticipates the healthcare provider will order which procedure to correct the heart defect? Select all that apply.
artery replacement
open heart surgery
heart transplant
balloon angioplasty
surgical repair
balloon angioplasty
surgical repair
For the treatment of coarctation of the aorta, surgical repair is the treatment of choice for infants younger than 6 months of age and for patients with long-segment stenosis or complex anatomy. Repair is by resection of the coarcted portion with an end-to-end anastomosis of the aorta or enlargement of the constricted section using a graft of prosthetic material or a portion of the left subclavian artery. Balloon angioplasty is being performed as a primary intervention for coarctation of the aorta in infants older than 6 months and children. In adolescents stents may be placed in the aorta to maintain patency.
While providing care for a 1 month old newborn, which clinical presentation observed by the registered nurse (RN) supports the possible diagnosis of tetralogy of fallot? Select all that apply.
abdominal distention
steady weight gain
cyanosis with crying
oxygen saturation of 80%
dyspnea with feeding
cyanosis with crying
oxygen saturation of 80%
dyspnea with feeding
With a diagnosis of tetralogy of fallot (TOF), some neonates may be acutely cyanotic at birth, others have mild cyanosis. This mild cyanosis will progress over the first year of life as the pulmonic stenosis worsens. Neonates with severe right ventricular outflow obstruction have severe cyanosis and dyspnea during feeding, leading to poor weight gain. Neonates with mild obstruction may not have cyanosis at rest. With TOF there is a characteristic systolic ejection murmur heard in the mid and upper sternal border.
The registered nurse (RN) is providing care for a 10 day old male diagnosed with coarctation of the aorta and recognizes which assessment is supportive of this diagnosis? Select all that apply.
lower extremities warmer to touch than upper extremities
decreased pulse force in the upper extremities
increased pulse force in the lower extremities
decreased blood pressure in the lower extremities
elevated blood pressure in the upper extremities
decreased blood pressure in the lower extremities
elevated blood pressure in the upper extremities
Physiologic consequences of coarctation of the aorta involve two phenomena: pressure overload in the arterial circulation proximal to the coarctation and hypoperfusion distal to the coarctation. Pressure overload causes left ventricular hypertrophy and hypertension in the upper part of the body, including the brain. Hypoperfusion affects the abdominal organs and lower extremities. Malperfusion of the intestine increases the risk of sepsis due to the enteric organisms. Ultimately, the pressure gradient increases collateral circulation to the abdomen and lower extremities via intercostal, internal mammary, scapular, and other arteries. If coarctation is significant, circulatory shock with renal insufficiency and metabolic acidosis may develop in the first 7 to 10 days of life.
While caring for a 10 year old male, which diagnostic test does the registered nurse (RN) anticipate the healthcare provider will order to verify the presence of coarctation of the aorta? Select all that apply.
cardiac stress test
cardiac enzymes
pulmonary function test
chest x-ray
echocardiogram
chest x-ray
echocardiogram
Diagnosis of coarctation of the aorta is supported by physical assessment of the newborn, including a blood pressure reading in all four extremities and palpation of femoral pulses. A chest x-ray will demonstrate the coarctation as a shadow in the upper left mediastinal area. An echocardiogram usually shows left ventricular hypertrophy but findings may be normal. The presence of a coarctation alters fetal circulation by shifting a higher proportion of flow through the right ventricle. Neonates and infants with severe coarctation usually have right ventricular hypertrophy rather than left ventricular hypertrophy.
During the postoperative care of a 6 month old infant following surgery to repair tetralogy of fallot, what presentation observed by the registered nurse (RN) is an indicator of heart failure?
increased temperature, accompanied by diaphoresis and crying
pink lips when crying and falling asleep while feeding
fretfulness with body position and surgical dressing changes
puffiness in eyes, coolness in extremities, and fewer wet diapers
puffiness in eyes, coolness in extremities, and fewer wet diapers
This answer is correct because puffiness in eyes, coolness in extremities, and fewer wet diapers is a presentation of heart failure. Heart failure is a risk after a surgical procedure to correct the tetralogy of fallot. The assessment of these presentations will require the RN to notify the healthcare provider promptly.
While caring for a 5 week old infant diagnosed with a ventricular septal defect, the registered nurse (RN) recognizes which clinical manifestation supports this diagnosis? Select all that apply.
continuous crying
poor weight gain
fatigue after feeding
grunting during feeding
loud systolic murmur
poor weight gain
fatigue after feeding
grunting during feeding
loud systolic murmur
A ventricular septal defect (VSD) is an abnormal opening between the right and left ventricles. Many VSDs will close spontaneously. Spontaneous closure is most likely to occur during the first year of life in children having small or moderate defects. A loud, harsh, holosystolic murmur at the lower left sternal border is common. Symptoms depend on defect size and magnitude of the left-to-right shunt. Children with a small ventricular septal defect are typically asymptomatic and grow and develop normally. In children with a larger defect, symptoms of heart failure (eg, respiratory distress, poor weight gain, grunting during feeding, and fatigue after feeding) appear at age 4 to 6 weeks when pulmonary vascular resistance falls. Frequent lower respiratory tract infections may occur. Small ventricular septal defects, particularly muscular septal defects, often close spontaneously during the first few years of life. A small defect that remains open does not require medical or surgical therapy. Larger defects are less likely to close spontaneously and require surgical intervention.
The registered nurse (RN) is caring for a 1 week old newborn diagnosed with a patent ductus arteriosus and anticipates the presence of what sound with the murmur?
sonorous type murmur
crescendo type murmur
purring type murmur
machinery-like murmur
machinery-like murmur
This answer is correct because machinery-like murmur is the sound expected with a murmur related to a patent ductus arteriosus. Patent ductus arteriosus is a failure of the ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life. Patent ductus arteriosus is a failure of the ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life.
Within hours of birth, the neonate develops severe cyanosis and hypoxia, followed by metabolic acidosis, that alerts the registered nurse (RN) to the presentation of what congenital heart defect?
tricuspid atresia
truncus arteriosus
tetralogy of fallot
transposition of the great arteries
transposition of the great arteries
This answer is correct because transposition of the great arteries does have a rapid presentation within hours of birth. With transposition of the great arteries, severe cyanosis occurs within hours of birth, followed rapidly by metabolic acidosis secondary to poor tissue oxygenation. In transposition of the great arteries, the pulmonary artery leaves the left ventricle, and the aorta exits from the right ventricle, with no communication between the systemic and pulmonary circulation.
What statement by the mother of a 10 day old male diagnosed with coarctation of the aorta demonstrates a need for further education by the registered nurse (RN) regarding treatment for this heart defect?
“If he does not have the surgery, then as he grows he has a great chance of developing high blood pressure even before he becomes an adult.”
“If he does not have the surgery, then when he grows up that will cause an increased risk of him having a stroke or worse.”
“I realize that once he has surgery he will need to be on antibiotic therapy for 6 months to protect him from a heart infection.”
“It will be better to wait until he is at least 4 years old for surgery so that he does not have anesthesia problems.”
“It will be better to wait until he is at least 4 years old for surgery so that he does not have anesthesia problems.”
This answer is correct because the statement “it will be better to wait until he is at least 4 years old for surgery so that he does not have anesthesia problems” does require further education. Infants with critical (severe) coarctation are likely to become acutely ill as soon as the ductus arteriosus constricts or closes. Untreated coarctation may result in left ventricular hypertrophy, as well as hypertension, heart failure, ruptured aorta, aortic aneurysm, and stroke. To prevent both hypertension at rest and exercise-provoked systemic hypertension after surgical repair, it is advised to perform the surgery within the first 2 years of life.
While caring for an infant diagnosed with tetralogy of fallot, the registered nurse (RN) identifies a hypercyanotic spell and implements which intervention? Select all that apply.
position the infant prone
stretch the infant’s legs out
administer oxygen therapy
swaddle the infant closely
provide the infant a pacifier
administer oxygen therapy
swaddle the infant closely
provide the infant a pacifier
Hypercyanotic spells, also referred to as tet spells, may occur in the pediatric client diagnosed with tetralogy of fallot (TOF). The infant becomes acutely cyanotic and hypoxic. Anoxic spells occur when the infant’s oxygen requirements exceed the blood supply. This usually occurs during crying, when waking up, and after feeding. These hypercyanotic spells require immediate intervention. These interventions include: place the infant with knees to chest ( older children assume a squatting position), establish a quiet environment, administer oxygen, and administer intravenous fluids to promote volume expansion. If the spell persists, morphine is administered. Ultimately, if positioning and drugs do not relieve the spell or if the infant is rapidly deteriorating, tracheal intubation may be indicated.
The registered nurse (RN) is caring for a 32 week neonate diagnosed with a patent ductus arteriosus and anticipates the order for which intravenous drug as treatment to promote closure?
digoxin
furosemide
spiranolactone
indomethacin
indomethacin
This answer is correct because indomethacin is the drug that will promote closure of the patent ductus arteriosus. In premature infants with a hemodynamically significant PDA and compromised respiratory status, the PDA can sometimes be closed by using a COX inhibitor, indomethacin, which works by blocking the production of prostaglandins. Fluid restriction is also implemented to help promote closure of the PDA.
The registered nurse (RN) is caring for an infant diagnosed with an atrial septal defect and recognizes which clinical manifestation as a presentation of this diagnosis? Select all that apply.
bradypnea at rest
steady weight gain
ease with exercise
diaphoresis with feeding
midsystolic murmur
diaphoresis with feeding
This answer is correct because diaphoresis with feeding is an expected clinical manifestation with atrial septal defect. Atrial septal defect may cause poor weight gain in early childhood and exercise intolerance, dyspnea during exertion, fatigue, and/or palpitations.
midsystolic murmur
This answer is correct because midsystolic murmur is an expected clinical manifestation with atrial septal defect. A soft midsystolic murmur, heard at the upper left sternal border, is a common assessment finding with atrial septal defect.
What statement by the registered nurse (RN) is the best response to the mother of a 10 day newborn asking for an explanation of her son’s diagnosis of coarctation of the aorta.
“This heart defect causes a twisting of the aorta (the major artery in the body) that causes a difference in blood flow to the upper and lower parts of your son’s body.”
“This heart defect causes a narrowing of the vena cava (major vein in the body) that causes a difference in blood flow to the upper and lower parts of your son’s body.”
“This heart defect causes a shortening of the aorta (the major artery in the body) that causes a difference in blood flow to the upper and lower parts of your son’s body.”
“This heart defect causes a narrowing of the aorta (the major artery in the body) that causes a difference in blood flow to the upper and lower parts of your son’s body.”
“This heart defect causes a narrowing of the aorta (the major artery in the body) that causes a difference in blood flow to the upper and lower parts of your son’s body.”
This answer is correct because the statement “this heart defect causes a narrowing of the aorta (the major artery in the body) that causes a difference in blood flow to the upper and lower parts of your son’s body” is the best response the RN will provide the mother.
