Chapter 24: Alterations of Cardiovascular Function in Children My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 24: Alterations of Cardiovascular Function in Children

Test Bank

MULTIPLE CHOICE

1. An 8-week-old infant presents to his pediatrician for a well-baby checkup. Physical exam reveals a murmur and an echocardiogram confirms a ventricular septal defect. Which of the following genetic factors should the nurse assess for as it would most likely accompany this diagnosis?

a.

Huntington disease

b.

Color blindness

c.

Down syndrome

d.

Hemophilia

ANS: C

Down syndrome is the genetic factor that would most likely accompany the diagnosis of a congenital heart defect.

Down syndrome, not Huntington disease, is the genetic factor that would most likely accompany a diagnosis of congenital heart defect.

Down syndrome, not color blindness, is the genetic factor that would most likely accompany a diagnosis of congenital heart defect.

Down syndrome, not hemophilia, is the genetic factor that would most likely accompany a diagnosis of congenital heart defect.

REF: p. 643

2. A newborn child is diagnosed with tetralogy of Fallot. What symptoms would the nurse expect to observe in the child?

a.

High-pitched cry and dyspnea

b.

Cyanosis and hypoxia

c.

Leg pain and twitching

d.

Epistaxis and anemia

ANS: B

The child will experience cyanosis and hypoxia.

This type of shunt decreases flow through the pulmonary system, causing less than normal oxygen delivery to the tissues and resultant cyanosis. It will not cause a high-pitched cry.

This type of shunt decreases flow through the pulmonary system, causing less than normal oxygen delivery to the tissues and resultant cyanosis. It will not cause leg pain; leg pain occurs in coarctation of the aorta.

This type of shunt decreases flow through the pulmonary system, causing less than normal oxygen delivery to the tissues and resultant cyanosis. Epistaxis is associated with coarctation of the aorta.

REF: p. 649

3. A newborn is diagnosed with congenital heart disease. Which of the following intrauterine factors should the nurse focus on during the history that could have caused this disorder?

a.

Diabetes

b.

Alcohol exposure

c.

Viral infection

d.

Dextroamphetamine

ANS: C

One of the identified causes of cardiac defects, such as pulmonic stenosis, is maternal conditions, such as intrauterine viral infections, especially rubella.

Diabetes contributes to large babies; maternal infection contributes to cardiac abnormalities.

Alcohol exposure contributes to abnormalities such as facial changes; maternal conditions, such as intrauterine viral infections, especially rubella, lead to congenital abnormalities.

Medications such as dextroamphetamines lead to other abnormalities; maternal conditions, such as intrauterine viral infections, especially rubella, lead to congenital abnormalities.

REF: p. 643

4. When a staff member asks what coarctation of the aorta is, how should the nurse respond? Coarctation of the aorta is the local narrowing of the aorta near the:

a.

Aortic valve

b.

Ductus arteriosus

c.

Diaphragm

d.

Bifurcation into the common iliac arteries

ANS: B

Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus.

Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus, not the aortic valve.

Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus, not the diaphragm.

Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus, not the bifurcation site.

REF: p. 644

5. A newborn is suspected of having coarctation of the aorta. Which of the following assessments would aid in diagnosis?

a.

Cyanosis

b.

Bounding pedal pulses

c.

Cool arms

d.

Weak or absent femoral pulses

ANS: D

The newborn will have weak or absent femoral pulses because blood flow is obstructed near the lower extremities.

The newborn will have weak or absent femoral pulses because blood flow is obstructed near the lower extremities. Coarctation is not a cyanotic defect.

The newborn will have weak or absent femoral pulses because blood flow is obstructed near the lower extremities, not bounding pedal pulses.

The newborn will have weak or absent femoral pulses because blood flow is obstructed near the lower extremities. The infant will have warm arms because blood flow is present in the upper extremities.

REF: p. 644

6. A 1-month-old infant visits his primary care provider for a well-baby check. Physical exam reveals decreased cardiac output, hypotension, tachycardia, and a loud murmur suggestive of aortic stenosis. Which of the following would be expected with this diagnosis?

a.

Atrial dilation

b.

Ventricular hypertrophy

c.

Atrial rigidity

d.

Decreased contractility

ANS: B

The infant with aortic stenosis will also be experiencing ventricular hypertrophy because of the resistance of blood flow from the left ventricle into the aorta.

Ventricular hypertrophy will occur, not atrial dilation.

Ventricular hypertrophy will occur, not atrial rigidity.

Ventricular hypertrophy will occur, not decreased contractility.

REF: p. 646

7. A newborn develops a murmur and cyanosis shortly after birth. She is diagnosed with pulmonic stenosis (PS) after an echocardiogram revealed narrowing of the pulmonary:

a.

Tree

b.

Artery

c.

Valve orifice

d.

Vein

ANS: C

PS is a narrowing or stricture of the pulmonary valve causing resistance to blood flow from the right ventricle to the pulmonary artery.

PS is a narrowing or stricture of the pulmonary valve, not the pulmonary tree, causing resistance to blood flow from the right ventricle to the pulmonary artery.

PS is a narrowing or stricture of the pulmonary valve, not the pulmonary artery, causing resistance to blood flow from the right ventricle to the pulmonary artery.

PS is a narrowing or stricture of the pulmonary valve, not the vein, causing resistance to blood flow from the right ventricle to the pulmonary artery.

REF: p. 647

8. When a staff member asks what the patent opening between the aorta and pulmonary artery in a fetus is called, how should the nurse reply? It is the:

a.

Foramen ovale

b.

Sinus venosus

c.

Ductus arteriosus

d.

Septal defect

ANS: C

In the fetal circulation, the ductus arteriosus is an opening between the aorta and the pulmonary artery.

The foramen ovale allows flow of blood between the left and right atrium.

The sinus venosus is a type of atrial septal defect.

The septal defect is an opening in the septum.

REF: p. 647

9. A 2-week-old infant presents with poor feeding, fatigue, dyspnea, and a murmur. She is diagnosed with a patent ductus arteriosus (PDA). A nurse recalls this condition results in a(n):

a.

Decreased pulmonary blood flow

b.

Right-to-left shunt

c.

Left-to-right shunt

d.

Increased systemic blood flow

ANS: C

PDA is failure of the fetal ductus arteriosus to close. The continued patency of this vessel allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a left-to-right shunt.

PDA is failure of the fetal ductus arteriosus to close. The continued patency of this vessel allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a left-to-right shunt. It does not cause decreased pulmonary blood flow

PDA is failure of the fetal ductus arteriosus to close. The continued patency of this vessel allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a left-to-right shunt.

PDA is failure of the fetal ductus arteriosus to close. The continued patency of this vessel allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a left-to-right shunt. It could decrease systemic blood flow, not increase it.

REF: p. 647

10. An infant undergoes an echocardiogram for a suspected heart defect. Tests reveal an opening in the middle of the atrial septum. What term would the nurse use to describe this defect?

a.

Ostium primum atrial septal defect (ASD)

b.

Ostium secundum ASD

c.

Sinus venosus ASD

d.

Eisenmenger syndrome

ANS: B

An opening in the middle of the atrial septum is referred to as an ostium secundum ASD.

An ostium primum ASD is an opening low in the atrial septum and may be associated with abnormalities of the mitral valve.

A sinus venosus ASD is an opening usually high in the atrial wall and may be associated with partial anomalous pulmonary venous connection.

Eisenmenger syndrome is a condition in which shunting of blood is reversed because of high pulmonary pressure and resistance.

REF: p. 648

11. Which is the most common type of congenital heart defect the nurse should assess for in infants?

a.

Atrial septal defect (ASD)

b.

Ventricular septal defect (VSD)

c.

Tetralogy of Fallot

d.

Atrioventricular canal defect

ANS: B

The most common type of congenital heart defect is a VSD.

The most common type of congenital heart defect is a VSD, not an ASD.

The most common type of congenital heart defect is a VSD, not tetralogy of Fallot.

The most common type of congenital heart defect is a VSD, not atrioventricular canal defect.

REF: p. 648

12. An 8-week-old infant presents to her primary care provider for a well-baby check. Physical exam reveals a murmur, and an echocardiogram shows a large ventricular septal defect. If left untreated, what condition should the nurse discuss with the parents?

a.

Pulmonary hypertension

b.

Cyanosis

c.

Dysrhythmias

d.

Valve damage

ANS: A

If the degree of shunting is significant and not corrected, the child is at risk for developing pulmonary hypertension.

If the degree of shunting is significant and not corrected, the child is at risk for developing pulmonary hypertension. Cyanosis is not present at first if the shift is left to right.

If the degree of shunting is significant and not corrected, the child is at risk for developing pulmonary hypertension. Dysrhythmias do not occur.

If the degree of shunting is significant and not corrected, the child is at risk for developing pulmonary hypertension. The defect does not lead to valve damage.

REF: p. 648

13. A 22-year-old pregnant woman presents to her OB/GYN for a prenatal checkup. The heartbeat sounds irregular, and a fetal echocardiogram reveals an atrioventricular canal (AVC) defect. This defect is the result of:

a.

Failure of the ductus arteriosus to close

b.

Fusion of the endocardial cushions

c.

A patent foramen ovale

d.

A right-to-left shunt

ANS: B

AVC defect is the result of incomplete fusion of endocardial cushions.

A patent ductus is the failure of the ductus arteriosus to close.

The infant will not experience a patent foramen ovale.

Flow is generally left to right, not right to left.

REF: p. 649

14. A newborn experiences frequent periods of cyanosis, usually occurring during crying or after feeding. Which of the following is the most likely diagnosis the nurse will observe on the chart?

a.

Atrioventricular canal (AVC) defect

b.

Ventricular septal defect (VSD)

c.

Tetralogy of Fallot

d.

Atrial septal defect (ASD)

ANS: C

Infants with tetralogy of Fallot experience cyanosis after crying or during feeding.

Infants with AVC defect may experience cyanosis, but it is not related to feeding or crying.

Infants with a VSD do not experience cyanosis.

Infants with an ASD do not experience cyanosis.

REF: p. 649

15. A newborn child has a murmur and cyanosis. An echocardiogram reveals that the tricuspid valve failed to develop and no blood flows between the right atrium and ventricle. What term will the nurse use to describe this condition? Tricuspid:

a.

Regurgitation

b.

Stenosis

c.

Atresia

d.

Transposition

ANS: C

Tricuspid atresia is failure of the tricuspid valve to develop; consequently, there is no communication from the right atrium to the right ventricle.

In regurgitation, blood moves backwards, but is not obstructed.

In stenosis, blood flow is narrowed, but not totally obstructed.

In transposition, the two great vessels are on opposite sides.

REF: p. 649

16. When the pediatrician cardiologist discusses total anomalous pulmonary venous connection, which of the following statements BEST describes this condition?

a.

The foramen ovale closes after birth.

b.

Pulmonary venous return is to the right atrium.

c.

Pulmonary venous return is to the left atrium.

d.

The foramen ovale does not close.

ANS: B

The pulmonary venous return is connected to the right side of the circulation, rather than to the left atrium.

The pulmonary venous return is connected to the right side of the circulation, rather than to the left atrium. It does not include closure of the foramen ovale after birth.

The pulmonary venous return is connected to the right side of the circulation, rather than to the left atrium.

The pulmonary venous return is connected to the right side of the circulation, rather than to the left atrium. It does not involve closure of the foramen ovale.

REF: p. 662

17. A newborn baby is severely cyanotic. An echocardiogram reveals transposition of the great arteries. A nurse assesses for which of the following, as it usually occurs with this defect?

a.

The pulmonary artery leaving the right ventricle

b.

The aorta leaving the right ventricle

c.

Ventricular septal defect (VSD)

d.

Atrial septal defect (ASD)

ANS: B

In transposition of the great arteries, the pulmonary artery leaves the left ventricle and the aorta exits from the right ventricle.

The pulmonary artery normally leaves the right ventricle.

A VSD is not associated with transposition of the great arteries.

An ASD is not associated with transposition of the great arteries.

REF: p. 651

18. A 1-month-old infant was diagnosed with truncus arteriosus (TA) with a ventricular septal defect. Which of the following would the nurse also expect?

a.

Hypertrophy of the aorta and major arteries

b.

Transposition of the aorta and the pulmonary trunk

c.

The aorta returning blood to the right atrium

d.

Blood from both ventricles mixing in a common vessel

ANS: D

TA is failure of normal separation and division of the embryonic outflow track into a pulmonary artery and an aorta, resulting in a single vessel that exits the heart.

TA is failure of normal separation and division of the embryonic outflow track into a pulmonary artery and an aorta, resulting in a single vessel that exits the heart. It does not involve hypertrophy of the aorta.

TA is failure of normal separation and division of the embryonic outflow track into a pulmonary artery and an aorta, resulting in a single vessel that exits the heart. It does not involve transposition of the aorta.

TA is failure of normal separation and division of the embryonic outflow track into a pulmonary artery and an aorta, resulting in a single vessel that exits the heart. It does not involve the aorta returning blood to the right atrium.

REF: p. 652

19. A 22-year-old pregnant female presents for a fetal echocardiogram. Tests reveal small left atrium and mitral valve and an absent left ventricle and aortic valve. The diagnosis is hypoplastic left heart syndrome (HLHS). The nurse will anticipate that the treatment for this defect is:

a.

An indication for neonatal heart transplant

b.

Rarely fatal

c.

Easily repaired

d.

Asymptomatic

ANS: A

Treatment of HLHS is heart surgery and the possibility of a heart transplant.

The disorder is often fatal.

Repair of the disorder requires multiple progressive surgeries.

Symptoms of the disorder includes mild cyanosis, tachypnea, and low cardiac output.

REF: p. 653

20. A 1-year-old female with a ventricular septal defect is experiencing left-sided heart failure. Which of the following symptoms will most likely occur?

a.

Failure to thrive and periorbital edema

b.

Edema to the hands and feet

c.

Weight loss and jaundice

d.

Flat neck veins and increased urinary output

ANS: A

Left heart failure in infants is manifested as poor feeding and sucking, often leading to failure to thrive and periorbital edema.

Left heart failure in infants is manifested as poor feeding and sucking, often leading to failure to thrive. Peripheral edema is a sign of right-sided failure.

Weight loss can occur, but not jaundice.

Flat neck veins and increased urinary output are not symptomatic of failure.

REF: p. 654

21. A 3-year-old male is diagnosed with Kawasaki disease. Which of the following does the nurse suspect is the most likely cause?

a.

A genetic defect causing left heart failure

b.

Autoimmune injury to the lymphatic vessels

c.

Infectious pericarditis

d.

Inflammation of the small capillaries, arteries, and veins

ANS: D

Kawasaki disease is related to inflammation of small capillaries.

Kawasaki disease is due to inflammation, not a genetic defect.

Kawasaki disease is due to inflammation, not an autoimmune disease.

Kawasaki disease is due to inflammation, not infectious pericarditis.

REF: p. 654

22. A 5-year-old female is found to have hypertension during three separate visits to her primary care provider. The nurse would expect tests to suggest that the hypertension is secondary to:

a.

Renal disease

b.

Brain tumor

c.

Hypocalcemia

d.

Hyponatremia

ANS: A

Hypertension in a 5-year-old is related to renal disease.

Hypertension in a 5-year-old is related to renal disease, not a brain tumor.

Hypertension in a 5-year-old is related to renal disease, not hypocalcemia.

Hypertension in a 5-year-old is related to renal disease, not hyponatremia.

REF: p. 655

MULTIPLE RESPONSE

1. A 40-year-old pregnant woman is concerned about the health of her unborn child. She has phenylketonuria (PKU) and recently had a viral infection. If the child is born with a congenital heart defect, which of the following is the most likely based on the mothers history? (Select all that apply.)

a.

Coarctation of aorta

b.

Pulmonic stenosis

c.

Ventricular septal defect

d.

Patent ductus arteriosus

e.

Tetralogy of Fallot

ANS: A, D

Coarctation of the aorta and patent ductus arteriosus are the disorders found in infants of mothers with PKU.

REF: p. 644

2. A newborn child is diagnosed with trisomy 18. Which of the following congenital heart defects should the nurse assess for in the infant? (Select all that apply.)

a.

Patent ductus

b.

Coarctation of the aorta

c.

Atrioventricular canal defect

d.

Ventricular septal defect

e.

Pulmonary stenosis

ANS: A, D, E

The infant with trisomy 18 could present with a ventricular septal defect, a patent ductus, or pulmonary stenosis.

REF: p. 644

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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