Chapter 12: Cardiovascular Disorders My Nursing Test Banks

Chapter 12: Cardiovascular Disorders

Multiple Choice

1. The right ventricle is responsible for:

1. Pumping blood to the left atrium.

2. Pumping deoxygenated blood to the lungs.

3. Pumping oxygenated blood to the body.

4. Returning oxygenated blood from the lungs.

ANS: 2

Feedback
1. The ventricle pumps blood to the lungs via the pulmonary artery.
2. The right ventricle pumps blood to the lungs to become oxygenated.
3. The left ventricle pumps oxygenated blood to the body.
4. The pulmonary artery returns the oxygenated blood from the lungs.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge |  REF: Chapter 12 | Type: Multiple Choice

2. The heart valve that connects the left atria and the left ventricle is:

1. The tricuspid valve.

2. The bicuspid valve.

3. The pulmonic valve.

4. The aortic valve.

ANS: 2

Feedback
1. This valve connects the right atria to the right ventricle.
2. This valve connects the left atria and the left ventricle.
3. This valve connects the right ventricle and the pulmonary artery.
4. This valve connects the left ventricle and the ascending aorta.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge |  REF: Chapter 12 | Type: Multiple Choice

3. In fetal development, the _________ is open to allow blood to flow in the heart.

1. Patent ductus arteriosus

2. Pulmonic valve

3. Aortic valve

4. Bicuspid valve

ANS: 1

Feedback
1. The patient ductus arteriosus is the opening in the heart that allows blood to flow in the heart.
2. The pulmonic valve is not the opening.
3. The aortic valve is open before and after birth.
4. The bicuspid valve is open before and after birth.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge |  REF: Chapter 12 | Type: Multiple Choice

4. A nurse is assessing a 4-year-old child with a known atrial septal defect. Identify what the nurse should expect to see in the assessment.

1. An increased heart rate

2. An increased respiratory rate

3. Lower oxygen saturation

4. A lower heart rate

ANS: 3

Feedback
1. The heart rate will be a normal rate for a 4-year-old child.
2. The respiratory rate will be a normal rate for a 4-year-old child.
3. Oxygen saturations are expected to be lower because of the leakage caused by the defect.
4. The heart rate will be a normal rate for a 4-year-old child.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension |  REF: Chapter 12 | Type: Multiple Choice

5. A nurse is discussing heart disorders that cause the mixing of oxygenated and deoxygenated blood with a new nurse. The nurse should explain that the mixed disorders consist of all of the following except:

1. Tetralogy of Fallot.

2. Hypoplastic left heart.

3. Truncus afteriosus.

4. Transposition of the great vessels.

ANS: 1

Feedback
1. This is an obstructive disorder.
2. A mixed blood heart defect
3. A mixed blood heart defect
4. A mixed blood heart defect

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application |  REF: Chapter 12 | Type: Multiple Choice

6. When assessing a newborn, a nurse should check capillary refill:

1. On the fingernail beds.

2. On the sternum.

3. On the arm.

4. On the hand.

ANS: 2

Feedback
1. Because of peripheral cyanosis, the fingernail beds will not respond quickly for an adequate measurement of capillary refill.
2. The sternum responds quickly for an adequate measurement of capillary refill.
3. The hand does not respond quickly for an adequate measurement of capillary refill.
4. The hand does not respond quickly for an adequate measurement of capillary refill.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application |  REF: Chapter 12 | Type: Multiple Choice

7. Weak peripheral pulses can indicate:

1. A weak heart.

2. Poor cardiac output.

3. Hypertension.

4. Patent ductus arteriosus.

ANS: 2

Feedback
1. The heart may be weak, but does not indicate that the pulses will be weak.
2. A lower amount of output does not allow for peripheral pulses to be easily felt.
3. If the patient has hypertension, the pulses may be bounding.
4. Patent ductus arteriosus may have bounding pulses.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension |  REF: Chapter 12 | Type: Multiple Choice

8. Identify the child that is demonstrating acrocyanosis.

1. A newborn shows slow capillary refill.

2. A newborns hands are blue following delivery.

3. A newborn with a fever has red hands.

4. A newborn with a lack of oxygen has blue hands.

ANS: 2

Feedback
1. Slow capillary refill can be demonstrated with acrocyanosis, but is not the cause.
2. The vasoconstriction after birth is a cause of acrocyanosis
3. A newborn with a fever will not demonstrate acrocyanosis.
4. Lack of oxygen will cause central cyanosis.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application |  REF: Chapter 12 | Type: Multiple Choice

9. A newborn is born with patent ductus arteriosus. If the patent ductus arteriosus does not close during this time, the newborn will exhibit:

1. Narrowing pulse pressures.

2. Widening pulse pressures.

3. A decreased heart rate.

4. Quick capillary refill.

ANS: 2

Feedback
1. The pulse pressures widen because of the low pressure gradient within the heart.
2. The widening occurs because of the low pressure gradient within the heart.
3. The heart rate will increase because of not perfusing to the lungs.
4. The capillary refill will be sluggish because the oxygenated blood is not going out to the rest of the body.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension |  REF: Chapter 12 | Type: Multiple Choice

10. A nurse is assessing a newborn with a known patent ductus arteriosus defect of the heart. The mother asks when she can start breastfeeding her infant. The best explanation by the nurse would be:

1. The newborn will need to have the defect repaired before oral feedings can start.

2. The newborn will need to have extensive rest time between feedings, so plan on breastfeeding one time, then we will give a nasogastric feeding the next time.

3. The nursing staff will monitor the newborn during feedings because she may sweat and have increased difficulty breathing.

4. The newborn should have no issues while breastfeeding.

ANS: 3

Feedback
1. Feedings can begin before the repair if the newborn does not demonstrate difficulties in cardiac and respiratory status.
2. Rest time will be needed before and after feedings, but there is no need to alternate between breast and nasogastic feedings.
3. Monitoring will enable the nurse to assess when the newborn needs a break in feedings.
4. The newborn will have some issues with feedings because of the heart issues.

KEY: Content Area: Cardiac | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity | Cognitive Level: Synthesis |  REF: Chapter 12 | Type: Multiple Choice

11. A 6 month old has a known diagnosis of an Atrial Septal Defect (ASD). The nurse would anticipate all except which of the following during an assessment?

1. Shortness of breath

2. Enlarged liver

3. Poor feeding

4. A diastolic murmur

ANS: 4

Feedback
1. Shortness of breath is expected since more blood flows to the pulmonary area because of the hole.
2. The liver enlarges because of the increase in blood flow.
3. Poor feedings are expected as a result of shortness of breath because of the pulmonary hypertension issues.
4. A systolic murmur is expected due to the blood being forced through the pulmonary valve.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

12. A nurse should question which of the following orders for a child with a known ASD?

1. A transesophogeal ultrasound

2. Digoxin

3. EKG

4. All are appropriate orders for a child with an ASD.

ANS: 4

Feedback
1. The ultrasound allows for the entire heart to be viewed in order to find the exact location of the ASD.
2. Digoxin will help with the cardiac output.
3. An EKG will help identify heart function.
4. All the orders would be appropriate for the child because each aids in gathering all the information needed for proper treatment of the defect.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: Chapter 12 | Type: Multiple Choice

13. A nurse knows that the mother understands the discharge instructions for an 8 month old that had a cardiac catheterization for an ASD when the mother states:

1. We will need to schedule weekly visits to make sure the heart is functioning properly.

2. The surgical site will require us to keep our child in isolation at home.

3. We will need to monitor the insertion site for drainage and temperature changes.

4. My child will not have any more issues with arrhythmias.

ANS: 3

Feedback
1. The visits will need to be prescribed by the doctor. Visits usually take place three months to one year after the procedure area heals.
2. The child will have a short recovery time and does not need to be in isolation.
3. The insertion site must be monitored for signs and symptoms of infection and bleeding.
4. The child may have arrhythmias his/her entire life.

KEY: Content Area: Cardiac | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity | Cognitive Level: Evaluation | REF: Chapter 12 | Type: Multiple Choice

14. The most common heart defect is:

1. ASD.

2. Patent Foramen Ovale (PFO).

3. Hypertrophic left heart syndrome.

4. Ventricular Septal Defect (VSD).

ANS: 4

Feedback
1. An ASD is not a common heart defect. Usually see closure within a few hours after birth.
2. The PFO is common in premature neonates.  Not common in full-term neonates thus is not the most common defect.
3. A rare heart congenital heart defect.
4. The most common defect.  The defect can be medically managed with minimal intervention.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: Chapter 12 | Type: Multiple Choice

15. A nurse is assessing a child with a known VSD. The nurse anticipates auscultating:

1. A systolic thrill in the lower left sternal border.

2. Wet lung sounds bilaterally.

3. A diastolic thrill in the upper left sternal border.

4. A diastolic wetness in the right sternal border.

ANS: 1

Feedback
1. A thrill sound in the left sternal border will be heard because of where the valve is located.
2. The lung sounds should be clear.
3. A systolic thrill and lower left sternal border thrill will be noted.
4. A thrill sound in the left sternal border with diastolic sounds will be heard because of where the valve is located.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Choice

16. An 18 month old with known Tetralogy of Fallot is seen squatting after running in the hospital playroom. The nurse knows the child is:

1. Having a rapid drop in the amount of oxygen in the blood and is short of breath.

2. Having a bowel movement.

3. About to faint because of the lack of oxygen in his blood.

4. Mimicking others in the playroom.

ANS: 1

Feedback
1. Squatting allows the child to take breaths and gain oxygen.
2. The child is attempting to inhale oxygen quickly.
3. The child is maintaining a position to gain oxygen in order to prevent fainting.
4. The child is squatting in order to take deep breaths and gain oxygen after the playing.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Evaluation | REF: Chapter 12 | Type: Multiple Choice

17. Jaycob, a 24-month-old child with a diagnosis of RSV and Tetrology of Fallot, is being cared for by a new nurse. Jaycob is agitated and is crying when care is provided. He begins to drop his oxygen saturations below an acceptable range. The nurse should:

1. Have the parent console the child.

2. Feed the child.

3. Call the doctor for an order for a sedative.

4. Cluster the care and allow the child time to rest.

ANS: 4

Feedback
1. The question does not state that the parent is available.
2. Feeding the child may cause oxygen saturations to drop lower.
3. All attempts at consoling the child should first be provided before asking for a sedative.
4. Clustering cares will allow for time to rest and result in less stress for the child.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

18. A newborn with a diagnosis of Tetrology of Fallot is demonstrating heart failure. The doctor orders a prostaglandin E1 drip. The nurse knows this is used to:

1. Maintain blood flow to the lungs.

2. Open the patent foramen ovale.

3. Increase blood flow to the extremities.

4. Decrease resistance of blood flow through the heart.

ANS: 1

Feedback
1. The prostaglandin will allow the Patent Ductus Arteriosis to have patency.
2. The patent foramen ovale is already open when a Tetrology of Fallot is present.
3. Blood flow to the heart and lungs rather than the extremities is the priority.
4. Because of the holes in the heart, the resistance is already low.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Choice

19. A nurse caring for a child with Eisenmengers syndrome should assess for all of the following except:

1. Fatigue.

2. Acrocyanosis.

3. Shortness of breath.

4. Blood pressure.

ANS: 2

Feedback
1. The child will have increased fatigue due to the lack of oxygen in the body.
2. The child will have cyanosis.
3. The child will demonstrate a shortness of breath because of the lack of oxygen being perfused to the lungs.
4. The blood pressure should be assessed to monitor how the heart is pumping.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

20. ECHMO is commonly used as a treatment for a baby with which defect/syndrome?

1. Eisenmengers syndrome

2. Coarctation of the aorta

3. ASD

4. Tetralogy of Fallot

ANS: 1

Feedback
1. ECHMO acts as a bypass for the heart and lungs to obtain enough oxygen for the body.
2. ECHMO acts as a bypass for the heart and lungs to obtain enough oxygen for the body. In coarctation, the heart and lungs are able to perfuse.
3. ECHMO acts as a bypass for the heart and lungs to obtain enough oxygen for the body.
4. ECHMO acts as a bypass for the heart and lungs to obtain enough oxygen for the body.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Choice

21. A child with a known diagnosis of coarctation of the aorta will have an increase in:

1. Blood pressure in the lower extremities.

2. Blood pressure in the upper extremities.

3. Blood pressure in the heart.

4. Blood pressure in the aortic arch.

ANS: 2

Feedback
1. Because of the low flow of blood, the lower extremities will have a lower flow of blood.
2. The upper extremities will demonstrate an increase in blood pressure.
3. The blood pressure affects the extremities.
4. The blood pressure affects the extremities.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

22. A nurse is assessing a child with coarctation of the aorta. The nurse knows she will find all the following except:

1. Decreased femoral pulses.

2. A report of chest pain.

3. Shortness of breath.

4. Poor growth.

ANS: 2

Feedback
1. The decreased blood flow to the lower extremities is noted in coarctation by assessing the pulses.
2. Coarctation can be asymptomatic.
3. Shortness of breath may be noted when exerting the body.
4. The child will have a slower growth rate than peers.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: Chapter 12 | Type: Multiple Choice

23. When assessing a child with coarctation of the aorta, the nurse should perform assessments to all of the follow areas except:

1. Blood pressure in all of the extremities.

2. Monitoring the perfusion to the extremities.

3. Pre-assessment for Digoxin before giving the prescribed doses.

4. Assessing the narrowing pulse pressures.

ANS: 4

Feedback
1. Blood pressure will greatly differ in the upper extremities versus the lower extremities.
2. Perfusion to the lower extremities will be worse than in the upper extremities.
3. Digoxin should always have a pre-assessment of an apical pulse for one minute.
4. Pulse pressures do not give adequate data for a child with coarctation of the aorta.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Evaluation |  REF: Chapter 12 | Type: Multiple Choice

24. A common bacteria that causes scarring on the aortic valve is:

1. Group A streptococcus bacteria.

2. Group B streptococcus bacteria.

3. Staphylococcus aureus.

4. E. coli.

ANS: 1

Feedback
1. This common bacteria causes scarring on the aortic valve.
2. This is not a common bacteria in the heart.
3. Common in endocarditis, but not a common cause of scarring on the aortic valve.
4. Usually attacks the GI tract

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Choice

25. Identify a common characteristic of pulmonary atresia.

1. Acrocyanosis at birth

2. Weight gain is similar to that of well newborns.

3. A murmur will be noted with an ASD or a PDA.

4. Severe cyanosis will be present at birth.

ANS: 4

Feedback
1. Cyanosis will be noted at birth.
2. Weight gain will be slower than peers.
3. A murmur will not be present with the ASD and the PDA.
4. Cyanosis will be noted at birth because of the fistula not allowing blood to go to the lungs in order to oxygenate.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Choice

26. Pulmonary stenosis causes an increased workload on:

1. The left atrium.

2. The right ventricle.

3. The left ventricle.

4. The right atrium.

ANS: 2

Feedback
1. This type of stenosis occurs in the right ventricle.
2. The right ventricle has an increased workload because of the lack of blood being pushed out of the heart.
3. The left ventricle does not have the workload because it is pushing oxygenated blood to the body.
4. The right atrium is filling with blood and does not have the resistance to push it to the lungs, thus decreasing the workload.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Choice

27. The nurse is assessing a baby with a known diagnosis of Tetralogy of Fallot with pulmonary atresia. The nurse should expect which of the following in her assessment of the baby?

1. A VSD murmur

2. Normal growth and development

3. Decreased peripheral pulses

4. Profound cyanosis

ANS: 4

Feedback
1. PDA murmur is common, not a VSD.
2. Growth and development will be delayed.
3. Peripheral pulses will be bounding.
4. Cyanosis will be present due to where the holes in the heart are located.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

28. An 18-pound, 12-month-old child with a known diagnosis of Tetralogy of Fallot with pulmonary atresia has been ordered to receive a calorie intake of 150 calories/kg per day. The total caloric intake prescribed is:

1. 1528

2. 1227

3. 2700

4. None of the above

ANS: 2

18/2.2= 8.18 kg

8.18 kg x 150 calories= 1227 calories per day

Feedback
1. Too many calories per day
2. Adequate calories per day
3. Too many calories per day
4. One answer is correct.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: Chapter 12 | Type: Multiple Choice

29. When a child with transposition of the greater vessels is assessed, the nurse should anticipate that:

1. The lower extremities will have bounding pulses.

2. Cyanosis will be noted when the child is sleeping on his/her back.

3. An ASD murmur will be present.

4. The oxygen saturations in the upper extremities will be lower than the oxygen saturations in the lower extremities.

ANS: 4

Feedback
1. The extremities will have weak pulses and low oxygen saturations.
2. Cyanosis will be present when crying.
3. The child will have a PDA.
4. The difference in oxygenation is caused by the aorta receiving deoxygenated blood.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

30. A newborn with transposition of the grater arteries has been prescribed Captopril. The mother asks why the child needs to be on such a medication. The best response by the nurse would be:

1. Your child needs the beta-blocker to decrease the angiotensin in the body.

2. The medication will help decrease the shortness-of-breath episodes.

3. The medication is an antihypertensive that helps relax the coronary arteries.

4. Your child is not responding to the prostaglandin E drip, so the Captopril needs to be started to decrease the blood pressure.

ANS: 3

Feedback
1. The medication is an ACE inhibitor.
2. The medication will not alter the respiratory rate.
3. The medication is an antihypertensive and relaxes the coronary arteries to help decrease blood pressure.
4. A prostaglandin E drip is not a long-term solution.

KEY: Content Area: Cardiac | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: Chapter 12 | Type: Multiple Choice

31. Identify the heart condition that will cause profound cyanosis, shock, and congestive heart failure if the PDA closes.

1. Truncus arteriosus

2. Total anomalous pulmonary venous return

3. Transposition of the greater vessels

4. ASD

ANS: 2

Feedback
1. The truncal valve remains open, so these signs and symptoms will not be noted.
2. The PDA must remain open to allow the oxygen from the pulmonary veins to move to the left atrium.
3. Transposition causes cyanosis, but does not lead to shock.
4. An ASD does not lead to shock.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Choice

32. A baby is born with a known hypoplastic left heart. At the delivery, the nurse should anticipate which of the following in the initial assessment after birth if the PDA closes?

1. Tachypnea and an ashy color

2. Tachycardia, pale in color, and apnea

3. Bradycardia and apnea

4. Ruddy color and tachycardia

ANS: 1

Feedback
1. Rapid breathing and an ashen look will be present because the baby is not able to push the blood to the lungs in order to get oxygen.
2. Tachycardia and apnea are not present.
3. Bradycardia and apnea are not present.
4. The baby would be ashen and have rapid tachypnea.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Evaluation | REF: Chapter 12 | Type: Multiple Choice

33. A mother arrives at a birth care center in full labor with no prenatal history. The mother states she has a form of mental illness that requires her to take lithium daily. The nurse knows that lithium use during pregnancy can cause which type of heart defect?

1. Hypoplastic left heart

2. Truncus arteriosus

3. An Epstein anomaly

4. Cardiomyopathy

ANS: 3

Feedback
1. There is no known reason for the development of a hypoplastic left heart.
2. Truncus arteriosus is not linked to use of lithium during pregnancy.
3. Maternal use of lithium has a strong correlation with an Epstein anomaly, which causes the tricuspid valve to be in the right ventricle, along with an enlarged right atrium and cardiomegaly.
4. Cardiomegaly occurs in an Epstein anomaly, but is not the direct defect.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

34. A doctor orders a blood-thinning medication for a 2 year old with known cardiomyopathy. The type of cardiomyopathy that may require blood-thinning medications would be:

1. Hypertrophic cardiomyopathy.

2. Restrictive cardiomyopathy.

3. Dilated cardiomyopathy.

4. Chronic cardiomyopathy.

ANS: 3

Feedback
1. The heart enlarges with hypertrophic cardiomyopathy and has leaky valves, but blood flows through at an adequate rate, decreasing the risk for clotting.
2. Restrictive cardiomyopathy makes the heart rigid, so blood does not have time to pool to create clots.
3. Dilated cardiomyopathy has slow-moving blood because the heart is not effectively pumping blood out of the chambers, increasing clot formation.
4. Chronic is not a type of cardiomyopathy.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Choice

35. A 12 year old has been admitted to the pediatric floor for cardiomyopathy. During the acute phase, the nurse should:

1. Have defibrillation equipment present for tachycardic situations.

2. Monitor for crackles in the lungs.

3. Provide string cheese for a snack.

4. All of the above would be appropriate nursing actions during the acute phase.

ANS: 4

Feedback
1. A defibrillator should be present if the child is having tachycardic instances.
2. Crackles in the lungs will indicate if excess fluid is present.
3. String cheese will provide the carnitine needed in the childs diet.
4. A defibrillator should be present if the child is having tachycardic instances. Crackles in the lungs will indicate if excess fluid is present. String cheese will provide the carnitine needed in the childs diet.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: Chapter 12 | Type: Multiple Choice

36. A physicians assistant has ordered Adderall for a 14-year-old boy with ADHD and a history of cardiomyopathy. The nurse should question the order because:

1. The dosing will need to be high because of the cardiac history and the bodys ability to quickly metabolize the medication.

2. Adderall is not effective for children over the age of 12.

3. ADHD medications should be avoided because they can cause sudden death in children with a history of cardiomyopathy.

4. The ADHD medication will not reach a therapeutic level because of the negative interactions with cardiac medications.

ANS: 3

Feedback
1. The medication should not be given with a history of cardiomyopathy.
2. Adderall can be effective in children over the age of 12. The issue is the past history of cardiomyopathy.
3. Sudden cardiac arrest can occur because of the history of cardiomyopathy.
4. Cardiomyopathy and ADHD medications cause an increased risk for sudden death.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: Chapter 12 | Type: Multiple Choice

37. A nurse is preparing to administer Digoxin to a 4 year old. The nurse should:

1. Administer the medication and check the blood pressure one hour later.

2. Give the medication with food.

3. Take the apical pulse for 30 seconds prior to giving the medication.

4. Note the rate, rhythm, and quality of the heart prior to giving the medication.

ANS: 4

Feedback
1. The baseline blood pressure is needed prior to the administration of the medication.
2. The medication should be taken on an empty stomach.
3. The apical pulse should be taken for 60 seconds.
4. A baseline of the rate, rhythm, and quality is needed.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

38. A mother calls the nursing clinic to report that her 13-year-old daughter has been using tampons for the last two days and now has a high fever. She has developed a rash over her entire body in the last hour. The mother asks if she should make a clinic appointment. The best response by the nurse would be:

1. Your daughter probably has a virus, so provide her with plenty of fluids. They symptoms should subside in a few days.

2. If you feel your daughter should be seen, then I will transfer you to the front desk to make an appointment.

3. Since your daughter is using tampons and has a high fever, she needs to be seen soon. Let me make an appointment for you as soon as possible today.

4. You daughter has toxic shock syndrome and should be seen right away.

ANS: 3

Feedback
1. The symptoms are similar to those of toxic shock syndrome, and the teen should be seen immediately.
2. Passing the patient to someone else for an appointment increases the chance of the parent hanging up the phone. The nurse should take responsibility in this situation.
3. The mother is reporting signs of toxic shock syndrome and should be seen immediately for confirmation of the syndrome.
4. A full assessment needs to be made by the doctor to confirm a medical diagnosis.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Synthesis | REF: Chapter 12 | Type: Multiple Choice

39. A nurse is discussing discharge instructions with parents of a child who received a cardiac transplant five weeks ago. The discharge instructions should include all of the following except:

1. Discussion of signs and symptoms of rejection.

2. The child should not participate in moderate to high physical activity.

3. Instructions to wear a medical alert bracelet.

4. Take the anti-rejection medications when signs of rejection arise.

ANS: 4

Feedback
1. The family should be informed about possible signs and symptoms for early detection.
2. Increased activity causes an increased workload on the heart, so this should be avoided until the doctor gives permission for increasing activity.
3. A medical alert bracelet is recommended so others are aware of needs of the patient.
4. The anti-rejection medications will need to be taken for the remainder of the childs life every day.

KEY: Content Area: Cardiac | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Synthesis | REF: Chapter 12 | Type: Multiple Choice

40. A 16 year old who is in the ER after an automobile accident is exhibiting signs of shock. The assessment indicates that the teen has a steering wheel bruise mark on his chest. The teen is exhibiting signs of cardiogenic shock. The nurse working with the trauma team knows the patient:

1. Has had a large loss of blood, which causes cardiogenic shock.

2. Has overwhelming sepsis from the accident, which is causing the cardiogenic shock.

3. The bruising to the chest could have caused damage to the heart, causing it to not be an effective pump, which results in cardiogenic shock.

4. The trauma to the chest has caused capillary leaking, leading to cardiogenic shock.

ANS: 3

Feedback
1. The large loss of blood volume depletes the patient, causing hypovolemic shock.
2. Overwhelming sepsis causes septic shock.
3. The bruising indicates that the chest and heart could have damaged the heart, causing cardiogenic shock.
4. The trauma can cause bruising to the heart muscle, but the capillary leaking will not cause cardiogenic shock.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Evaluation | REF: Chapter 12 | Type: Multiple Choice

41. A father is discussing dietary needs for his son, who has a diagnosis of CHF. The nurse knows the father understands the dietary needs when he states:

1. I can let my son have french fries once a week.

2. I will need to make sure he drinks eight 8-ounce glasses of water every day.

3. When having scalloped potatoes and ham for dinner, we should plan an alternative meal for my son.

4. I will need to give my child his diuretic at bedtime because food can interfere with the medication action.

ANS: 3

Feedback
1. A diet that is low in sodium is needed.
2. Close monitoring of fluid intake is needed because the heart can easily become overloaded with fluid.
3. Ham has a large concentration of sodium, thus the child should have an alternative meal.
4. The diuretic should be given earlier in the day to decrease the number of times needed to urinate during sleep time.

KEY: Content Area: Cardiac | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Evaluation | REF: Chapter 12 | Type: Multiple Choice

42. The nurse assessing a child with known right-sided heart failure will expect to find which of the following symptoms?

1. Crackles in the lungs

2. Increased edema in the face

3. A galloping rhythm

4. All of the above are symptoms of right-sided heart failure.

ANS: 4

Feedback
1. Crackles may be present because of the pooling of blood in the lungs.
2. The edema occurs because of the lack of venous return.
3. A galloping rhythm will be present.
4. Crackles may be present because of the pooling of blood in the lungs. The edema occurs because of the lack of venous return. A galloping rhythm will be present.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

43. A child with hyperlipidemia should consume no more than _________ mg of cholesterol a day.

1. 200

2. 500

3. 50

4. 100

ANS: 1

Feedback
1. A child should not consume more than 200 mg of cholesterol a day.
2. Too much cholesterol for a healthy diet
3. Too little cholesterol for a healthy diet
4. Too little cholesterol for a healthy diet

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: Chapter 12 | Type: Multiple Choice

44. A nursing student is assessing children at a well-child clinic. The nursing student should know that routine monitoring of blood pressure should begin at what age?

1. 4 years of age

2. 3 years of age

3. 10 years of age

4. 12 years of age

ANS: 2

Feedback
1. Screening should be done prior to this age.
2. Screening should begin at this age.
3. Screening should be done prior to this age.
4. Screening should be done prior to this age.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | REF: Chapter 12 | Type: Multiple Choice

45. The nurse caring for a child with a suspected congenital heart defect performs the hyper-oxygenation test appropriately when he/she applies the pulse oximeter to the childs:

1. Left arm.

2. Right leg.

3. Left leg.

4. Right arm.

ANS: 4

Feedback
1. The left arm is postductal and not an accurate reflection of the true oxygen saturation.
2. The right leg, although preductal, is not the best choice for obtaining an accurate oxygen concentration that is close to the heart.
3. The left leg is postductal and not an accurate reflection of the true oxygen saturation.
4. The right arm is preductal and the most accurate assessment of the oxygen saturation prior to most congenital heart defects.

KEY: Content Area: Cardiac| Integrated Processes: Nursing Process| Client Need: Safe and Effective Care Management| Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Choice

46. The nurse is caring for a 4-year-old child who comes to the pediatricians office with cold symptoms and appears pale. Vital signs are obtained and the childs blood pressure is 68/42 mmHg, a pulse of 98, and respirations of 20. The nurse is aware that:

1. The vital signs are normal in a child this age with cold symptoms.

2. The respiratory rate is elevated and should be communicated to the physician immediately.

3. The systolic blood pressure is too low and should be communicated to the physician.

4. The pulse is too rapid and should be communicated to the physician.

ANS: 3

Feedback
1. The blood pressure is too low.
2. The respiratory rate is consistent with a 4 year old with cold symptoms.
3. The systolic blood pressure is 70 mmHg + (two times the age in years) or 78 mmHg.
4. The pulse is normal for a 4-year-old child.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Safe and Effective Care Management | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Choice

47. The nurse is aware that utilizing the proper size cuff is important for an accurate assessment of the blood pressure. For this reason, the nurse chooses a cuff that:

1. Is somewhat smaller than the circumference of the childs left arm.

2. Is somewhat larger than the circumference of the childs right arm.

3. Fits snugly, but not too tight around either arm.

4. The cuff should fit 40 percent of the upper arm between the acromion process and the elbow.

ANS: 4

Feedback
1. A smaller size cuff will result in a higher blood pressure.
2. A larger size cuff will result in a lower blood pressure.
3. This fit will not give an accurate measurement for blood pressure.
4. This is the correct method of measuring the size of a blood pressure cuff.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process/Assessment | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis |  REF: Chapter 12 | Type: Multiple Choice

48. The nurse has been caring for a child on the pediatric floor and notes that the childs PMI has shifted to the midline. The nurse is aware that this can indicate:

1. Poor inspiratory effort by the child.

2. Pneumonia in the left lung.

3. Pneumothorax.

4. Neurological integrity has been compromised.

ANS: 3

Feedback
1. Point of maximum impulse is the hearts sounds.
2. Pneumonia may mask the hearts sounds, but should not indicate a shift in the PMI.
3. Air is very heavy and will shift the heart to the midline of the sternum, resulting in a shift of the point of maximum impulse.
4. PMI does not refer to any neurological alterations.

KEY: Content Area: Cardiac Assessment | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis |  REF: Chapter 12 | Type: Multiple Choice

49. The prevalent incidence of rheumatic heart disease occurs in:

1. Late spring and winter.

2. Summer and early spring.

3. Early spring and fall.

4. Early spring and winter.

ANS: 4

Feedback
1. There is a two-fold increase in the early spring, not late spring, and winter for the development of rheumatic fever.
2. The increase is not in the summer.
3. The increase is not in the fall.
4. There is a two-fold increase in the early spring and winter for the development of rheumatic fever.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Knowledge | REF: Chapter 12 | Type: Multiple Choice

50. A 14-year-old girl is admitted to the pediatric emergency room with symptoms of fever, rash, syncope, nausea, and vomiting. The most important information that the admitting nurse should obtain is:

1. Are you currently menstruating?

2. When did you last eat?

3. Have you been in contact with anyone who has had the flu?

4. Are you sexually active?

ANS: 1

Feedback
1. If the girl is currently menstruating, the use of tampons may indicate toxic shock syndrome.
2. This is not the most important factor to obtain given the symptoms the patient has exhibited.
3. While knowledge of a childs exposure to viruses is important, it is not the most important factor to obtain.
4. This is not the most important factor to obtain given the symptoms the patient has exhibited.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

51. The primary mechanism responsible for the closure of fetal ducts following birth is:

1. Suctioning of the nose and mouth.

2. The first breath of the infant.

3. High carbon dioxide levels.

4. Stimulation of the infant.

ANS: 2

Feedback
1. Suctioning of the nose and mouth do not assist in closing the fetal ducts, but instead result in hypoxia.
2. The first breath by the infant results in higher oxygen levels and relaxation of the pulmonary artery. In turn, the pressure gradients within the heart change and force the fetal ducts to close.
3. High carbon dioxide levels would result in pulmonary vasoconstriction, which would not close the fetal ducts.
4. Stimulation of the infant may assist the infant in taking his/her first breath, but it is the first breath that assists in closing the fetal ducts.

KEY: Content Area: Growth and Development | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

52. In educating the caregivers about the administration of Digoxin (Lanoxin) to their child, the nurse instructs the caregivers to:

1. Notify the physician of weight gain of two pounds or more per day.

2. Administer the medication at any set time during the day, every day.

3. Administer the medication two hours before meals and one hour after meals.

4. Hold the Digoxin if the heart rate is <60/minute or >120/minute.

ANS: 1

Feedback
1. The physician should be notified of weight gain, which can place extra strain on the heart and may indicate congestive heart failure.
2. The Digoxin should be administered in the morning.
3. The medication should be given one hour before meals and two hours after meals.
4. The medication should be held for a heart rate <60/minute and >100/minute.

KEY: Content Area: Pharmacology | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

53. In caring for a patient with Tetralogy of Fallot, the nurse understands that during a tet spell, the following nursing intervention will reduce the symptoms of this disorder.

1. Increase the oxygen level of the child

2. Set the infant in an upright position

3. Bounce or pat the child until they are consoled.

4. Place infant in a knee-chest position

ANS: 4

Feedback
1. While this may improve oxygenation, it will not alleviate the symptoms of the disorder.
2. This will have no effect on the clamping down of the vasculature.
3. Although there is an emotional component to the tet spell, this will not alleviate the symptoms of the disorder.
4. Placing the child in a knee-chest position will aid in returning the blood flow back to the heart and improving the cyanosis. Flexing the legs decreases venous flow from the lower extremities and decreases shunting through the ventricular septal defect. It increases vascular resistance and increases pressure in the left ventricle.

KEY: Content Area: Cardiac | Integrated Processes: Caring | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

54. Children who have defects with decreased pulmonary blood flow exhibit which of the following common symptoms?

1. Nausea and vomiting

2. Weight gain

3. Tachypnea, bradycardia, and diaphoresis

4. Cyanosis, tachypnea, and polycythemia

ANS: 4

Feedback
1. This is not a symptom of decreased pulmonary blood flow.
2. This is more a symptom of congestive heart failure.
3. Tachypnea and diaphoresis are correct, but bradycardia, or slow heart rate, is not a symptom of decreased pulmonary blood flow.
4. Cyanosis and tachypnea are symptoms of decreased pulmonary blood flow, which decreases the bodys ability to oxygenate the blood. Polycythemia occurs due to a chronic decrease in oxygenation. The body attempts to produce more red blood cells to carry additional oxygen.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Choice

55. In a newborn nursery, a nurse indicates she hears a soft murmur in one of the newborns. After obtaining blood pressures on all four extremities, she finds that the blood pressure is higher in the right arm than the right leg. The nurse knows this can indicate:

1. Nothing, as this is a normal finding.

2. Coarctation of the aorta.

3. Ventricular septal defect.

4. Shock due to poor perfusion in the lower extremities.

ANS: 2

Feedback
1. This is not a normal finding.
2. This is a predominant sign of COA due to a narrowing of the aortic arch after the innervation to the upper extremities, thus resulting in a lower blood pressure in the lower extremities.
3. This is not a sign of VSD.
4. Shock would indicate a low blood pressure in all extremities.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

56. The nurse knows that one of the most likely symptoms of congestive heart failure (CHF) in infants is:

1. Jugular vein distention (JVD).

2. Decreased blood pressure.

3. Periorbital edema.

4. Diaphoresis with feedings.

ANS: 4

Feedback
1. JVD is not a symptom of CHF in infants.
2. Increased, not decreased, blood pressure is an indicator of CHF.
3. Although periorbital edema occurs in infants with prolonged CHF, it is not a likely symptom of CHF.
4. This is the most common symptom due to sympathetic stimulation.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

57. A nurse should be most concerned about which type cyanosis in a newborn infant?

1. Cyanosis of the hands

2. Cyanosis of the feet

3. Periorbital cyanosis

4. Circumoral cyanosis

ANS: 4

Feedback
1. Cyanosis of the hands is normal for a transitioning newborn.
2. Cyanosis of the feet is normal for a transitioning newborn.
3. While abnormal in a newborn, it may indicate a transitioning newborn.
4. Circumoral cyanosis of the mouth and mucus membranes indicates central cyanosis.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

58. The nurse knows that a child on Digoxin (Lanoxin) requires frequent monitoring of:

1. Sodium levels.

2. Potassium levels.

3. Complete blood count.

4. Creatinine levels.

ANS: 2

Feedback
1. Sodium levels do not affect the function of Digoxin.
2. Potassium levels affect the contractility of the heart muscle and affect whether Digoxin should be administered.
3. Complete blood count would not affect the administration of Digoxin.
4. Creatinine levels do not affect the function of Digoxin.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

59. An infant with a patent ductus arteriosus will exhibit which type of heart murmur?

1. Washing machine murmur

2. Gallop style murmur

3. Clicking murmur

4. Harsh, loud murmur

ANS: 1

Feedback
1. PDA murmurs sound like a washing machine due to pulmonary congestion.
2. This is not the type of murmur heard in a PDA.
3. This is not the type of murmur heard in a PDA.
4. This is not the type of murmur heard in a PDA.

KEY: Content Area: Cardiac Assessment | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Choice

60. The nurse knows that Kawasaki disease is:

1. Contagious, especially among children in close settings, such as day-care institutions.

2. Mainly due to a cascading process.

3. Diagnosed as an exclusion process.

4. Most prevalent when the signs and symptoms have been present for less than three days.

ANS: 3

Feedback
1. The disease is not contagious among children, but is seen in certain geographic areas during certain times of the year.
2. This disease is thought to be caused by an infectious organism.
3. Kawasaki disease is diagnosed as a process of exclusion.
4. Symptoms of red lips and a strawberry tongue usually occur following a fever after 5 days.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

61. The Jones Criteria established in 1944 was established to assist in the diagnosis of:

1. Kawasaki disease.

2. Rheumatic heart disease(RHD).

3. Subacute Bacterial Endocarditis.

4. Toxic Shock Syndrome.

ANS: 2

Feedback
1. The Jones Criteria was established for RHD.
2. The Jones Criteria has established minor and major criteria for the diagnosis of RHD.
3. The Jones Criteria was established for RHD.
4. The Jones Criteria was established for RHD.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity| Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

62. A child with congenital heart disease is more prone to develop which complication?

1. Urinary disturbances

2. Bleeding tendencies

3. Repeated abdominal distention

4. Repeated respiratory infections

ANS: 4

Feedback
1. Congenital heart disease does not cause urinary disturbances.
2. Congenital heart disease does not result in bleeding tendencies.
3. Congenital heart disease does not result in repeated abdominal distention.
4. Congenital heart disease does predispose the child to repeated respiratory infections due to pulmonary congestion.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Choice

63. Which of the following symptoms would an 18-month-old child exhibit when experiencing left-sided heart failure?

1. Tachypnea

2. Tachycardia

3. Syncope

4. Nausea and vomiting

ANS: 1

Feedback
1. Tachypnea is caused by the pooling of secretions and increased incidence of congestive heart disease.
2. Tachycardia is a late sign of left-sided heart failure.
3. Syncope is not a sign of left-sided heart failure.
4. Nausea and vomiting are not symptoms of left-sided heart failure.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Choice

64. A 7-year-old child is discharged following a cardiac catheterization yesterday. The nurse should instruct the mother to:

1. Allow the child to take a tub bath today.

2. Allow the child to resume normal physical activities, including sports.

3. Limit diet within the first few days to prevent straining to stool.

4. Observe for signs and symptoms of infection for the first few days.

ANS: 4

Feedback
1. The child can take showers, not baths, for the first several days.
2. The child should not lift anything heavy and should not resume physical activity for two weeks.
3. There is no limit on the diet of the child.
4. The child should be monitored for signs and symptoms of infection.

KEY: Content Area: Cardiac | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Choice

65. An 8 year old is receiving Digoxin (Lanoxin) for congestive heart failure. The nurse provides the caregiver with the following education, indicating that the medication is effective when:

1. The child is happy and active.

2. The child is pink and breathing easily.

3. The childs urine output increases.

4. The child has an improvement in his/her sleeping at night.

ANS: 3

Feedback
1. This is not an indicator of effective drug mechanisms.
2. This is not an indicator of effective drug mechanisms.
3. This indicates improved cardiac output, resulting in improved urine output.
4. This is not an indicator of effective drug mechanisms.

KEY: Content Area: Pharmacology | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Choice

66. A 12 year old is suspected of having rheumatic heart disease. What factors would indicate that this child has this disease?

1. The onset of symptoms occurs around 20 days after streptococcus throat infection or scarlet fever.

2. The child lives in the most common area of the western United States.

3. The disease produces lesions in the mouth and oropharynx.

4. The disease results in damage to the peripheral sensory nerves.

ANS: 1

Feedback
1. This is the normal course of this disease.
2. Most cases occur in the northeastern part of the United States.
3. The disease produces polyarthritis, carditis, subcu nodules, and a low-grade fever.
4. The disease produces polyarthritis, carditis, St. Vitus Dance, and a low-grade fever.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity| Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Choice

Multiple Response

67. A child has been struck by a car and has perfuse bleeding from the left leg. The nurse at the scene is assessing the patient. Identify the signs and symptoms the patient will have if hypovolemic shock is occurring. Select all that apply.

1. Sweating

2. Ruddy skin

3. Bounding pulses in the lower extremities

4. A rapid respiratory rate

5. A rapid heart rate

ANS: 1, 4, 5

Feedback
1. Will be present if the child is in hypovolemic shock
2. The skin will be pale.
3. The pulse will be weak in the extremities because the body is trying to perfuse vital organs only.
4. The respiratory rate will be increased due to the ineffective pumping by the heart to the lungs.
5. The heart rate will be increased because the heart is trying to push the limited amount of blood available to the body.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Response

68. Identify the common nursing practices for a newborn with a known patent ductus arteriosus diagnosis. Select all that apply.

1. Maintain intake and output

2. Daily weight checks

3. Monitor feeding tolerance

4. Weekly weight checks

5. Monitor output only

ANS: 1, 2, 3

Feedback
1. Fluid balance will indicate if the newborns body is able to excrete fluid.
2. Daily weight checks will indicate the cardiac performance.
3. Feeding tolerance will indicate the level of energy needed to digest food.
4. Weight checks need to be monitored closer because the newborn could go into fluid overload if only checked once a week.
5. Intake monitoring is needed so a measure can be made of the amount of fluid the body is retaining and voiding.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Response

69. Parents have been given the news that their unborn baby will be born with Tetralogy of Fallot. The parents are asking the nurse what the defects will consist of with this diagnosis. The nurse knows the defects are: (Select all that apply.)

1. VSD

2. Pulmonary stenosis

3. Overriding aorta

4. Thickening of the left ventricle

5. Patent Foramen Ovale

ANS: 1, 2, 3

Feedback
1. Present in Tetralogy of Fallot
2. Present in Tetralogy of Fallot
3. Present in Tetralogy of Fallot
4. Thickening of the right ventricle occurs because of the restrictive blood flow.
5. The patent foramen ovale is not present in Tetralogy of Fallot.

KEY: Content Area: Cardiac | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Response

70. Identify the characteristics of a patient with Tetralogy of Fallot with pulmonary atresia. Select all that apply.

1. Ventricle defects

2. Anal anomalies

3. Transesophageal anomalies

4. Atrial anomalies

5. Acrocyanosis

ANS: 2, 3

Feedback
1. The defects are not in the ventricles.
2. The defects of the heart are usually associated with other defects, primarily in the anal and transesophageal regions.
3. The defects of the heart are usually associated with other defects, primarily in the anal and transesophageal regions.
4. Atrial anomalies are not noted in a patient with these defects.
Cyanosis is noted in the patient.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: Multiple Response

71. Identify common characteristics in an assessment of a child with a truncus arteriosus heart defect. Select all that apply.

1. Cyanosis

2. Narrow pulse pressures

3. Grunting and retractions while breathing

4. Diaphoresis

5. Bradycardic

ANS: 1, 3, 4

Feedback
1. Cyanosis is present because of an incompetent truncal valve.
2. Pulse pressures widen with the disorder.
3. These reactions are present because of the lack of blood being oxygenated and the vascular resistance on the vessel going over the right and left ventricles.
4. Diaphoresis is present because of the increased workload on the heart and also due to vascular resistance.
5. The heart rate is usually within normal limits.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: Multiple Response

72. A nurse assessing a 6 year old with cardiomyopathy would anticipate which of the following signs in his assessment? Select all that apply.

1. A murmur with a thrill

2. Fatigue when eating

3. Dysrhythmia after playing with toy cars

4. Sweating while sitting in bed watching cartoons

5. Dizziness when standing at the bedside

ANS: 2, 3, 5

Feedback
1. The murmur will be a gallop.
2. Fatigue occurs with many activities, including eating.
3. Dysrhythmias can occur at any time.
4. Sweating occurs when eating, not during quiet times.
5. Dizziness while standing or changing positions is common.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Evaluation | REF: Chapter 12 | Type: Multiple Response

73. Cardiovascular disease in children can be classified according to: (Select all that apply.)

1. Increased or decreased pulmonary blood flow.

2. Acyanotic flow.

3. Obstructive flow.

4. Acquired.

5. Mixed blood flow.

ANS: 1,3,4,5

Feedback
1. Nurses know that one of the classifications of heart disease is increased or decreased pulmonary blood flow.
2. This is a current incorrect classification of cardiovascular disease in children.
3. Obstructive flow is a current classification of cardiovascular disease.
4. Acquired cardiovascular disease is accurate.
5. Mixed blood flow is accurate for cardiovascular disease.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Management of Care | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Response

74. The nurse is aware that the risk factors for the development of congenital heart disease include: (Select all that apply.)

1. Family history of congenital heart disease or genetic disorders.

2. Exposure to alcohol, cocaine, or phenytoin.

3. Exposure to teratogens.

4. Weight at birth.

5. Infants of diabetic mothers.

ANS: 1, 2, 3, 5

  1. 1.
Feedback
  1. 2.
A family history of CHD or genetic defects significantly increases the chances of an infant being born with a CHD.
1. Alcohol, cocaine, or other drugs act as teratogens to the developing fetus.
2. A teratogen results in congenital defects, including heart disease.
3. Weight at birth has no influence on the development of CHD.
4. Infants of diabetic mothers have a higher incidence of developing CHD.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Response

75. In educating an adolescent and his/her caregivers on the modifiable risk factors related to the hypertension, the nurse would include information related to: (Select all that apply.)

1. Age.

2. Race or ethnicity.

3. Hyperlipidemia.

4. Exercise levels.

5. Weight management.

ANS: 3, 4, 5

Feedback
1. Age is not a modifiable risk factor.
2. Race and ethnicity are not modifiable risk factors.
3. Hyperlipidemia through diet education is a modifiable risk factor.
4. Exercise levels are modifiable risk factors that can reduce hypertension.
5. Weight management is a modifiable risk factor that can reduce hypertension.

KEY: Content Area: Cardiac | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis | REF: Chapter 12 | Type: Multiple Response

True/False

76. A child with a VSD will have cardiomegaly of the left side of the heart.

ANS: T

Feedback
1. The left side of the heart will be increased because of the increased pulmonary vascularity.
2. The increase in pulmonary vascularity causes cardiomegaly of the left side of the heart.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: Chapter 12 | Type: True/False

77. When assessing pulses of a child with coarctation of the aorta, the nurse should use the right subclavian artery.

ANS: F

Feedback
1. The right brachial artery should be used because the subclavian can give a false reading.
2. The right brachial artery should be used because the subclavian can give a false reading.

KEY: Content Area: Cardiac | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Application | REF: Chapter 12 | Type: True/False

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