Hearts
An infant is being prepared for surgical repair of a ventricular septal defect (VSD). Which of the following problems will be prevented by closing the defect?
a. Ventricular dysrhythmias
b. Heart block
c. Failure to thrive
d. Respiratory alkalosis
c. Failure to thrive
The healthcare provider is caring for an infant with a diagnosis of a congenital heart defect. The baby’s pulse is 153 and the respiratory rate is 74. Which of the following is the best position for the baby to be placed?
a. Side-lying with a blanket roll at the back
b. Upright in an infant seat
c. Supine with the legs slightly elevated
d. Prone position with the head elevated
b. Upright in an infant seat
The healthcare provider is caring for a child with congenital heart disease. When planning care, monitoring for which of the following complications will be included in the plan of care?
a. Bradycardia and hepatomegaly
b. Pulmonary hypotension and cyanosis
c. Increased pulmonary compliance and cyanosis
d. Congestive heart failure and hypoxemia
d. Congestive heart failure and hypoxemia
The healthcare provider is planning the discharge for a child with a ventricular septal defect. Which of the following is a priority to include in the discharge instructions?
a. Provide instructions on monitoring the child’s growth
b. Suggest quiet activities for the child to decrease physical activity
c. Ensure the parents know how to take the child’s blood pressure at home
d. Advise the family to feed to child meals low in fat and calories
a. Provide instructions on monitoring the child’s growth
Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? Select all that apply.
a. Allow parents to hold and rock their child.
b. Feed only when the infant is crying.
c. Keep the child uncovered to promote low body temperature.
d. Make frequent position changes.
e. Feed the child when sucking the fists.
f. Change bed linens only when necessary.
g. Organize nursing activities.
a. Allow parents to hold and rock their child.
d. Make frequent position changes.
e. Feed the child when sucking the fists.
f. Change bed linens only when necessary.
g. Organize nursing activities.
During bedside report, the healthcare provider learns that the cardiac circulation of an infant with Eisenmenger syndrome is shunting from right to left. The infant may have impaired gas exchange related to:
a. Decreased pulmonary vascular pressure
b. Decreased ventilation in relation to perfusion
c. Decreased pulmonary blood flow
d. Dilated pulmonary capillaries
c. Decreased pulmonary blood flow
The nurse is caring for a child with a diagnosis of a right-to-left cardiac shunt. On review of the child's record, the nurse should expect to note documentation of which most common assessment finding?
a. Severe bradycardia
b. Asymptomatic after feeding
c. Bluish discoloration of the skin
d. Higher than normal body weight
c. Bluish discoloration of the skin
A 5-year-old child with a congenital heart defect is to receive digoxin PO. Prior to administration, the healthcare provider checks the most recent laboratory report. Which laboratory value should be of most concern to the healthcare provider?
a. Creatinine 0.4 mg/dL
b. Hemoglobin 10 g/ dL
c. Digoxin 0.8 ng/mL
d. Potassium 3.2 mEq/L
d. Potassium 3.2 mEq/L
The healthcare provider is caring for a patient with a congenital heart defect and is reviewing fetal circulation. Which of the following statements most accurately explains the major difference between fetal circulation and the circulation established after birth? (SATA)
a. Oxygenated blood flows from the placenta through the umbilical vein to the fetus
b. After the umbilical cord is cut, the foramen ovale opens to allow more blood flow to the lungs
c. Systemic vascular resistance is lower than pulmonary vascular resistance in the fetus
d. In the fetus, the ductus arteriosus diverts most of the blood away from the lungs
e. The ductus venosis closes after birth so blood is no longer diverted from the ventricles to the atria
a. Oxygenated blood flows from the placenta through the umbilical vein to the fetus
c. Systemic vascular resistance is lower than pulmonary vascular resistance in the fetus
d. In the fetus, the ductus arteriosus diverts most of the blood away from the lungs
During an examination of an infant with a patent ductus arteriosus (PDA), the healthcare provider should expect to observe: (SATA)
a. Clubbing of the fingers and toes
b. Widening pulse pressure
c. Systolic murmur
d. Profound cyanosis
e. Bounding peripheral pulses
b. Widening pulse pressure
c. Systolic murmur
e. Bounding peripheral pulses
During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to:
a. Lay the child flat to promote hemostasis.
b. Lay the child flat with legs elevated to increase blood flow to the heart.
c. Sit the child on the parent's lap, with legs dangling, to promote venous pooling.
d. Hold the child in knee-chest position to decrease venous blood return
d. Hold the child in knee-chest position to decrease venous blood return
In which congenital heart defect (CHD) would the nurse need to take upper and lower extremity BPs?
a. Transposition of the great vessels
b. Aortic stenosis (AS)
c. Coarctation of the aorta (COA)
d. Tetralogy of Fallot (TOF)
c. Coarctation of the aorta (COA)
The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has:
a. Transposition of the great vessels
b. Coarctation of the aorta (COA)
c. Aortic stenosis (AS)
d. Pulmonic stenosis (PS)
b. Coarctation of the aorta (COA)
The nurse explains that a ventricular septal defect will allow:
a. blood to shunt left to right, causing increased pulmonary flow and no cyanosis.
b. blood to shunt right to left, causing decreased pulmonary flow and cyanosis.
c. no shunting because of high pressure in the left ventricle.
d. increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume.
a. blood to shunt left to right, causing increased pulmonary flow and no cyanosis.
An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). The nurse understands dyspnea occurs because blood is:
a. circulated through the lungs again, causing pulmonary circulatory congestion.
b. shunted past the pulmonary circulation, causing pulmonary hypoxia.
c. shunted past cardiac arteries, causing myocardial hypoxia.
d. circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.
a. circulated through the lungs again, causing pulmonary circulatory congestion.
The nurse is aware that the infant born with hypoplastic left heart syndrome must acquire his or her oxygenated blood through:
a. the closure of the ductus arteriosus
b. a ventricular septal defect
c. the closure of the foramen ovale
d. an atrial septal defect
d. an atrial septal defect
When auscultating the heart of a patient with an atrial septal defect (ASD), the healthcare provider hears a split S2. What is the significance of this heart sound?
a. The S2 is normally split so this is not a significant finding
b. Because closure of the pulmonary valve is delayed in ASD, a split S2 is produced
c. When the ventricles fill rapidly the split S2 is produced
d. The split S2 is produced when the mitral valve opens with a snap
b. Because closure of the pulmonary valve is delayed in ASD, a split S2 is produced
A newborn infant is cyanotic at birth. You suspect transposition of the great arteries. A mixing lesion is necessary for life. Which of the following lesions would allow better mixing?
a. VSD
b. PDA
c. ASD
c. ASD
Which of the following lesions would result in the greatest amount of pulmonary blood flow and hence the early development of CHF?
a. Large ASD
b. Large VSD
c. Tetrology of Fallot
d. A complete AVSD
e. Truncus arteriosus
e. Truncus arteriosus
A baby that was born 5 minutes earlier is tachypneic, tachycardic, and markedly cyanotic. A STAT echocardiogram confirms the presence of a cyanotic congenital cardiac defect. Which of the following defects would be consistent with the assessment findings?
a. Patent ductus arteriosus
b. Ventricular septal defect
c. Atrial septal defect
d. Transposition of the great vessels
d. Transposition of the great vessels